Medicare Covers a Lot. The Expensive Part Is Knowing What It Doesn’t.
The Risk Management guide connects this page with related MoneyBucket guidance. Turning 65 does not make every healthcare expense disappear. Original Medicare leaves several common services uncovered, and even Medicare-covered care can still leave you with premiums, deductibles, coinsurance and other out-of-pocket costs.
First: Know Which Medicare You Mean
“Medicare” is not one single insurance policy. What you have and what you add to it can change both your coverage and your costs.
Hospital Insurance
Part A helps cover qualifying inpatient hospital care, skilled nursing facility care, hospice and certain home health services.
Medical Insurance
Part B helps cover qualifying doctor services, outpatient care, preventive services, durable medical equipment and certain other medical services.
Medicare Advantage
Private Medicare-approved plans provide Part A and Part B benefits and usually include Part D. Many plans offer extra benefits such as dental, vision or hearing coverage.
Drug Coverage
Part D helps pay for prescription drugs. People using Original Medicare can add a separate Medicare drug plan.
Many of the gaps on this page refer specifically to Original Medicare. Medicare Advantage plans may cover services that Original Medicare leaves out, but benefits, provider networks, rules and out-of-pocket costs vary by plan.
Medicare Is Not Free: A 2026 Cost Snapshot
Even before you reach a service Medicare does not cover, you can owe money for care Medicare does cover.
Selected 2026 Original Medicare Costs
Medicare costs change. Recheck current Medicare figures whenever you make a healthcare or retirement-budget decision.
The Original Medicare Part A hospital deductible applies by benefit period. It is possible to have more than one benefit period, and potentially more than one Part A deductible, during the same year.
7 Major Medicare Gaps to Plan For
These are the expenses most likely to surprise someone who assumes Medicare works like an all-inclusive retiree health plan.
Most Routine Dental Care
Original Medicare generally does not cover routine dental exams, cleanings, fillings, most tooth extractions, dentures or implants.
Medicare can cover certain dental services when they are directly connected with qualifying covered medical treatment, but that is very different from having ordinary dental insurance.
Routine Vision Exams, Glasses and Contacts
Original Medicare generally does not cover routine eye exams for prescription eyeglasses or contact lenses, and it usually does not pay for ordinary glasses or contacts.
There are exceptions. For example, Part B can cover one pair of standard-frame eyeglasses or one set of contact lenses after qualifying cataract surgery with an implanted intraocular lens.
Hearing Aids and Hearing-Aid Fitting Exams
Original Medicare does not cover hearing aids or exams performed to fit hearing aids.
Medicare may cover certain diagnostic hearing and balance exams when they meet Medicare’s medical-necessity requirements. That is not the same as routine hearing-aid coverage.
Most Long-Term Custodial Care
This can be the biggest financial misunderstanding on the page.
Medicare generally does not pay for long-term custodial care when that is the only care you need. Custodial care includes ongoing help with activities such as bathing, dressing, eating and using the bathroom.
Medicare can cover qualifying short-term skilled nursing or rehabilitation services, but skilled medical care and long-term custodial care are not the same thing.
A Traditional Routine Physical
Medicare covers many preventive and screening services, including the one-time “Welcome to Medicare” preventive visit and qualifying yearly “Wellness” visits.
Those visits are not the same as a traditional head-to-toe routine physical. If your provider performs services outside the Medicare-covered preventive benefit, you may owe additional costs.
Most Medical Care Outside the United States
Original Medicare generally provides very limited coverage for care received outside the United States, with narrow exceptions.
Some Medigap policies include limited foreign-travel emergency coverage. Medicare Advantage plans have their own rules and may offer some emergency or urgently needed international coverage.
Most Outpatient Prescription Drugs Are Not Included in Parts A and B
Part B covers a limited group of outpatient prescription drugs under qualifying circumstances, such as certain drugs administered by a healthcare professional.
For broader prescription coverage, people with Original Medicare generally need separate Medicare drug coverage through Part D. Most Medicare Advantage plans include drug coverage, but plan formularies, pharmacies and costs can differ.
Medicare Gap Check
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Your Medicare verification list
Educational use only. Coverage can depend on the exact service, diagnosis, medical necessity, provider, location, timing, coverage type, plan documents, and current Medicare rules.
The Hidden Medicare Gap: Original Medicare Has No Annual Out-of-Pocket Maximum
This is not an uncovered service. It is a financial exposure created by how Original Medicare cost sharing works.
A Covered Service Can Still Cost You Money
For many Part B-covered services, a beneficiary typically pays 20% of the Medicare-approved amount after meeting the Part B deductible when the provider accepts assignment.
If your remaining share is a percentage rather than a fixed dollar amount, expensive medical care can still produce expensive bills. Supplemental coverage can change that risk.
How People Fill Medicare’s Gaps
There is no single add-on that fills every hole. The right approach depends on whether you choose Original Medicare or Medicare Advantage and which risks matter most to you.
Parts A + B
You can generally see any doctor or hospital that accepts Medicare.
You may add a separate Part D drug plan and, when eligible, purchase Medigap to help with certain Original Medicare cost sharing.
Original Medicare itself does not have a general annual out-of-pocket maximum.
Supplement Original Medicare
Medigap is private supplemental insurance designed to help pay certain deductibles, coinsurance and copayments left by Original Medicare.
Medigap generally does not provide ordinary dental, vision, hearing-aid or long-term care coverage.
Alternative Medicare Coverage
Medicare Advantage plans provide Part A and Part B benefits through private Medicare-approved plans.
Most include drug coverage, and many offer extra benefits such as dental, hearing or vision.
Plans can have provider networks, authorization rules and varying costs, so compare the actual plan rather than the benefit headline.
Medigap is mainly designed to help with your share of costs for services Original Medicare covers. It generally does not cover long-term care, routine vision or dental care, hearing aids, glasses or private-duty nursing.
Pay Attention to the Medigap Enrollment Window
Federal law provides a six-month Medigap Open Enrollment Period that starts the first month you have Part B and are age 65 or older.
During that period, insurers generally cannot refuse to sell you a Medigap policy they offer or charge you more because of pre-existing health problems. Outside that window, federal protections can be more limited, though state rules and guaranteed-issue rights can create other opportunities.
Medicare vs. Long-Term Care: Know the Difference Before You Need It
A nursing facility can provide both skilled medical care and long-term custodial care. Medicare’s treatment of those services is very different.
Medicare May Cover Qualifying Skilled Care
Part A can cover qualifying skilled nursing facility care for a limited period when Medicare’s eligibility requirements are met.
For 2026, covered skilled nursing facility care costs $0 for days 1 through 20 and $217 per day for days 21 through 100. After day 100, you generally pay all costs for that benefit period.
Medicare Generally Does Not Cover Long-Term Custodial Care
If what you need is ongoing help with daily activities rather than qualifying skilled medical care, Medicare generally does not pay for that long-term custodial care.
That can apply whether the care is received at home, in the community, in assisted living or in a nursing facility.
Healthcare planning should include the possibility that you may someday need help Medicare was never designed to pay for. Connect this page with MoneyBucket’s Retirement Planning Guide rather than assuming your normal Medicare budget covers long-term care.
What Else Does Original Medicare Commonly Leave Out?
The seven gaps above are the ones most likely to affect a retirement budget, but Medicare lists other uncovered items and services too.
- Most cosmetic surgery that is not medically necessary under Medicare rules.
- Massage therapy.
- Concierge or membership-style medical care fees.
- Private-duty nursing in many situations.
- Services from providers who have opted out of Medicare, except in certain emergency or urgent situations.
Your Medicare Gap Planning Roadmap
Do this before a healthcare bill forces you to learn your coverage the expensive way.
Decide How You Will Receive Medicare
Compare Original Medicare with Medicare Advantage based on your doctors, medications, travel, expected care, total costs and plan rules.
List the Services You Actually Use
Include prescriptions, dentists, eye doctors, hearing care, specialists, therapy and recurring medical equipment.
Check Your Prescription Coverage
Make sure your drugs and preferred pharmacies fit the Part D or Medicare Advantage plan you are considering.
Plan for Cost Sharing
Budget for premiums, deductibles, copays and coinsurance, not simply uncovered services.
Decide How You Will Handle Dental, Vision and Hearing
Know whether those expenses are covered by your plan or need their own line in your retirement budget.
Make a Long-Term Care Plan
Do not confuse skilled nursing coverage with open-ended nursing-home or custodial-care coverage.
Review Coverage Every Year
Medicare Advantage and Part D plan premiums, formularies, networks and benefits can change. Recheck your plan rather than assuming last year’s choice still fits.
Building a Medicare Budget
A useful retirement healthcare budget needs more than a Part B premium.
- Part B premium and any applicable income-related adjustment.
- Medicare Advantage, Medigap or Part D premiums when applicable.
- Deductibles, coinsurance and copays.
- Prescription drug spending.
- Dental care.
- Vision care and glasses.
- Hearing aids and related expenses.
- Travel medical protection if you spend time outside the United States.
- A separate strategy for possible long-term care.
Use MoneyBucket’s Budgeting Guide to build recurring Medicare premiums and expected healthcare expenses directly into your monthly plan.
What If Medicare Costs Are Hard to Afford?
People with limited income and resources may qualify for programs that reduce Medicare expenses.
Check These Programs Before Assuming You Do Not Qualify
- Medicare Savings Programs can help qualifying beneficiaries with certain Medicare premiums and, in some cases, other cost sharing.
- Extra Help can reduce qualifying Part D prescription drug costs.
- Medicaid may help eligible people with healthcare and long-term care costs under state rules.
- State Health Insurance Assistance Programs provide free Medicare counseling.
Medicare Coverage Gap FAQ
Does Medicare cover dental care?
Original Medicare generally does not cover routine dental care such as cleanings, fillings, dentures and implants. Medicare can cover certain dental services when they are directly connected with qualifying covered medical treatment. Some Medicare Advantage plans include dental benefits.
Does Medicare cover eyeglasses?
Original Medicare usually does not cover routine eyeglasses or contact lenses. Part B can cover one pair of standard-frame eyeglasses or contact lenses after qualifying cataract surgery that implants an intraocular lens.
Does Medicare cover hearing aids?
Original Medicare does not cover hearing aids or exams for fitting hearing aids. Some Medicare Advantage plans offer hearing benefits.
Does Medicare pay for nursing homes?
Medicare can pay for qualifying short-term skilled nursing facility care when its requirements are met. It generally does not pay for long-term custodial nursing-home care when that is the only care needed.
Does Medicare cover an annual physical?
Medicare covers certain preventive visits, including a one-time “Welcome to Medicare” visit and qualifying yearly “Wellness” visits. These are not the same thing as a traditional routine physical. Extra services performed during a visit can create additional costs.
Does Original Medicare cover prescription drugs?
Part B covers a limited number of outpatient prescription drugs under qualifying conditions. Broader prescription coverage is available through Part D or many Medicare Advantage plans that include drug coverage.
Does Medicare cover healthcare outside the United States?
Original Medicare generally provides very limited coverage outside the United States. Some Medigap policies and Medicare Advantage plans may provide certain foreign-travel or emergency benefits.
Does Original Medicare have an out-of-pocket maximum?
No. Original Medicare by itself does not have a general annual limit on what you can pay out of pocket for covered Part A and Part B services. Medigap, Medicaid, employer or retiree coverage, or Medicare Advantage can change your financial exposure.
Does Medigap cover dental, vision and hearing?
Medigap is primarily designed to help with certain cost sharing left by Original Medicare. Standard Medigap policies generally do not cover routine dental or vision care, hearing aids, glasses or long-term care.
What is the Part D out-of-pocket limit for 2026?
For 2026, out-of-pocket costs for drugs covered by Medicare drug coverage are capped at $2,100 for the year. Certain payments made on your behalf can count toward the limit under Medicare rules.
Can Medicare Advantage cover things Original Medicare does not?
Yes. Many Medicare Advantage plans offer extra benefits such as dental, vision or hearing coverage. Benefits, provider networks, authorization requirements and out-of-pocket costs depend on the individual plan.
Medicare Is Coverage. It Is Not a Blank Check.
Know what your plan covers. Know what it leaves out. Know what you pay when care is covered. Then make a plan for the gaps before they become bills.
The healthcare expense that hurts a retirement plan most is often the one you assumed somebody else would pay.