Most people think the hard part is over once they reach Medicare. Then a bill shows up for something they were sure was covered. Here are seven things Medicare doesn’t cover, and how to handle each one.
By the time you turn 65 and go on Medicare, it can feel like the finish line. And for the big stuff, hospital stays, doctor visits, and prescriptions, Medicare is excellent coverage, especially with a Medigap plan. But there are real gaps. Some of the most common needs in your 70s, 80s, and 90s are only partly covered, or not covered at all. We’ll start with the one that can do the most financial damage.
1. Long-term care, the one that can cost six figures a year
This is the big one, so we lead with it. Original Medicare, Medigap, and Medicare Advantage generally do not cover custodial long-term care. Some Advantage plans now offer limited in-home support as an extra benefit, but none of them pay for ongoing custodial care, period.
Long-term care means help with everyday activities: bathing, dressing, eating, getting out of bed, using the bathroom. When you can no longer do those things on your own, you need custodial care, at home or in a facility, and that is exactly what Medicare will not pay for.
Yes, Part A covers up to 100 days of skilled nursing per benefit period, after a qualifying hospital stay. But once the skilled rehab ends, ongoing help with daily living is on you. And it is costly. According to CareScout’s 2025 survey, a private nursing-home room runs about $130,000 a year, a semi-private room about $115,000, and assisted living about $75,000. A stay can last a few weeks or several years, so a long one can erase a lifetime of savings. For a couple where both spouses need care, the numbers double.
2. Dental care
Dental catches people off guard, because it was usually covered at work and didn’t seem pricey. Original Medicare does not cover routine dental: cleanings, fillings, crowns, extractions, dentures, or implants. The only exceptions are dental work tied to another medical procedure, like clearance before a heart valve replacement or jaw reconstruction. Your twice-a-year cleaning does not count.
It adds up. Among retirees who use dental care, the average spends about $874 a year, and the top 10% spend over $2,100 (per KFF). Implants alone can run several thousand dollars.
How to get it covered: Many Medicare Advantage plans include a dental benefit, but it usually covers only basics like cleanings and x-rays, not crowns or implants, so read the fine print. You can also buy a standalone dental plan for roughly $20 to $50 a month, or set money aside to cover it yourself.
3. Routine physical exams
This gap is sneaky, because people swear their physical is covered. Here is the catch. Medicare covers an annual wellness visit once you’ve been enrolled for 12 months. But a wellness visit is not a physical exam. It’s a prevention and planning conversation, not a head-to-toe checkup.
Medicare generally does not cover a traditional, head-to-toe annual physical the way many employer plans did. Depending on what services are actually performed, you may owe cost-sharing. It gets trickier, too: if you raise a new problem during your free wellness visit, say a sore back or an odd mole, your doctor can address it, but that can turn into a billable office visit. People walk out thinking it was free and get a bill weeks later.
The fix is simple. Keep your wellness visit focused on prevention, and if a new problem comes up, book a separate appointment for it.
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4. Hearing aids
Hearing is one of the biggest dollar gaps. Original Medicare doesn’t cover hearing aids, and it generally doesn’t cover exams performed solely to fit them. (A diagnostic hearing test your doctor orders to check for a medical problem can be covered.) But if your audiologist says you need a pair of aids, you’re writing the check.
And the need is common. About one in four adults aged 65 to 74 has disabling hearing loss, and by age 75 it’s roughly half. A pair of prescription hearing aids runs from about $2,500 to $4,000 or more.
How to get it covered: Thanks to a 2022 law, over-the-counter hearing aids are now available for mild to moderate loss, often $200 to $1,500 a pair. For moderate to severe loss, you’re back to prescription devices. Some Medicare Advantage plans offer a hearing benefit, but it’s usually capped low and limited to in-network providers.
5. Vision
Vision is usually the smallest dollar amount on this list, but it surprises people the most. Original Medicare doesn’t cover routine eye exams for glasses or contacts, and it doesn’t cover the glasses or contacts themselves.
There are narrow exceptions tied to medical conditions: a yearly diabetic eye exam if you have diabetes, cataract surgery plus one pair of corrective lenses afterward, and glaucoma testing if you’re high-risk. Everything else is out of pocket, though the typical cost is modest, around $200 to $250 a year.
How to get it covered: Some Medicare Advantage plans include a vision benefit, you can buy a standalone vision plan, or you can simply budget for it.
6. Routine foot care
Original Medicare doesn’t cover routine foot care for an otherwise healthy person, meaning regular nail trimming or treating corns and calluses. It does step in when foot care is medically necessary, for example if you have diabetes-related nerve damage in your feet, or you need treatment for a foot injury or a condition like a bunion or heel spur. In those cases you pay the usual 20% after the Part B deductible.
How to get it covered: If you have diabetes or another qualifying condition, ask your doctor, because your podiatry visits may already be covered. Otherwise, some Medicare Advantage plans include routine foot care, and many podiatrists charge a fair cash price for a simple visit.
7. Medical care outside the U.S.
Original Medicare almost never covers care outside the United States. Get sick on a cruise or while visiting family abroad, and you could be looking at the full bill yourself.
How to get it covered: Several Medigap plans (C, D, F, G, M, and N) include foreign travel emergency coverage. They pay 80% of eligible emergency costs after a $250 deductible, up to a $50,000 lifetime limit, and only for emergencies that begin in the first 60 days of a trip. For bigger risks, like a medical evacuation that can top $100,000, a separate travel medical policy is a smart add-on.
The real takeaway: six are annoying, one can break you
Here’s the honest summary. Six of these seven, dental, vision, hearing, physicals, foot care, and travel, are irritating and add up over time, but they won’t sink you. Long-term care is different. A single year of nursing care can cost more than many people earned in their best working year. That’s why we led with it.
So build your plan in this order:
- Plan for long-term care first, while you’re healthy. You can set aside dedicated savings (if you built up a Health Savings Account before going on Medicare, those funds can still be spent tax-free on many qualified care costs), buy traditional long-term care insurance, choose a hybrid life-and-long-term-care policy, or plan a careful Medicaid spend-down. Just know there’s a five-year look-back on gifts and transfers, so “do nothing” is the riskiest choice of all.
- Pick your Medicare path with eyes open. Medicare Advantage often bundles some dental, vision, and hearing, while Original Medicare with a Medigap plan does not. But Advantage trades that for networks, prior authorizations, and provider lists that change year to year. Choose based on your doctors and hospitals first, not on a dental perk. And if you travel abroad, make sure your Medigap plan includes foreign travel coverage.
- Cover dental, vision, hearing, and foot care on purpose, with a combination plan or by setting aside $100 to $200 a month.
- Use your wellness visit correctly, and schedule a separate appointment for any new problem.
Medicare is genuinely confusing, and a wrong guess can cost hundreds or thousands of dollars a year. This is one area where sitting down with an unbiased advisor who can compare every plan in your area, often at no cost to you, is well worth the twenty minutes.
This is educational information, not personal financial, tax, or medical advice. Rules and dollar figures change, so confirm your own situation at Medicare.gov, call 1-800-MEDICARE, or talk with a licensed professional before you decide.
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