Seniors, Take Note: Medicare Won’t Cover These 13 Common Medical Needs

You’ve worked hard your whole life. You’ve paid into the system. Now, as you approach retirement, you’re counting on Medicare to be your healthcare safety net.

For nearly 69 million Americans, it is a vital lifeline. But what happens when that net has holes? Many retirees are shocked to discover that Medicare doesn’t cover everything.

Navigating the world of Medicare can feel overwhelming. The rules seem complex, and the exceptions are confusing. This can lead to unexpected bills and significant out-of-pocket healthcare costs.

But don’t worry. We’re here to shine a light on these Medicare coverage gaps. Let’s dive into the 13 key areas where you might be on your own.

1. Most Dental Care

This is one of the biggest surprises for new Medicare beneficiaries. Original Medicare (Part A and Part B) does not pay for most routine dental care. That means cleanings, fillings, tooth extractions, dentures, and crowns are not covered.

This is a major gap, as out-of-pocket spending accounts for nearly 39% of all dental costs for seniors .

• The Exception: Medicare may pay for dental services that are a necessary part of a covered medical procedure. For example, if you break your jaw in an accident, Medicare might cover the required dental work.
• The Solution: Many Medicare Advantage (Part C) plans include benefits for routine dental care, like exams and cleanings. You can also buy a separate, standalone dental insurance policy.

2. Vision Care and Eyewear

Need new glasses? Don’t expect Original Medicare to help. It doesn’t cover routine eye exams, eyeglasses, or contact lenses.

With the average cost of glasses hitting $531 in 2025, this is a significant expense that most seniors will face.

• The Exception: Medicare Part B will help pay for one pair of glasses or contacts after you have cataract surgery that implants an intraocular lens. It also covers exams for conditions like glaucoma and diabetic retinopathy.
• The Solution: Vision benefits are a common feature in Medicare Advantage plans. For those with low incomes, non-profits like EyeCare America and VSP Vision offer programs for free or low-cost exams and eyewear.

3. Hearing Aids and Routine Tests

Age-related hearing loss is common, but help can be expensive. Original Medicare does not cover hearing aids or the exams for fitting them.

With hearing aids costing an average of $4,672 in 2025, this is one of the most challenging medical costs Medicare won’t cover for seniors.

• The Exception: Part B may cover a diagnostic hearing exam if your doctor orders it to identify a medical cause for your hearing loss.
• The Solution: Again, Medicare Advantage plans often include hearing aid benefits. Over-the-counter (OTC) hearing aids are also becoming a more affordable option for mild to moderate hearing loss. Organizations like the Lions Club may also offer financial assistance.

4. Long-Term Care

This is the single biggest, and most financially dangerous, gap in Medicare coverage. Medicare does not pay for long-term custodial care. This means help with daily activities like bathing, dressing, eating, or using the bathroom is not covered.

A shocking 62% of older Americans believe Medicare will cover this, but they are mistaken.

• The Exception: Medicare covers limited, short-term stays in a skilled nursing facility for rehabilitation after a qualifying hospital stay. It does not cover long-term residency.
• The Solution: The primary options are to purchase private long-term care insurance or qualify for Medicaid, which has strict income and asset limits.

5. Most Cosmetic Surgery

If a procedure is done purely to improve your appearance, Medicare won’t pay for it. This includes things like facelifts or other elective surgeries.

• The Exception: Medicare does cover reconstructive surgery. This applies if it’s needed to repair an accidental injury, improve the function of a malformed body part, or for breast reconstruction after a mastectomy.
• The Solution: For elective procedures, you will have to pay 100% out of pocket. Be wary of financing options, as they can come with high interest rates.

6. Medical Care Outside the U.S.

Planning to travel the world in retirement? Your Original Medicare card won’t do you much good. Medicare provides virtually no coverage for healthcare you receive outside of the United States.

• The Exception: There are a few very rare exceptions, such as if you are in the U.S. and a foreign hospital is closer than a domestic one during an emergency.
• The Solution: This is where a Medicare Supplement (Medigap) plan is crucial. Several Medigap plans offer a foreign travel emergency benefit, covering 80% of costs up to a lifetime limit of $50,000. Purchasing a separate travel insurance policy is also a wise choice.

7. Most Alternative Therapies

Many people find relief from treatments like massage, acupuncture, and chiropractic care. However, Medicare’s coverage for these is extremely limited.

• Massage Therapy: Original Medicare does not cover massage therapy. Some Medicare Advantage plans may offer it as a supplemental benefit.
• Acupuncture: Medicare Part B now covers up to 20 acupuncture sessions per year, but only for chronic low back pain. It does not cover it for any other condition.
• Chiropractic Care: Part B covers only one specific service: manual manipulation of the spine to correct a vertebral subluxation. It does not cover exams, X-rays, or other services ordered by a chiropractor.

Also Read: 13 Countries Where Americans Find World-Class Health Care So Good and Cheap It’s Pennies vs. U.S. Costs

8. Routine Physical Exams

Here’s a tricky one that often trips people up. Federal law prohibits Medicare from paying for a routine annual physical exam.

If you call your doctor and schedule a “physical,” you could be responsible for 100% of the bill.

• The Exception: Medicare covers a one-time “Welcome to Medicare” visit within your first year on Part B. After that, it covers a yearly “Annual Wellness Visit”.
• The Solution: Be specific. When you book your appointment, ask for your “Annual Wellness Visit.” This visit focuses on creating a personalized prevention plan and is not a hands-on physical. Some Medicare Advantage plans do cover a traditional physical.

9. Prescription Drugs (Under Original Medicare)

This is a foundational point to understand. Original Medicare (Parts A and B) does not include coverage for most outpatient prescription drugs you pick up at the pharmacy.

• The Exception: Part B covers a limited number of drugs, like some chemotherapy infusions, that are administered in a doctor’s office.
• The Solution: You must enroll in a separate Medicare Part D plan or choose a Medicare Advantage plan that includes drug coverage (MA-PD).
• Big News for 2025: A major change from the Inflation Reduction Act takes effect in 2025. Your out-of-pocket costs for Part D drugs will be capped at $2,000 for the year. Also, a new program will let you spread your costs into monthly payments.4

10. Concierge Medicine Fees

Concierge medicine, where you pay a yearly or monthly fee for enhanced access to a doctor, is growing in popularity. Medicare will not pay for this membership fee.

• The Distinction: While Medicare won’t pay the fee, it will still pay for the covered medical services you receive from that doctor, assuming they accept Medicare. The fee is for non-covered perks like 24/7 access.
• The Solution: Understand that you are paying out-of-pocket for the convenience and access, not for the medical care itself.

11. Routine Foot Care

Original Medicare does not cover routine foot care. This includes services like trimming toenails or removing corns and calluses for maintenance purposes.

• The Exception: Medicare does cover medically necessary foot care for an injury or disease, like bunions or heel spurs. Crucially, it also covers foot exams every six months for people with diabetes-related nerve damage.
• The Solution: Look for community programs or senior centers that may offer low-cost foot care. Some Medicare Advantage plans also offer podiatry benefits.

12 & 13. Your Share of the Costs (Premiums, Deductibles, Co-pays)

Finally, Medicare itself has built-in costs that you must pay. The program does not pay for its own premiums, deductibles, and coinsurance. These are some of the most certain medical costs Medicare won’t cover for seniors.

In 2025, you are responsible for:

• Part A Premium: $0 for most people, but up to $518/month if you didn’t pay enough Medicare taxes.
• Part A Deductible: $1,676 for each hospital benefit period.
• Part B Premium: The standard premium is $185/month.
• Part B Deductible: $257 for the year.
• Part B Coinsurance: Typically 20% of the cost for most services, with no annual limit.
• The Solution: Medicare Supplement (Medigap) plans are specifically designed to cover these out-of-pocket healthcare costs. For those with limited incomes, Medicare Savings Programs can help pay these expenses.

*Sources: Medicare.gov, CMS.gov (As of Sep 2025)

Take Control of Your Healthcare Costs

Knowing about these Medicare coverage gaps isn’t meant to scare you. It’s meant to empower you. 

Original Medicare is a strong foundation, but it’s not a complete house. By understanding the medical costs Medicare won’t cover for seniors, you can build the rest of your financial protection plan.

Take the time to assess your health needs and budget. Explore what Medicare Advantage and Medigap plans are available in your area.

Being proactive is the best way to ensure that a healthcare issue doesn’t become a financial crisis in your retirement years.