Many people are surprised to learn that Medicare doesn’t cover every health expense. While it provides a solid foundation for hospital and medical care, there are still important gaps that can leave you paying out of pocket. Understanding what Medicare does not cover is key to protecting your health and your finances in retirement.
What Medicare Does Cover (Quick Review)
Medicare has two main parts that work together to cover basic health services:
• Medicare Part A helps pay for hospital stays, hospice, limited home health, and skilled nursing care.
• Medicare Part B covers doctor visits, outpatient care, lab tests, ambulance services, and medical equipment.
These make up what’s known as Original Medicare. However, there are many areas that these two parts do not cover — and knowing them in advance can help you avoid unexpected costs.
12 Common Things Medicare Doesn’t Cover
• Routine Eye Exams, Glasses, or Contacts – Medicare won’t pay for regular eye exams or prescription glasses. Coverage may apply only if you’ve had cataract surgery. Learn more at Medicare.gov
• Most Dental Care – Services such as cleanings, crowns, dentures, and fillings are not included. To get dental coverage, consider a Medicare Advantage plan that includes it.
• Hearing Aids and Fittings – Original Medicare doesn’t cover hearing aids or exams for fitting them. Many Medicare Advantage plans offer this as an extra benefit.
• Prescription Drugs (under Original Medicare) – Parts A and B don’t cover most medications you take at home. To get prescription coverage, you need Medicare Part D
• Most Immunizations and Vaccines – Medicare Part B covers only certain vaccines like flu, COVID-19, pneumococcal, and tetanus (in emergencies). For others, you’ll need a Part D plan.
• Full Annual Physical Exams – Medicare covers “Welcome to Medicare” and yearly wellness visits, but not complete physicals that check every body system.
• Long-Term or Custodial Care – Medicare doesn’t pay for help with daily living (bathing, dressing, eating) in a nursing home or assisted living facility.
• Massage Therapy or Alternative Treatments – Services such as massage therapy or acupuncture are generally not covered. Medicare limits chiropractic care to spinal adjustments for specific conditions.
• Medical Care Outside the U.S. – Original Medicare usually doesn’t pay for care outside the country, with only rare exceptions.
• Cosmetic Surgery – Procedures done solely for appearance aren’t covered unless medically necessary after injury or illness.
• Concierge or Membership Fees – Doctors who charge extra “membership” or “concierge” fees can’t bill Medicare for them, leaving those costs entirely up to you.
• Routine Foot Care and Orthotics – Medicare doesn’t pay for routine foot care or custom orthotics unless you have a medical condition such as diabetes that makes them necessary.
How to Fill the Medicare Coverage Gaps
• Consider a Medicare Advantage Plan – Many Medicare Advantage (Part C) plans include extra benefits such as dental, vision, hearing, and fitness programs. Learn more: Medicare Advantage
• Add a Medigap Policy – Medigap (Supplemental Insurance) helps cover deductibles, coinsurance, and copayments that Medicare doesn’t pay for. Details: Medigap
• Buy Stand-Alone Plans – You can add private dental, vision, hearing, or long-term care plans to strengthen your overall coverage.
• Use Local Assistance Programs – State Health Insurance Assistance Programs provide free, unbiased help with Medicare questions. Find resources near you: SHIPHelp.org
• Plan Ahead for Out-of-Pocket Costs – Budgeting early for health expenses or using HSA funds (if available) can help you stay financially secure when unexpected costs arise.
Why It Matters
Knowing what Medicare doesn’t cover means you can prepare now instead of being caught off guard later. By adding the right supplemental plans and budgeting for possible expenses, you can enjoy the peace of mind that comes with complete coverage.
If you’re unsure where to start, One Source Benefits can help you compare plans, review costs, and find the best coverage for your needs — all at no charge.
