If you’re on Medicare, you might assume it covers just about everything medical. But that’s not true. Medicare is a big program, but it has big gaps. Many people find out the hard way-when they get a bill for something they thought was included. Here are the eight most common things Medicare doesn’t cover, and what you can do about them.
1. Routine dental care
Medicare won’t pay for cleanings, fillings, crowns, dentures, or root canals. Even if you need emergency dental work because of an accident, Medicare usually won’t step in. There are rare exceptions-like jaw surgery after an injury or if you’re hospitalized and need dental care during that stay-but daily dental needs? You’re on your own.
Over 100 million Americans don’t have dental insurance. For seniors, that often means skipping checkups until pain becomes unbearable. The average cost of a cleaning is $75-$200, and a crown can run $800-$1,500. If you need regular dental care, consider a standalone dental plan or a Medicare Advantage plan that includes dental benefits. Some plans offer two cleanings a year and basic fillings at little or no extra cost.
2. Hearing aids and hearing exams
Medicare doesn’t cover hearing aids, even though nearly 1 in 3 people over 65 have hearing loss. It also won’t pay for routine hearing tests unless they’re ordered because of a medical condition like vertigo or dizziness. If your doctor says you need a hearing test just to check your hearing? That’s out-of-pocket.
Hearing aids can cost anywhere from $1,000 to $6,000 per pair. Most people need two, so that’s a $2,000-$12,000 expense. Some Medicare Advantage plans now include hearing benefits, and a few states offer assistance programs for low-income seniors. Check with your State Health Insurance Assistance Program (SHIP) to see what’s available locally.
3. Vision care (except after cataract surgery)
Medicare covers one pair of glasses or contact lenses after cataract surgery-nothing else. Routine eye exams for glasses or contact lenses? Not covered. Glaucoma screenings? Only if you’re high risk (diabetic or have family history). Dry eye treatment, prescription sunglasses, or even new glasses because your prescription changed? You pay.
Over 60% of seniors need corrective lenses. The average cost of a pair of glasses is $200-$300. Some Medicare Advantage plans include vision coverage, often with an annual exam and discount on frames and lenses. Look for plans with VSP or EyeMed networks if you want regular eye care without surprise bills.
4. Long-term care
This is one of the biggest surprises. Medicare doesn’t cover long-term care-meaning help with daily tasks like bathing, dressing, eating, or using the bathroom. That includes nursing home stays for ongoing personal care, assisted living, or in-home aides who help you get through the day.
Medicare will pay for up to 100 days in a skilled nursing facility, but only if you’re recovering from a hospital stay and need daily skilled care like physical therapy or wound care. Once that’s done, you’re on your own. The average cost of a private room in a nursing home is over $100,000 a year. Most people end up paying out of pocket, using savings, or qualifying for Medicaid after they’ve spent down their assets.
5. Cosmetic surgery
Medicare won’t pay for procedures done just to improve your appearance. That includes facelifts, liposuction, breast augmentation, or tummy tucks. Even if you’ve lost a lot of weight and have excess skin, Medicare won’t cover skin removal unless it’s causing medical problems-like rashes, infections, or mobility issues.
Some people qualify for a panniculectomy (removal of hanging abdominal skin) if it’s medically necessary. But you’ll need documentation from your doctor proving it’s causing health problems. Most cosmetic procedures cost $5,000-$15,000. If you’re considering one, look into medical financing or payment plans. Don’t assume Medicare will help.
6. Alternative therapies
Acupuncture, chiropractic care (except for back pain), massage therapy, naturopathy, and most holistic treatments are not covered by Original Medicare. Even if your doctor recommends them, Medicare says they’re not proven enough to pay for.
Chiropractic care is the only exception: Medicare will cover spinal manipulation for subluxation (misalignment) of the spine, but nothing else-no X-rays, no supplements, no physical therapy from the chiropractor. Acupuncture is only covered for chronic low back pain, and only under specific conditions. Most alternative therapies cost $50-$150 per session. Some Medicare Advantage plans now include limited coverage for acupuncture or wellness programs. Always check your plan details.
7. Private-duty nursing
Medicare covers skilled nursing care in short bursts, like after surgery. But it won’t pay for someone to sit with you all day to help you eat, remind you to take pills, or keep you company. That’s private-duty nursing-and it’s not covered.
Private-duty nurses can cost $20-$40 per hour. If you need 8 hours a day, that’s $5,800-$11,600 a month. Some families hire aides through home care agencies, but those services aren’t medical and fall outside Medicare’s scope. Medicaid may cover this if you qualify based on income and assets. Otherwise, long-term care insurance is the only reliable way to pay for it.
8. Foot care (unless it’s medically necessary)
Medicare covers podiatry only if you have a medical condition like diabetes, nerve damage, or foot ulcers. Routine foot care-trimming nails, treating corns or calluses, or getting orthotics for comfort-is not covered.
People with arthritis, flat feet, or balance issues often need custom orthotics. A pair can cost $300-$600. If you’re diabetic, Medicare will cover one pair of therapeutic shoes and inserts per year. But if you just want extra cushioning for your feet? You pay. Many seniors end up going without proper foot care until pain becomes disabling. Some Medicare Advantage plans offer limited podiatry benefits-check your plan’s summary of benefits.
What can you do about these gaps?
Medicare was never meant to cover everything. It’s designed as a foundation, not a full safety net. The good news? You have options.
- Consider a Medicare Advantage plan-many include dental, vision, hearing, and even gym memberships.
- Buy a Medigap policy to help with out-of-pocket costs, but know it won’t cover the eight things listed above.
- Look into supplemental insurance for dental, vision, or hearing.
- Check if your state offers low-income assistance programs for seniors.
- Ask about community programs-many churches, nonprofits, and Area Agencies on Aging offer free or low-cost services.
Don’t wait until you get a bill you can’t pay. Review your coverage every year during Open Enrollment. Know what’s missing. Plan ahead. Medicare is a lifeline-but it’s not a magic wand.
Does Medicare cover dental implants?
No, Medicare does not cover dental implants. Even if you’ve lost teeth due to disease or injury, implants are considered elective and cosmetic. Some Medicare Advantage plans may offer limited dental benefits, but implants are rarely included. You’ll need to pay out of pocket or look into dental discount plans or financing options.
Can I get Medicare to pay for a recliner chair?
Medicare will only cover a recliner chair if it’s classified as durable medical equipment (DME) and prescribed by a doctor for a specific medical reason-like severe arthritis, COPD, or heart failure that makes sitting upright painful. Even then, it must meet strict criteria: the chair must be primarily medical in nature, not comfort-focused, and you must have a written order from your doctor. Most standard recliners won’t qualify. If approved, Medicare pays 80% of the approved amount after you meet your Part B deductible.
What’s the difference between Medicare and Medicaid?
Medicare is federal health insurance for people 65 and older or those with certain disabilities, regardless of income. Medicaid is a joint federal and state program for low-income individuals of any age. Medicaid often covers services Medicare doesn’t-like long-term care, dental, vision, and hearing aids. If you qualify for both, Medicaid can help pay Medicare premiums and cover the gaps.
Are over-the-counter medicines covered by Medicare?
No, Medicare Part D (prescription drug coverage) doesn’t cover over-the-counter (OTC) medications like pain relievers, allergy meds, or sleep aids-unless they’re prescribed by a doctor and included in your plan’s formulary. Even then, it’s rare. Some Medicare Advantage plans include OTC allowances, giving you a monthly card to buy eligible items like bandages or vitamins at participating stores.
Does Medicare cover transportation to doctor appointments?
Original Medicare doesn’t cover non-emergency transportation. But some Medicare Advantage plans include rides to medical appointments as a supplemental benefit. You might also qualify for free or low-cost rides through local Area Agencies on Aging, senior centers, or nonprofit groups. Medicaid covers transportation if you’re enrolled and meet income requirements.
