Medicare doesn’t cover routine dental care, vision exams or eyeglasses, hearing aids, long-term custodial care, most chiropractic services, cosmetic surgery, or healthcare received outside the United States. While Original Medicare provides strong core coverage for hospital stays, doctor visits, and many medical procedures, these gaps can cost beneficiaries thousands of dollars each year unless they’re filled with a Medicare Advantage plan, a Medicare Supplement policy, or standalone insurance for specific needs.

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The 7 Biggest Medicare Coverage Gaps

Most new Medicare enrollees assume their coverage works like the employer plans they’ve had for decades. It doesn’t. These are the gaps that catch people off guard.

1. Routine Dental Care

Original Medicare doesn’t cover cleanings, fillings, dentures, root canals, or extractions. The only dental services Medicare typically covers are emergency procedures during a hospital stay or dental work medically necessary to enable another covered treatment.

How to fill the gap: Many Medicare Advantage plans include routine dental, often with annual allowances for preventive care and major services. Standalone dental insurance is also widely available.

2. Vision Care

Annual eye exams, eyeglasses, and contact lenses are not covered by Original Medicare. Medicare will cover medical eye conditions like cataract surgery, glaucoma testing for high-risk patients, and macular degeneration treatment — but routine vision care for prescription updates is on you.

How to fill the gap: Most Medicare Advantage plans include routine vision benefits. Standalone vision policies are also affordable.

3. Hearing Aids and Hearing Exams

Original Medicare doesn’t cover routine hearing exams or hearing aids — and hearing aids commonly cost $2,000–$6,000 per pair out of pocket. Diagnostic hearing tests ordered by a doctor for a specific medical condition may be covered, but the devices themselves aren’t.

How to fill the gap: Many Medicare Advantage plans include hearing benefits with allowances toward hearing aids. Some carriers partner with specific hearing aid networks for discounted pricing.

4. Long-Term Custodial Care

This is the gap that financially devastates more Medicare beneficiaries than any other. Medicare covers up to 100 days of skilled nursing facility care after a qualifying hospital stay — but only the skilled care portion, and only if the patient is medically improving. It does not cover custodial care: help with bathing, dressing, eating, and other daily activities. That’s what most nursing home and assisted living care actually is, and it can cost $5,000–$10,000 per month.

How to fill the gap: Long-term care insurance (purchased before you need it), hybrid life/long-term care policies, personal savings, or Medicaid — which only kicks in after most assets are spent down. This is a planning conversation worth having long before age 65.

5. Healthcare Outside the United States

Original Medicare generally doesn’t cover medical care received outside the US. There are narrow exceptions — care in Canada or Mexico in certain cross-border emergencies, and care on cruise ships within six hours of a US port — but for practical purposes, if you travel internationally, you have no coverage.

How to fill the gap: Some Medicare Supplement plans (Plans C, D, F, G, M, and N) include foreign travel emergency benefits up to a lifetime maximum. Travel medical insurance is also available for trip-specific coverage.

6. Cosmetic Surgery

Medicare doesn’t cover purely cosmetic procedures. It will cover reconstructive surgery after an accident, mastectomy, or other medically necessary surgical event — but elective cosmetic work isn’t covered under any circumstances.

7. Most Prescription Drugs Outside Part D

Original Medicare (Parts A and B) only covers drugs administered in a clinical setting, like chemotherapy infusions or some injectables given in a doctor’s office. The medications you pick up at the pharmacy require enrollment in either a standalone Part D plan or a Medicare Advantage plan that includes drug coverage. Without one of these, you’ll pay full retail for prescriptions — and you’ll accrue a permanent late enrollment penalty for every month you go without creditable coverage.

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The Smaller Gaps That Add Up

A few additional coverage gaps that catch people by surprise:

• Acupuncture — only covered for chronic low back pain, with strict limits
• Most chiropractic care — only covered when correcting a subluxation
• Routine foot care — covered only if related to a medical condition like diabetes
• Private hospital rooms — only covered when medically necessary
• 24-hour nursing care at home — not covered
• Meals delivered to your home — not covered, except very limited Advantage plan benefits

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How to Cover the Gaps Strategically

You generally have three paths to fill Medicare’s coverage gaps, and they’re not mutually exclusive:

1. Choose a Medicare Advantage plan that bundles in the extras most relevant to you (dental, vision, hearing). Best for people who want one plan handling everything.
2. Pair Original Medicare with a Medigap policy to cover the cost-sharing gaps, then add standalone Part D, dental, and vision plans as needed. Best for people who want maximum doctor flexibility.
3. Plan separately for long-term care with a long-term care insurance policy or a hybrid life insurance product. This isn’t something Medicare or Medigap solves — it requires its own strategy.

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Frequently Asked Questions

Does Medicare cover dental implants?

No, Original Medicare doesn’t cover dental implants under any circumstances, since they’re considered routine dental work. Some Medicare Advantage plans include dental implant coverage as part of their major dental benefits, though coverage limits and waiting periods vary widely by carrier. If implants are likely in your future, look closely at the dental allowance and the specific list of covered procedures before choosing a plan.

Will Medicare pay for hearing aids?

Original Medicare does not cover hearing aids or routine hearing exams to fit them. It will cover diagnostic hearing tests ordered by your doctor to investigate a specific medical concern, but the devices themselves are out of pocket. Many Medicare Advantage plans now include hearing aid benefits — typically a set allowance toward devices through a partner network — which can make a meaningful dent in the $2,000–$6,000 typical retail cost.

Does Medicare cover nursing homes?

Medicare provides limited coverage for skilled nursing facility care, but only after a qualifying inpatient hospital stay of at least three days, and only when skilled care is medically necessary and the patient is improving. Coverage caps at 100 days per benefit period, with significant daily copays after day 20. Medicare does not cover custodial nursing home care — help with bathing, dressing, eating, and supervision — which is the type of long-term care most seniors actually need. That kind of care is typically paid for through long-term care insurance, personal assets, or Medicaid after assets are spent down.

Can I get vision coverage through Medicare?

Original Medicare doesn’t cover routine vision exams, eyeglasses, or contact lenses, but it does cover certain medical eye conditions — cataract surgery (including one pair of corrective lenses afterward), glaucoma screenings for high-risk patients, and treatment for macular degeneration and diabetic retinopathy. For routine vision care, your options are a Medicare Advantage plan that includes vision benefits, a standalone vision insurance policy, or paying out of pocket.

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Worried about gaps in your Medicare coverage? Schedule a free Medicare review with The Advocate Group → We’ll walk through what Medicare covers, what it doesn’t, and which combination of plans actually closes the gaps for your situation.