You sign up for Medicare, start paying your Part B premium, and assume you're covered. Then you need a crown and your dentist's office tells you to pay the full $1,500 at the desk. Or you break your hip traveling abroad and find out your Medicare card is essentially useless. Or a parent with dementia needs round-the-clock care and someone says the words “nursing home,” and Medicare covers almost none of it.
These aren't edge cases. They're the most common expensive surprises that Medicare beneficiaries run into. Original Medicare was built in 1965 to cover hospital stays and doctor visits. It was never designed to cover the full spectrum of care that people actually need as they age, and it hasn't caught up.
The good news is that most of these gaps have solutions, if you know about them before you need them. Here's what to look out for and how to fill the holes.
Dental care
Original Medicare does not cover routine dental care. That means no cleanings, no fillings, no crowns, no dentures, and no extractions for the average beneficiary. The exceptions are narrow: Medicare will pay for dental work that's necessary before an organ transplant or certain cancer treatments, or to clear an infection before dialysis. Everything else is on you.
This matters more than most people expect. Skipping dental care doesn't just affect your teeth. Untreated gum disease is linked to cardiovascular disease and poorly controlled diabetes, two conditions that are extremely common among people on Medicare. A cleaning today is a lot cheaper than a hospitalization later.
If you're on Original Medicare and want dental coverage, you have three options: switch to a Medicare Advantage plan that includes it, buy a standalone dental plan, or pay out of pocket. Medicare Advantage plans vary widely in what they cover, so read the fine print on any plan before you sign up. Some cover only preventive care (cleanings and X-rays). Others include major restorative work but cap annual benefits at $1,500 or $2,000, which won't get you far if you need implants or significant reconstruction.
Hearing aids
Medicare doesn't cover hearing aids or the exams used to fit them. This is one of the most consequential gaps in the program. Untreated hearing loss is associated with cognitive decline, social isolation, and a higher risk of falls in older adults. Yet the average cost of a pair of hearing aids runs between $2,000 and $6,000, and most people pay every cent out of pocket.
Medicare will cover a diagnostic hearing exam if your doctor orders one for a specific medical reason, but that's different from the exam you need to get fitted for a hearing aid. The fitting exam: not covered.
Your options here include Medicare Advantage plans, many of which now offer hearing aid benefits, though the coverage often comes with restrictions on brands or requires using specific network audiologists. Since 2022, over-the-counter hearing aids have been legal in the United States for adults with mild to moderate hearing loss, which has significantly brought down prices for people who don't need a custom fit. They're available at pharmacies and retailers without a prescription and run as low as a few hundred dollars. That's not a perfect solution, but it's worth knowing about.
Routine vision care and glasses
Medicare covers diagnosis and treatment of eye diseases like glaucoma, cataracts, and diabetic retinopathy. What it doesn't cover are routine eye exams, prescription eyeglasses, or contact lenses, except for one pair of glasses or contacts after cataract surgery.
For most people, this means paying out of pocket for annual eye exams and new lenses every year or two. Depending on your prescription and whether you need progressives, that bill can run $300 to $600 or more. If you have a condition like macular degeneration or a history of glaucoma that requires more frequent monitoring, the costs compound quickly.
Many Medicare Advantage plans include a vision benefit with an annual exam and a modest allowance toward frames or lenses. Standalone vision plans are also available and often cost $10 to $20 a month. The coverage is not comprehensive but it takes the edge off regular costs. If you're comparison shopping Medicare Advantage plans, pay attention to what each plan's vision allowance actually buys versus what you typically spend.
Routine foot care
Medicare doesn't cover routine foot care: no nail trimming, no callus removal, no corn treatment. You pay 100% in most cases. This surprises people who assume a podiatrist visit is just a specialist visit covered at the usual 80%.
The exception is meaningful: if you have diabetes with lower-extremity nerve damage, Medicare will cover a foot exam once a year. People with circulatory disorders or other systemic conditions that make routine foot care medically risky may also qualify for coverage. But for everyone else, if a podiatrist is trimming your nails because you can't reach them comfortably, that bill is yours. Treatment for structural foot problems (bunions, heel spurs, hammertoe) and injuries is covered, because those are medically necessary procedures, not maintenance. Ask your podiatrist before your appointment which services Medicare will cover, and which it won't.
Long-term care and nursing home stays
This is the gap that can wipe out a retirement. Medicare does not cover long-term custodial care in a nursing home or assisted living facility. It doesn't matter how long you've paid into the system or how much you need the care. If you need help with bathing, dressing, eating, or managing daily life because of age or a chronic condition, Medicare won't pay for it.
What Medicare does cover is short-term skilled nursing care after a qualifying hospital stay of at least three days. Under that scenario, the first 20 days are fully covered. Days 21 through 100 require a daily coinsurance payment of $217 in 2026. After day 100, Medicare pays nothing at all. The median cost of a private room in a nursing home in the U.S. is roughly $11,000 a month, which means a long stay can cost more than $130,000 a year.
Most people end up paying out of pocket until they've spent down enough assets to qualify for Medicaid, which does cover long-term nursing home care for those who meet the income and asset limits. Long-term care insurance is another option, but premiums are expensive and policies are harder to qualify for the older you are when you buy them. At age 55, premiums run around $950 a year for men and $1,500 for women for a modest benefit. If you're thinking about it, buy it while you're still healthy. If you have a veteran in the family who needs long-term care, VA benefits may also be an option worth exploring.
Care when you travel abroad
Medicare generally doesn't pay for health care you receive outside the United States. If you get sick or injured in Europe, Mexico, Canada, or anywhere else outside U.S. territories, you're on your own. There are narrow exceptions: if you live near the border and a foreign hospital is closer than any U.S. facility, or if you need emergency care while traveling through Canada on the way to Alaska. For everyone else in most situations, Medicare is a domestic benefit only.
This is worth taking seriously before any international travel. Air ambulance evacuations to bring you back to the U.S. for treatment can cost more than $100,000. Emergency surgery in a country with private hospital pricing can run tens of thousands of dollars with no reimbursement coming.
Some Medigap supplement plans (specifically Plans C, D, F, G, M, and N) cover 80% of emergency medical costs abroad after a $250 annual deductible, up to a $50,000 lifetime limit, but only for emergencies that occur within the first 60 days of a trip. That's limited but better than nothing for short vacations. Some Medicare Advantage plans also offer some international emergency coverage, though rules vary by plan. For longer trips or more frequent travel, a dedicated travel medical insurance policy is the more reliable option. It typically covers emergency care, hospitalization, and medical evacuation, and annual plans are available for people who travel more than once a year.
Most acupuncture, chiropractic care, and alternative treatments
Medicare added limited acupuncture coverage in 2020, but only for chronic low back pain, and only up to 12 sessions per year (20 if you're showing improvement). For everything else, acupuncture is not covered. The same applies to naturopathic care, massage therapy, and most alternative or integrative treatments.
Chiropractic care is partially covered, but the rules are strict. Medicare covers spinal manipulation to correct a subluxation, the specific condition where a vertebra moves out of position. It does not cover the X-rays your chiropractor might take, physical therapy-style exercises performed in the office, or maintenance visits once you've stopped improving. Many people assume their regular chiropractic appointments are covered, then get a bill for services Medicare wouldn't pay for.
Ask your chiropractor before each visit exactly which services Medicare will cover and which it won't. Medicare Advantage plans sometimes offer broader chiropractic or wellness benefits, so if these are services you use regularly, it's worth factoring them into plan comparison.
What to do now
The Annual Enrollment Period for Medicare runs October 15 through December 7 each year. That's the window to switch from Original Medicare to Medicare Advantage, change Advantage plans, or add or change a Part D drug plan. Changes take effect January 1 of the following year.
If you're on Original Medicare and want to add dental, vision, or hearing coverage, you can buy standalone plans at any time. If you want to add a Medigap supplement plan to cover gaps like coinsurance and foreign travel emergencies, the best time to buy is during your Medigap Open Enrollment Period, which is the six months starting the month you turn 65 and enroll in Part B. During that window, insurers can't charge you more or deny you coverage based on health conditions. After it closes, they can.
A free resource worth using: your State Health Insurance Assistance Program (SHIP), which offers unbiased, one-on-one help with Medicare decisions from counselors who aren't affiliated with any insurance company. Find your local program at shiphelp.org.
Medicare covers a lot. What it leaves out can cost a great deal more if you're not prepared for it.
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