What does Medicare not cover?
The big four: most dental work, routine vision, hearing aids, and long-term care. And Original Medicare has no yearly cap on your share of costs. Here is what falls outside the lines, and how people actually fill the gaps.
Mostly not covered
Cleanings, fillings, crowns, and dentures fall outside Original Medicare. It steps in only when dental work is part of a covered medical procedure, like jaw surgery after an accident.
Routine care is on you
Routine eye exams, glasses, and contacts are not covered. Medical eye care is different: cataract surgery, glaucoma tests, and treatment for eye disease are covered under Part B.
Aids are out of pocket
Hearing aids and the exams to fit them are not covered by Original Medicare, and good ones run thousands of dollars a pair.
The biggest gap of all
Help with daily living, assisted living, and custodial nursing home care are not covered. Medicare pays only for short-term skilled care after a qualifying hospital stay, not the long haul.
How people fill the gaps
Many Medicare Advantage plans bundle dental, vision, and hearing allowances as extra benefits. Those extras are plan features, not Medicare rights, so the details and dollar limits vary widely by plan and county, and they should never be the only reason you pick a plan.
On the Original Medicare route, standalone dental and vision plans fill the same space. Long-term care is its own planning conversation entirely, worth having with a financial advisor well before it is needed. We will happily tell you what each plan in your ZIP code actually includes. Start with the two routes.
Related questions
Does Medicare cover prescription drugs? +
Not by itself. Drug coverage comes from a Part D plan or a Medicare Advantage plan that includes it. Going without creditable drug coverage starts a permanent penalty clock.
Does Medicare work outside the United States? +
Generally no. Some Medicare Supplement plans add emergency coverage while traveling abroad, which is worth checking if you travel often.
Are weight-loss drugs like Ozempic covered? +
It depends on the prescription and the plan. When prescribed for diabetes, coverage is common. For weight loss alone, most plans do not cover it today. Bring us your exact drug list and we will check plan by plan.
Know the gaps before they find you.
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