What Medicare Doesn’t Cover (That Surprises Most People)
When you first sign up for Medicare, you might assume it covers everything you need as you get older. But here’s the truth: there are several important things that Medicare simply doesn’t pay for, and many people don’t find out until they get a bill. Understanding what Medicare doesn’t cover can save you from some big financial surprises and help you plan ahead.
According to data from the Centers for Disease Control and Prevention, 64% of people aged 65 and older went to the dentist last year. But does Medicare cover routine dental visits? The answer might surprise you. Let’s review what Medicare does not cover and why it matters to you.
What Medicare Doesn’t Cover in Dental, Vision, and Hearing Care
The number one surprise for most people is that original Medicare does not cover dental, vision, or hearing care unless it’s related to a medical emergency.
- Dental: Medicare does not cover routine exams, cleanings, x-rays, fillings, dentures, implants, or root canals. The only time dental work is covered is if it’s considered medical. For example, reconstructive jaw surgery after an accident.
- Vision: Cataract surgery, glaucoma treatments, and other medical eye procedures are covered; however, Medicare does not cover routine eye exams, glasses, or contact lenses.
- Hearing: As of 2025, Medicare does not cover hearing aids or routine hearing exams.
Some Medicare Advantage (Part C) plans cover eye, hearing, and dental care. These benefits are provided by private insurance and vary depending on the plan. If these advantages are important to you, you should carefully compare Advantage options.
Long-Term Care in a Nursing Home
Another major expense that catches many seniors off guard is long-term nursing home care. Medicare will pay for short-term skilled nursing or rehabilitation after a hospital stay. For example, if you are recovering from a stroke or knee surgery.
But if you need to stay in a nursing home for the long term because you require round-the-clock care, Medicare does not cover it. This includes permanent residency for dementia care, as well as daily assistance with activities such as eating, bathing, and dressing.
To plan for this, consider exploring long-term care insurance, Medicaid (if you qualify), or other financial strategies to cover nursing home costs.
Care Outside the United States
Do you love to travel? Here’s an important fact: Medicare does not cover you outside the United States.
If you take a cruise, vacation abroad, or travel to Canada or Mexico, Original Medicare will not cover your hospital stays, doctor visits, or emergency care. Some Medigap (supplement) plans will cover 80% of emergency medical costs incurred outside the country, but you must verify your plan details to confirm. Some Medicare Advantage plans also offer worldwide coverage, but this must be clearly stated in the plan benefits.
If you’re a frequent traveler, consider purchasing travel medical insurance or choosing a Medicare plan that includes global coverage.
In-Home Nursing Care and Home Modifications
Many people assume that Medicare will cover the cost of a nurse visiting their home if they require daily assistance. Unfortunately, this is not the case.
Medicare only covers short-term home health care after a qualifying hospital or nursing home stay, and its goal is to help you transition back to independence. It does not cover:
- Long-term home health aides.
- Daily nursing visits for chronic conditions.
- Help with bathing, cleaning, cooking, or going to the bathroom.
- Home modifications such as ramps, grab bars, or stair lifts.
If you require ongoing care, you may need to pay out of pocket unless you also qualify for Medicaid, which provides some coverage for in-home support services.
Other Services That Might Surprise You
In addition to the big four above, here are a few more things Medicare doesn’t cover that you should be aware of:
- Aesthetic surgery (unless it is medically necessary after an accident)
- Regular foot care (unless you have diabetes or a medical reason to do otherwise)
- Most prescription drugs are not covered unless you have a Part D or Advantage plan that covers drugs.
- Private-duty nursing for long periods of time.
Being aware of these gaps can help you avoid unexpected costs and plan ahead with supplemental insurance or savings.
Frequently Asked Questions
Does Medicare cover dental services?
No, Medicare does not cover routine dental services, such as cleanings, fillings, or extractions. While Medicare Part A may cover dental services if you’re hospitalized for a dental procedure, dental coverage typically requires additional insurance through a Medicare Advantage plan or standalone dental insurance.
What does Medicare Complete cover?
Medicare Complete is a term often used for Medicare Advantage plans. These plans combine the coverage of Original Medicare (Parts A and B) and typically include additional benefits, such as vision, dental, hearing, and prescription drug coverage. The specifics vary by plan, so it’s important to review the details of your specific plan to understand what’s covered.
How much does Medicare cost at age 65?
The cost of Medicare at age 65 depends on several factors, including whether you enroll in Original Medicare (Parts A and B) or a Medicare Advantage plan. Part A is usually free if you’ve worked and paid Medicare taxes for at least 10 years, while Part B typically has a monthly premium, which can range from $164.90 to higher amounts depending on income. Additional costs may apply for prescription drug coverage or supplemental insurance (Medigap).
Does Medicare cover hearing aids or exams?
No, Original Medicare (Parts A and B) does not cover hearing aids or the exams required to get them. If you need hearing aids, you will have to pay for them out of pocket unless you have a Medicare Advantage plan that offers additional hearing coverage.
Does Medicare cover long-term care?
No, Medicare generally does not cover long-term care, such as extended stays in nursing homes or custodial care. Medicare only covers skilled nursing care under specific conditions, typically for a limited time following a hospital stay. For long-term care, you may need a Medicaid program or a long-term care insurance policy.
Why This Matters
Medicare is designed to cover hospital and medical care, but it doesn’t meet every need as you get older. By learning what isn’t covered, you have time to look into options like Medigap, Medicare Advantage, long-term care insurance, or savings to help fill these gaps.
Final Thoughts
Understanding what Medicare doesn’t cover can make a big difference in your financial planning. The most common surprises are dental, vision, hearing, nursing home stays, and care outside the U.S., all of which can be expensive if you’re not ready. If you’re unsure about your coverage, LMS Insurance Group can help you compare plans, find dental, vision, or hearing coverage, and prepare for costs that Medicare won’t pay for. Our help is free to you.
Call LMS Insurance Group now to review your Medicare options, close coverage gaps, and protect your future. Don’t wait. Take steps today to secure your peace of mind.
