What Medicare Doesn't Cover
Original Medicare has significant gaps that catch many new enrollees off guard. Dental, vision, hearing, long-term care, overseas travel, and most prescription drugs are not covered — or only partially covered.
By William Gray, The Medicare Dude — independent Medicare broker licensed in Florida. This guide covers every major Medicare coverage gap and the options available to fill them.
No cost · No obligation · Takes 15 minutes
Important: "Medicare" in this guide refers to Original Medicare (Parts A and B). Medicare Advantage plans (Part C) often include additional benefits like dental, vision, and hearing — but come with network restrictions and prior authorization requirements. This guide explains the gaps in Original Medicare and your options for filling them.
The Major Medicare Coverage Gaps
These are the services that Original Medicare either does not cover at all, or covers only in very limited circumstances.
Dental
Not Covered
- Routine cleanings and exams
- Fillings and extractions
- Dentures and dental implants
- Root canals
- Orthodontia
- Periodontal treatment
Partially Covered
Dental care that is integral to a covered medical procedure (e.g., jaw reconstruction after trauma)
How to Fill This Gap
- Medicare Advantage with dental
- Standalone dental insurance
- Dental discount plans
Vision
Not Covered
- Routine eye exams for glasses/contacts
- Eyeglasses and contact lenses
- LASIK and refractive surgery
- Routine vision screenings
Partially Covered
Diabetic retinopathy exams, glaucoma screening (high-risk), cataract surgery, treatment of eye diseases
How to Fill This Gap
- Medicare Advantage with vision
- Standalone vision insurance
- VSP or similar discount plans
Hearing
Not Covered
- Hearing aids
- Hearing aid fittings and exams
- Routine hearing screenings
- Cochlear implant mapping (routine)
Partially Covered
Diagnostic hearing exams ordered by a doctor to determine medical treatment need
How to Fill This Gap
- Medicare Advantage with hearing
- Standalone hearing insurance
- Costco or discount hearing programs
Long-Term Care
Not Covered
- Custodial care in a nursing home
- Assisted living facility costs
- Home health aide (non-skilled)
- Adult day care
- Memory care facilities
Partially Covered
Skilled nursing facility care up to 100 days after a 3-day hospital stay; home health care for skilled services
How to Fill This Gap
- Long-term care insurance
- Medicaid (income/asset limits apply)
- Personal savings / hybrid life insurance
Prescription Drugs
Not Covered
- Most outpatient prescription drugs (Parts A & B)
- Over-the-counter medications
- Vitamins and supplements
- Weight loss drugs (most)
Partially Covered
Drugs administered in a hospital or doctor's office (Part B); Part D covers outpatient drugs if enrolled
How to Fill This Gap
- Medicare Part D plan
- Medicare Advantage with Part D
- Extra Help (Low Income Subsidy)
Medicare's Cost-Sharing Gaps (What You Owe Out of Pocket)
Even for services that Medicare does cover, you are responsible for significant cost-sharing. Unlike most private insurance, Original Medicare has no out-of-pocket maximum — your costs are theoretically unlimited. This is the gap that Medicare Supplement (Medigap) plans are designed to fill.
| Cost-Sharing Item | Your Cost (2026) | Covered By |
|---|---|---|
| Part A deductible (per benefit period) | $1,736 | Medigap Plan G/N |
| Part B deductible (annual) | $283 | Medigap Plan G only |
| Part B coinsurance (20% of all outpatient costs) | 20% — no cap | Medigap Plan G/N |
| Skilled nursing coinsurance (days 21–100) | $194.50/day | Medigap Plan G/N |
| Part B excess charges | Up to 15% above Medicare rate | Medigap Plan G only |
| Foreign travel emergencies | Not covered at all | Medigap Plan G/N (80% up to $50k) |
No out-of-pocket maximum in Original Medicare
Original Medicare has no cap on what you can owe in a year. If you have a serious illness requiring multiple hospitalizations, your Part A deductible resets each benefit period. The 20% Part B coinsurance applies to all outpatient services with no annual limit. A single cancer treatment course can cost tens of thousands of dollars in cost-sharing. Medigap Plan G eliminates virtually all of this exposure.
Two Ways to Fill Medicare's Gaps
There are two fundamentally different approaches to supplementing Original Medicare. Understanding the trade-offs is essential before choosing.
Option 1: Medicare Supplement (Medigap)
Works alongside Original Medicare to cover cost-sharing gaps
Best for: People who want maximum freedom and predictable costs, especially those with serious health conditions or who travel frequently.
Option 2: Medicare Advantage (Part C)
Replaces Original Medicare with a private plan
Best for: Healthy seniors who want lower premiums and don't mind network restrictions, or those who need dental/vision/hearing benefits.
William compares both options for your specific situation.
The right choice depends on your health, your doctors, your prescriptions, and your budget. William Gray analyzes total annual costs — premiums plus expected out-of-pocket — for both Medigap and Medicare Advantage options in your area before making any recommendation.
Other Services Medicare Doesn't Cover
Overseas medical care
Not covered except very limited border emergencies. Medigap covers 80% up to $50k lifetime.
Cosmetic surgery
Not covered unless medically necessary (e.g., reconstructive after mastectomy).
Routine foot care
Not covered. Covered only if related to a medical condition like diabetes.
Chiropractic care
Only covered for manual manipulation of the spine to correct subluxation. Exams and X-rays not covered.
Acupuncture (most)
Only covered for chronic low back pain (up to 20 sessions/year). Not covered for other conditions.
Weight loss programs
Not covered. Obesity counseling is covered, but structured weight loss programs are not.
Gym memberships
Not covered by Original Medicare. Many Medicare Advantage plans include SilverSneakers or similar fitness benefits.
Nutritional counseling
Covered only for diabetes or kidney disease. Not covered for general nutrition guidance.
Transportation to appointments
Not covered by Original Medicare. Some Medicare Advantage plans include non-emergency medical transportation.
Personal care at home
Custodial care (bathing, dressing, eating) is not covered. Only skilled nursing or therapy services qualify.
Experimental treatments
Not covered unless part of a Medicare-approved clinical trial.
Private-duty nursing
Not covered. Medicare covers skilled nursing only in limited circumstances.
What Original Medicare Does Cover
Despite its gaps, Original Medicare covers a broad range of medically necessary services. Here's a summary of what is covered.
Medicare Part A (Hospital Insurance)
- Inpatient hospital care (after deductible)
- Skilled nursing facility care (after 3-day hospital stay, up to 100 days)
- Home health care (skilled nursing, therapy)
- Hospice care
- Inpatient mental health care
- Blood transfusions (after first 3 pints)
Medicare Part B (Medical Insurance)
- Doctor visits and specialist care
- Outpatient surgery and procedures
- Preventive services (annual wellness visit, screenings)
- Durable medical equipment (wheelchairs, walkers)
- Mental health services (outpatient)
- Ambulance services
- Lab tests and X-rays
- Physical, occupational, and speech therapy
- Chemotherapy and radiation (outpatient)
- Dialysis for kidney failure
Frequently Asked Questions
Does Medicare cover dental care?
Original Medicare (Parts A and B) does not cover routine dental care, including cleanings, fillings, extractions, dentures, or dental implants. Medicare Part A may cover dental services that are an integral part of a covered medical procedure — for example, jaw reconstruction after an accident — but this is narrow. Medicare Advantage plans often include dental benefits, though coverage varies significantly by plan. Standalone dental insurance is another option.
Does Medicare cover vision care?
Original Medicare does not cover routine eye exams for glasses or contact lenses, eyeglasses, or contact lenses. Medicare Part B does cover annual eye exams for diabetic retinopathy if you have diabetes, and it covers treatment for eye diseases like glaucoma and macular degeneration. Cataract surgery is covered by Part B. Many Medicare Advantage plans include routine vision benefits.
Does Medicare cover hearing aids?
Original Medicare does not cover hearing aids or the exams to fit them. Medicare Part B covers diagnostic hearing exams ordered by a doctor to determine if medical treatment is needed, but not routine hearing tests or hearing aids. Some Medicare Advantage plans include hearing benefits, though coverage limits vary. Standalone hearing insurance and discount programs are also available.
Does Medicare cover long-term care?
Original Medicare does not cover custodial care — help with activities of daily living like bathing, dressing, and eating — in a nursing home or at home. Medicare Part A covers skilled nursing facility care only after a qualifying hospital stay of at least 3 days, and only for up to 100 days per benefit period (with significant cost-sharing after day 20). Long-term care insurance, Medicaid, or personal savings are the primary ways to cover custodial care costs.
Does Medicare cover prescription drugs?
Original Medicare Parts A and B do not cover most outpatient prescription drugs. Medicare Part D is a separate prescription drug plan that covers outpatient medications. If you have Original Medicare, you need to enroll in a standalone Part D plan. Medicare Advantage plans (Part C) typically include Part D drug coverage. Failing to enroll in Part D when first eligible results in a permanent late enrollment penalty.
Does Medicare cover overseas travel?
Original Medicare generally does not cover medical care received outside the United States. There are very limited exceptions for emergency care near the US-Canada or US-Mexico border. Medicare Supplement (Medigap) plans G and N include foreign travel emergency coverage — 80% of covered costs after a $250 deductible, up to a $50,000 lifetime limit. If you travel internationally, a Medigap plan or travel health insurance is essential.
Does Medicare cover cosmetic surgery?
Medicare does not cover cosmetic surgery or procedures done solely to improve appearance. However, Medicare Part B does cover reconstructive surgery after an accident, injury, or mastectomy, and surgery to correct a functional impairment. The key distinction is medical necessity — if a procedure is medically necessary, it may be covered even if it also improves appearance.
Does Medicare cover acupuncture?
Medicare Part B covers acupuncture for chronic low back pain — up to 12 sessions in 90 days, with an additional 8 sessions if there is improvement. This is the only acupuncture coverage under Original Medicare. Acupuncture for other conditions is not covered. Some Medicare Advantage plans offer broader acupuncture benefits.
What is the Medicare coverage gap (donut hole)?
The Medicare Part D coverage gap, historically called the 'donut hole,' was a period where you paid more for prescription drugs after reaching an initial coverage limit. As of 2025, the Inflation Reduction Act capped out-of-pocket Part D drug costs at $2,000 per year, effectively eliminating the coverage gap for most beneficiaries. However, you still pay premiums, deductibles, and copays up to that cap.
How do I fill Medicare's coverage gaps?
The main options for filling Medicare's coverage gaps are: (1) Medicare Supplement (Medigap) plans, which cover cost-sharing like deductibles and coinsurance for covered services but do not add new benefits like dental or vision; (2) Medicare Advantage plans, which often include dental, vision, and hearing benefits but restrict you to a network; (3) standalone dental, vision, and hearing insurance; (4) long-term care insurance for custodial care. William Gray helps you evaluate all options based on your specific health needs and budget.
Not Sure Which Gaps You Need to Fill?
William Gray reviews your specific health needs, doctors, prescriptions, and budget — then recommends the most cost-effective way to fill your Medicare gaps. Free consultation, no pressure.
No cost · No obligation · Takes 15 minutes
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY: 1-877-486-2048) to get information on all of your options.
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Not all plans or types of coverage may be available in your area. Plan availability, benefits, and premiums vary by county and ZIP code. Enrollment in any plan depends on contract renewal. Benefits, premiums, and cost-sharing may change on January 1 of each year.
Independent Agent & Compensation Disclosure. William Gray is an independent licensed insurance agent (FL License #W690237) and is not employed by or exclusively affiliated with any single insurance company. William is compensated by insurance carriers when you enroll in a plan. This compensation does not affect the premium you pay — your premium is the same whether you enroll through a broker or directly with the carrier. Affiliated agents are independent contractors solely responsible for their own conduct and representations.