Many people assume that once they enroll in Medicare, most of their healthcare expenses will be covered. While Medicare provides excellent coverage for hospital and medical services, Original Medicare (Part A and Part B) still leaves several important gaps.
Understanding these gaps can help you avoid unexpected medical bills and decide whether a Medicare Supplement (Medigap) or Medicare Advantage plan might be right for you.
Below are some of the most common healthcare expenses that Original Medicare does not fully cover — or doesn’t cover at all.
1. Prescription Drugs (Most Medications)
Original Medicare generally does not cover most prescription drugs you take at home.
Medicare Part B only covers a limited number of medications, such as:
Certain injectable drugs administered in a doctor's office
Some cancer treatments
Specific medications used with durable medical equipment
Most prescriptions require Medicare Part D coverage or a Medicare Advantage plan with drug coverage.
Without it, you would be responsible for 100% of your prescription drug costs. Additionally, if or when you later decide to purchase Part D coverage, you will have a Late Enrollment Penalty to pay for the rest of your life. The penalty will be larger according to the length of time you went without the coverage.
2. Long-Term Care (Custodial Care)
A big misconception about Medicare is that it covers long-term care in nursing homes.
In reality, Medicare only covers short-term skilled nursing care following a hospital stay.
It does not cover custodial care, which includes:
Help bathing
Dressing
Eating
Assistance with daily living activities
These services can cost $4,000 to $9,000 per month depending on the type of care and location. Long Term Care insurance isn’t cheap, but is an important consideration for retirement security.
3. Dental Care
Original Medicare does not cover most dental services, including:
Routine dental exams
Cleanings
Fillings
Dentures
Tooth extractions
Dental implants
Because dental health is closely tied to overall health, many seniors choose Medicare Advantage plans that include dental benefits or purchase separate dental coverage.
4. Vision Care
Routine eye care is another major gap in Original Medicare.
Medicare typically does not cover:
Eye exams for glasses or contact lenses
Eyeglasses
Contact lenses
Routine vision checkups
There are some limited exceptions (such as eye exams related to diabetes or glaucoma), but routine vision care usually requires additional coverage.
5. Hearing Services and Hearing Aids
Hearing loss affects nearly two-thirds of adults over age 70, yet Original Medicare does not cover most hearing services.
Medicare generally does not pay for:
Hearing aids
Hearing aid fittings
Routine hearing exams
Hearing aids alone can cost $2,000 to $7,000 per pair, which is why many people consider plans that include hearing benefits.
6. Care Outside the United States
Original Medicare typically does not cover healthcare received outside the U.S.
If you travel internationally and need medical treatment, you may have to pay the full cost of care.
Many but not all Medicare Supplement plans offer limited foreign travel emergency coverage, which can provide peace of mind for travelers. Medicare Advantage plans will also reimburse their plan participants for urgent or emergency eare received outside the United States.
7. Most Out-of-Pocket Costs
Even for services Medicare does cover, you are still responsible for significant costs.
With Original Medicare, you must pay:
Part A deductible
Part B deductible
20% coinsurance for most medical services
No annual out-of-pocket maximum
This means serious illnesses can lead to thousands of dollars in medical expenses.
Why Many People Choose Additional Medicare Coverage
Because of these gaps, many beneficiaries choose additional coverage such as:
Medicare Supplement (Medigap)
Medigap plans help cover costs like:
Deductibles
Copayments
Coinsurance
Some emergency care abroad
These plans work alongside Original Medicare.
Medicare Advantage (Part C)
Medicare Advantage plans often include extra benefits, such as:
Prescription drug coverage
Dental
Vision
Hearing
Fitness programs
Annual out-of-pocket maximums
These plans replace Original Medicare with coverage provided by private insurers.
The Bottom Line
Original Medicare provides a strong foundation for healthcare coverage, but it does not cover everything. Expenses like dental care, hearing aids, long-term care, and prescription drugs can add up quickly.
That’s why many people explore Medicare Supplement or Medicare Advantage plans to help fill the gaps and protect themselves from unexpected costs.
✔ Want help finding the right coverage?
Contact us. We can help you compare Medicare Supplement and Medicare Advantage plans available in your area to see which option best fits your healthcare needs and budget.