Quick Answer: Original Medicare (Parts A and B) does not cover routine dental, vision, hearing aids, long-term custodial care, most prescription drugs, overseas medical care, or cosmetic surgery. As of 2026, these gaps can cost beneficiaries tens of thousands of dollars per year if they are not prepared.
Most people enroll in Medicare expecting broad coverage. They are often shocked when the bills arrive. Original Medicare covers hospital stays, doctor visits, and some preventive services, but it leaves out a long list of common, costly services that older adults actually need.
This guide covers the 11 biggest Medicare exclusions as of 2026, what the gaps cost out of pocket, and what options exist to fill them. If you are not sure whether you qualify for supplemental coverage or Medicaid-based help, check your eligibility at the CoveredUSA screener. It takes about two minutes.
1. Routine Dental Care
Original Medicare does not cover dental cleanings, exams, X-rays, fillings, crowns, root canals, tooth extractions, or dentures. This is one of the most common surprises for new Medicare enrollees.
The numbers are significant. In 2026, a single dental crown averages around $1,500. A full set of dentures can exceed $5,000. Routine cleanings and X-rays, which most people need twice a year, add up to $300 to $600 annually with no coverage.
Medicare will cover dental work only when it is directly tied to a covered medical procedure. For example, oral surgery required before a heart valve procedure. Routine checkups are entirely excluded under Medicare.gov's official coverage rules.
How to fill this gap: Many Medicare Advantage plans include dental benefits, but annual maximums are often capped at $1,500 to $2,000 for major services. Standalone dental insurance, dental savings plans, and community dental clinics are other options.
2. Vision Exams, Eyeglasses, and Contact Lenses
Original Medicare does not pay for routine eye exams, eyeglasses, or contact lenses. There is one narrow exception: Medicare covers one pair of eyeglasses or contact lenses after cataract surgery.
For everything else (annual exams to update your prescription, progressive lenses, contacts) you pay out of pocket. In 2026, a simple pair of progressive lenses costs around $600 without coverage.
Medicare does cover medically necessary eye care for conditions like cataracts, glaucoma, diabetic retinopathy, and macular degeneration. The key distinction is medical treatment versus routine vision maintenance.
How to fill this gap: Many Medicare Advantage plans include a vision allowance, typically $150 to $300 per year for eyewear. Standalone vision plans and retail optical chains also offer affordable options.
3. Hearing Aids and Routine Hearing Exams
Original Medicare does not cover hearing aids or the exams needed to fit them. Medicare may cover a diagnostic hearing test if your doctor orders it to evaluate a medical condition, but the hearing aid itself and routine hearing checkups are excluded.
This matters financially. In 2026, prescription-grade hearing aids for moderate to severe hearing loss cost $4,000 to $6,000 per pair. Over-the-counter aids are cheaper but are not appropriate for all levels of hearing loss.
How to fill this gap: Some Medicare Advantage plans include a hearing benefit. As of 2026, nearly 90% of individual Medicare Advantage plans offered some form of dental, vision, or hearing benefit, according to industry data. Coverage levels vary widely by plan and region.
4. Long-Term Custodial Care
This is the coverage gap that surprises people the most, and costs the most.
Medicare does not pay for custodial care. Custodial care means help with daily living activities: bathing, dressing, eating, using the toilet, and moving around. This is the kind of care most people need in a nursing home or assisted living facility.
What Medicare does cover is a limited amount of skilled nursing facility (SNF) care after a qualifying hospital stay. The rules in 2026:
- Days 1 to 20: Medicare pays 100% after you meet the Part A deductible ($1,736 in 2026)
- Days 21 to 100: You pay $217 per day; Medicare pays the rest
- Day 101 and beyond: You pay 100%
Once skilled care is no longer needed and the patient only requires custodial assistance, Medicare stops paying, even if the person is still in the facility.
The cost of long-term care in 2026:
| Type of Care | Average Annual Cost (2026) |
|---|
| Nursing home, private room | $131,000+ per year |
| Nursing home, semi-private room | $115,000 per year |
| Assisted living facility | $64,000 per year |
| Home health aide (full-time) | $65,000+ per year |
Sources: Medicare.gov long-term care overview, Medicaid Planning Assistance national cost data.
How to fill this gap: Medicaid pays for long-term custodial care for people who meet income and asset limits. Long-term care insurance (purchased before you need it) is another option, though premiums are high. This is one of the most important planning issues for anyone approaching Medicare age.
5. Prescription Drugs (Without Part D)
Original Medicare Parts A and B do not cover most outpatient prescription medications. You need a separate Medicare Part D plan (or a Medicare Advantage plan that includes drug coverage) to get prescription benefits.
Part D is optional to enroll in, but skipping it when you are first eligible triggers a late enrollment penalty that follows you permanently. The penalty is 1% of the national base beneficiary premium for each full month you went without creditable drug coverage.
As of 2026, enrollees with Part D gained important protections under the Inflation Reduction Act, including a $2,000 out-of-pocket cap on Part D drug costs per year. This cap did not exist before 2025.
Important: If you have employer coverage that counts as creditable, you can delay Part D without penalty. Check with your plan before skipping enrollment.
6. Overseas Medical Care
Original Medicare generally does not cover medical services received outside the United States. If you travel abroad and need emergency treatment, you are on your own.
There are three narrow exceptions where Medicare may pay for foreign hospital care (per medicare.gov rules):
- You are in the U.S. when an emergency occurs, but the closest hospital is in Canada or Mexico
- You are traveling through Canada between Alaska and another state and require emergency care
- You are on a cruise ship within six hours of a U.S. port
Outside these situations, Medicare provides no coverage abroad.
How to fill this gap: Medigap Plans C, D, F, G, M, and N each provide foreign travel emergency coverage (up to $50,000 lifetime, with a $250 deductible and 20% coinsurance) when care starts within 60 days of leaving the U.S. Some Medicare Advantage plans also include emergency international coverage.
7. Cosmetic Surgery
Medicare does not cover elective cosmetic procedures: facelifts, rhinoplasty, liposuction, breast augmentation, and similar surgeries. The exclusion applies when the procedure is for appearance only and not medically necessary.
There are exceptions when surgery is needed to correct a deformity, repair damage from an injury, or treat a medical condition. Examples Medicare does cover: breast reconstruction after mastectomy, correction of a physical deformity from an accident, and surgery to address a condition causing functional impairment.
8. Routine Foot Care
Medicare does not cover routine podiatry: trimming toenails, removing corns and calluses, or general foot maintenance. This surprises many older adults who see a podiatrist regularly.
Medicare does cover medically necessary foot care for conditions like bunions, hammertoes, and heel spurs. For people with diabetes, Medicare covers an annual diabetic foot exam and therapeutic shoes or inserts when ordered by a doctor. The distinction is routine maintenance versus medical treatment.
9. Personal Home Care and Housekeeping
Medicare will pay for limited skilled home health services (nursing, physical therapy) when you are homebound and need those specific services. It does not cover personal care aides who help you bathe, dress, or get out of bed if that is the only type of help you need.
Housekeeping services (shopping, cooking, cleaning) are also not covered, except during hospice care.
This is a meaningful gap for people who want to stay at home but need daily assistance. The 2026 cost for full-time home health aide services averages over $65,000 per year nationally.
10. Acupuncture and Most Alternative Therapies
Medicare added limited coverage for acupuncture in 2020, specifically for chronic low back pain, up to 12 sessions in 90 days (with an option to extend to 20 sessions if improvement is shown). Beyond that one exception, acupuncture is not covered.
Other alternative therapies excluded from Medicare: massage therapy, naturopathy, homeopathy, aromatherapy, and most chiropractic care. Medicare does cover chiropractic manipulation of the spine to correct a subluxation, but not x-rays or other chiropractic services.
11. Incontinence Supplies and Personal Hygiene Items
Medicare considers adult diapers, incontinence pads, and similar products personal hygiene items rather than medical treatment. They are not covered.
Some Medicare Advantage plans cover incontinence supplies as a supplemental benefit, but coverage varies widely by plan.
How Medicare Advantage Can Help Close These Gaps
Medicare Advantage (Part C) plans are offered by private insurers approved by CMS. They must cover everything Original Medicare covers, and many add benefits that Original Medicare excludes.
In 2026, nearly 90% of Medicare Advantage plans include some dental, vision, or hearing benefit. Many also include gym memberships, transportation to appointments, over-the-counter allowances, and telehealth services.
Trade-offs to know: Advantage plans have provider networks. You may need referrals to see specialists. Out-of-network care may be expensive or not covered. Compare plans carefully for your specific zip code, since benefit packages differ significantly by region and insurer.
You can compare 2026 Advantage plans at Medicare.gov's Plan Finder.
How to Apply for Medicare and Supplemental Coverage
2026 Medicare enrollment windows:
- Initial Enrollment Period (IEP): Starts 3 months before your 65th birthday month, includes your birthday month, and ends 3 months after, for a 7-month window total
- General Enrollment Period (GEP): January 1 to March 31 each year, for people who missed IEP (coverage starts July 1)
- Special Enrollment Periods (SEP): Available if you had employer coverage, moved, lost other coverage, or qualify based on other qualifying life events
Step-by-step application:
- Sign up for Medicare at ssa.gov or at your local Social Security office (recommended 3 months before your 65th birthday)
- Decide between Original Medicare or Medicare Advantage. Compare plans at medicare.gov/plan-compare
- If you choose Original Medicare, consider adding a Medigap supplement plan to cover cost-sharing
- Enroll in a Part D drug plan at medicare.gov or through a broker if you choose Original Medicare
- Check if you qualify for Medicare Savings Programs (MSP). These are Medicaid-funded programs that help pay Medicare premiums, deductibles, and coinsurance for people with limited income and assets
Documents needed when applying:
- Social Security number
- Birth certificate or proof of age
- Proof of citizenship or legal residency
- W-2 forms or tax returns if you or your spouse worked
- Documentation of any employer coverage you are ending
Common reasons applications get delayed or denied:
- Missed the enrollment window (triggers late penalties for Part B and Part D)
- Income verification issues with Social Security
- Not yet enrolled in Social Security benefits at age 65 (you need to actively apply for Medicare)
- Work history questions if applying based on disability (SSDI) rather than age
Medicare Savings Programs: Help for People with Limited Income
If you have Medicare but struggle to pay premiums and out-of-pocket costs, Medicare Savings Programs may cover your costs. These are federally approved programs funded through Medicaid.
2026 Medicare Savings Program income limits (approximate; limits are adjusted annually by each state):
| Program | Covers | Individual Income Limit | Couple Income Limit |
|---|
| Qualified Medicare Beneficiary (QMB) | Part A and B premiums, deductibles, coinsurance | ~$1,255/month | ~$1,704/month |
| Specified Low-Income Medicare Beneficiary (SLMB) | Part B premium only | ~$1,478/month | ~$1,992/month |
| Qualifying Individual (QI) | Part B premium only | ~$1,660/month | ~$2,239/month |
| Qualified Disabled and Working Individuals (QDWI) | Part A premium only | ~$4,945/month | ~$6,659/month |
Source: Medicare.gov Medicare Savings Programs overview. Income limits are updated each January.
To apply for a Medicare Savings Program, contact your state Medicaid office or check your eligibility at CoveredUSA. It will tell you which programs you likely qualify for in about two minutes.
Frequently Asked Questions
Does Medicare cover dental implants in 2026?
No. Original Medicare does not cover dental implants, crowns, cleanings, or any routine dental services. Some Medicare Advantage plans include dental benefits, but implants are frequently excluded or subject to annual benefit caps that fall far below their cost. Always check a plan's Evidence of Coverage document before assuming dental implants are included.
Will Medicare pay for a nursing home?
Medicare pays for up to 100 days of skilled nursing facility care after a qualifying hospital stay of at least three days. It does not pay for long-term custodial care in a nursing home (help with bathing, dressing, eating). After 100 days, or once skilled care is no longer needed, you pay 100% of nursing home costs. In 2026, that averages over $9,000 per month for a semi-private room.
What happens if I need medical care while traveling abroad?
In almost all cases, Original Medicare does not cover care received outside the United States. The three narrow exceptions involve Canadian or Mexican border hospitals during a U.S. emergency and cruise ships within six hours of a U.S. port. Medigap Plans G, F, N, and others include foreign travel emergency coverage up to $50,000 lifetime.
Does Medicare cover hearing aids in 2026?
No. Original Medicare does not cover hearing aids or the exams to fit them. Prescription hearing aids cost $4,000 to $6,000 per pair in 2026. Some Medicare Advantage plans include a hearing benefit. Check the plan's specific coverage before enrolling.
Can I get prescription drug coverage through Medicare?
Yes, but not through Original Medicare Parts A and B alone. You must enroll in a separate Medicare Part D plan or a Medicare Advantage plan that includes drug coverage. Skipping Part D when first eligible triggers a late enrollment penalty that applies permanently. As of 2026, Part D enrollees benefit from a $2,000 annual out-of-pocket cap on covered drugs under the Inflation Reduction Act.
What is a Medicare Savings Program and do I qualify?
Medicare Savings Programs are Medicaid-funded programs that pay some or all Medicare costs (premiums, deductibles, coinsurance) for people with limited income. In 2026, individual income limits range from roughly $1,255 to $1,660 per month depending on the specific program. Apply through your state Medicaid agency or check your eligibility at CoveredUSA.
Does Medicare Advantage cover all the things Original Medicare misses?
Not automatically. Advantage plans must cover everything Original Medicare covers and many add dental, vision, and hearing benefits. But these supplemental benefits vary widely by plan and are often capped. An Advantage plan does not automatically cover long-term custodial care, for example. Always review the full Evidence of Coverage document for any plan you are considering.
How do I know which Medicare plan is best for my situation?
The right plan depends on your health needs, prescription list, preferred doctors, budget, and zip code. The best starting point is Medicare.gov's Plan Finder at medicare.gov/plan-compare, which compares all available plans in your area. A licensed Medicare broker can also help at no cost to you since brokers are paid by the insurance companies, not the enrollee.
Check your eligibility now at CoveredUSA. It takes 2 minutes.
If you are on Medicare and struggling with costs, or if you are approaching 65 and trying to figure out which coverage option fits your situation, the CoveredUSA screener shows you which programs you qualify for based on your income, household size, and state. It covers Medicare Savings Programs, Medicaid, and ACA plans.
