What Medicare Doesn't Cover in 2026

Most people approaching Medicare assume it's comprehensive health coverage. It's not. Original Medicare (Parts A and B) leaves four major categories uncovered — dental, vision, hearing, and long-term care — plus a handful of other gaps that surprise retirees who didn't plan for them. For someone retiring with $300,000–$500,000 in annual income, these gaps can cost $5,000–$15,000 per year out-of-pocket unless addressed in the retirement income plan.

The core rule: Medicare covers medically necessary care — hospital stays, doctor visits, outpatient procedures, lab work, and preventive screenings. It does not cover routine maintenance of your teeth, eyes, ears, or personal care. Those are treated as lifestyle expenses, not medical ones — regardless of how much you paid in Medicare taxes during your career.

1. Dental Care

Original Medicare does not cover routine dental services including:¹

Routine exams and cleanings
X-rays
Fillings and crowns
Extractions (except in specific medical contexts)
Dentures and dental implants
Periodontal treatment

The exclusion is statutory — Medicare's governing statute specifically excludes payment for items and services "in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting the teeth."

Limited dental exceptions

Medicare does cover oral care in narrow medical circumstances:

Oral exam before a heart valve replacement or organ/bone marrow transplant
Tooth extraction to treat a mouth infection before cancer treatment
Dental complications arising during head and neck cancer treatment
Oral exams before and during kidney dialysis for End-Stage Renal Disease

None of these are "dental coverage" in any meaningful sense — they're incidental to treating another condition.

What dental care costs in retirement

The typical retiree spends $1,200–$2,500/year on dental care (more if crowns, implants, or extractions are involved). A single implant runs $3,000–$5,000. Dentures: $1,500–$3,500 per arch. These costs are fully out-of-pocket under Original Medicare unless you purchase a supplemental dental plan or choose a Medicare Advantage plan with dental benefits.

2. Vision Care

Original Medicare does not cover:¹

Routine annual eye exams
Eyeglasses or contact lenses (with one exception)
Exams to fit glasses or contacts

The one vision exception

After cataract surgery that implants an intraocular lens, Medicare Part B covers one pair of corrective eyeglasses or one set of contact lenses. This is the only eyewear Medicare covers — and only if an intraocular lens was implanted. A standard cataract surgery without a lens implant does not qualify.

Medically necessary vs. routine

Medicare Part B does cover diagnostic eye exams when a doctor orders them as medically necessary — for example, an exam to monitor glaucoma in someone already diagnosed with the disease, or a low-vision evaluation after trauma. Preventive annual exams and standard vision correction do not meet the threshold.

Annual eye exams from an optometrist run $100–$250. Eyeglasses add $200–$600+. If you wear contacts, add another $200–$400/year. A standalone vision plan typically costs $12–$25/month and covers basic exams and an allowance toward frames.

3. Hearing Aids and Hearing Exams

Original Medicare does not cover hearing aids or exams specifically for fitting hearing aids.² This is one of the most financially significant gaps for retirees — about one in three adults age 65–74 and half of those 75+ have disabling hearing loss.

What hearing aids cost

According to a 2026 survey of over 1,100 hearing aid purchasers (HearingTracker), the average out-of-pocket cost for a pair of prescription hearing aids is $2,694. Premium brands (Phonak, Widex, Oticon) range from $3,800–$4,200 per pair. Hearing aids typically need replacement every 3–7 years, meaning a retiree who lives to 85 may purchase 2–3 pairs at full price.

Since the FDA authorized over-the-counter (OTC) hearing aids in 2022, more affordable options exist for mild-to-moderate hearing loss: OTC devices run $200–$1,400 per pair. These are not appropriate for severe or profound hearing loss, which requires prescription fitting.

Diagnostic exams are different

If your doctor orders a hearing exam as part of diagnosing a medical condition, Part B covers the diagnostic exam (you pay 20% after meeting the $283 Part B deductible). But a hearing exam ordered solely to fit hearing aids is not covered.

4. Long-Term Care and Custodial Care

Medicare does not cover custodial care — help with activities of daily living (ADLs) such as bathing, dressing, eating, toileting, or transferring — unless you also need skilled nursing care at the same time.³

This distinction matters enormously. The majority of nursing home and home care costs are custodial. Medicare's SNF benefit covers skilled nursing care for up to 100 days per benefit period following a qualifying hospital stay — but only the first 20 days are fully covered. Days 21–100 require a $217/day coinsurance payment in 2026 (covered by Medigap Plan G and Plan N). After day 100, Medicare pays nothing.

The nursing home gap in numbers. The median annual cost for a private room in a nursing home is approximately $108,000 (Genworth Cost of Care Survey). Medicare covers none of this for custodial care and only a limited window for skilled care. The average nursing home stay is approximately 2.5 years. Medicaid picks up the bill only after you've spent down assets to qualify — typically $2,000 or less in countable assets in most states.

What "skilled care" means

Skilled care requires a licensed professional — a registered nurse or therapist performing services that could not be done safely by a layperson. Examples: wound care requiring skilled nursing, physical/occupational/speech therapy after a stroke. "Maintenance therapy" (keeping you at your current level, not improving) does not qualify as skilled care for Medicare purposes.

5. Other Notable Exclusions

Cosmetic surgery

Medicare does not cover cosmetic procedures unless needed to restore function lost due to an accident, trauma, or medical treatment (e.g., reconstructive surgery after mastectomy, which is covered under federal law).

Routine foot care

Trimming toenails, routine callus removal, and foot soaks are not covered. Exceptions apply for patients with diabetes, peripheral vascular disease, peripheral neuropathy, or specific conditions where a foot infection could be dangerous — a doctor must document the medical necessity.

Care outside the United States

Original Medicare generally does not cover emergency or routine care received outside the U.S. or its territories. Narrow exceptions exist: if you're in Canada en route between Alaska and another U.S. state and the nearest hospital is Canadian, or on a cruise ship within 6 hours of a U.S. port. Medigap Plans C, D, G, M, and N include a foreign travel emergency benefit (80% after a $250 deductible, up to $50,000 lifetime).

Concierge medicine and direct primary care fees

The retainer fee for concierge or direct primary care (DPC) practices is not covered by Medicare, even if the underlying services would otherwise be billable. Some concierge physicians opt out of Medicare entirely; their services are not reimbursable regardless of your supplemental coverage.

Experimental treatments and non-approved drugs

Medicare does not cover drugs or treatments deemed experimental, investigational, or not "reasonable and necessary." Medicare Advantage plans may offer broader coverage for clinical trials in some cases.

What Medicare Does Cover (That Surprises People)

Before assuming everything is excluded, a few things Medicare does cover that often surprise beneficiaries:

Acupuncture: Up to 12 visits in 90 days for chronic low back pain with no known cause. Up to 20 total visits in 12 months if you show improvement.⁴
Annual Wellness Visit: A free preventive visit once per year (not a full physical, but a health risk assessment and personalized prevention plan).
Preventive screenings: Mammograms, colorectal cancer screenings (colonoscopy covered in full with no cost-sharing under Part B), bone density tests, diabetes screening, and cardiovascular screenings.
Mental health: Outpatient therapy, psychiatry visits, and inpatient psychiatric care (with limits). Part B covers 80% after deductible.
Diabetes supplies: Blood glucose monitors, test strips, lancets, and some insulin (via Part D or Part B depending on delivery method).
Telehealth: Significantly expanded coverage since 2020; most services available via telehealth at the same cost as in-person.

How to Close the Gaps

Option 1: Medicare Advantage (Part C)

Medicare Advantage plans are required to cover everything Original Medicare covers, but most also offer supplemental benefits — dental, vision, and hearing coverage that Original Medicare excludes. Coverage varies widely: some plans offer a $2,000 dental allowance and $300 hearing aid benefit; others offer token coverage. The tradeoff is a narrower provider network and prior authorization requirements. See Medicare Advantage vs. Medigap: How to Decide.

Important: MA dental/vision/hearing benefits are not standardized. Comparing plan-specific benefits in your zip code requires actually reading the Evidence of Coverage (EOC) document, not just the marketing summary.

Option 2: Standalone supplemental plans

If you're on Original Medicare + Medigap, you can purchase standalone dental and vision plans. Standalone dental plans run $20–$50/month and typically cover two cleanings/exams per year and a percentage of major work after a waiting period. Standalone vision plans run $12–$25/month for basic coverage. Neither is a great value for heavy users — they're more suitable for budget certainty than actual cost reduction.

Option 3: HSA spending on Medicare expenses

If you accumulated funds in an HSA before Medicare enrollment, you can use those funds tax-free for Medicare-eligible expenses — and the list is broader than most realize. HSA-eligible Medicare expenses include:

Part B premiums (and IRMAA surcharges)
Part D premiums
Medicare Advantage plan premiums
Dental care, vision care, and hearing aids
Long-term care insurance premiums (up to IRS age-based limits)
Qualified long-term care services

You cannot use HSA funds for Medigap premiums — that's the one notable exclusion. See Medicare and HSA Rules for the enrollment timing trap to avoid before turning 65.

Option 4: Long-term care insurance

Traditional LTC insurance, hybrid LTC/life policies, and short-term care insurance all exist to cover the custodial care gap that Medicare leaves. The best time to purchase was 10–15 years before you need it (typically 55–65). Premiums rise significantly with age and health status. A 60-year-old couple can typically purchase joint coverage for $3,000–$6,000/year in combined premium; a 70-year-old faces 2–3× that cost for equivalent coverage — if they're still insurable.

Option 5: Self-insuring

Retirees with significant assets sometimes choose to self-insure for uncovered costs. This requires explicitly budgeting for dental, vision, hearing, and potential LTC costs as part of the retirement income plan — not just assuming Medicare covers it. A realistic budget for a couple with Original Medicare + Medigap might include $3,000–$5,000/year for dental/vision/hearing and a separate LTC reserve of $300,000–$500,000.

The planning window that matters most. The decisions that determine how well these gaps are covered — LTC insurance purchase age, MA vs. Medigap choice, HSA accumulation strategy, dental plan selection — are largely made in the 5 years before Medicare enrollment. Once you're enrolled and past the Medigap Open Enrollment Period, switching becomes difficult or impossible. A Medicare-specialist advisor models these gap costs alongside your retirement income plan while you still have options.

Get your Medicare gaps modeled

A specialist advisor looks at your full retirement picture — not just what Medicare covers, but what it leaves uncovered and how to budget for it. HSA coordination, LTC insurance timing, MA vs. Medigap tradeoffs. Free match.

Related guides

Medicare Advantage vs. Medigap: How to Decide — the coverage choice that determines how you fill Part A/B gaps
Medigap Plan G vs. Plan N vs. High-Deductible G — detailed plan comparison for Original Medicare beneficiaries
Medicare and HSA Rules — how to use accumulated HSA funds after you enroll in Medicare
Medicare Costs 2026: Premiums, Deductibles & IRMAA — full cost reference for what Medicare does charge you
Retiring Before 65: Health Insurance Until Medicare — bridging the gap before Medicare eligibility
Medicare IRMAA Bracket Calculator — see what your total Medicare costs will be based on income
Medicare Planning Complete Guide

Medicare dental and vision exclusions: medicare.gov — What's Not Covered; CMS Medicare Dental Coverage; medicare.gov Dental Services. Statutory basis: Social Security Act § 1862(a)(12).
Hearing aid exclusion: medicare.gov — Hearing Aids. Prescription hearing aid average cost $2,694/pair per HearingTracker 2026 survey of 1,100+ purchasers. OTC range $200–$1,400 following FDA OTC authorization 2022.
Custodial/long-term care exclusion: medicare.gov — Long Term Care Coverage. SNF coinsurance days 21–100: $217/day 2026, per CMS 2026 Parts A & B Premiums and Deductibles Fact Sheet.
Acupuncture coverage — up to 12 visits in 90 days (20 total with improvement) for chronic low back pain: medicare.gov — Acupuncture; CMS NCD 30.3.3.
Medicare Advantage supplemental benefits (dental/vision/hearing): medicare.gov — Coverage Options. Benefits are plan-specific and not standardized across MA plans.

Medicare coverage rules verified May 2026 against medicare.gov and CMS sources. Cost estimates (hearing aids, dental, nursing home) are approximate and vary by geography, insurer, and individual circumstance. Long-term care insurance premiums are illustrative estimates; actual premiums depend on age, health, benefit design, and carrier.