You’ve worked hard your whole life, paid your taxes, and now you’re approaching that magic number: 65. You might be thinking, “Finally! Medicare is here to cover all my healthcare costs.” It’s a common belief, but unfortunately, it’s a myth. And it can be a costly one.
Here’s a dose of reality from the Commonwealth Fund: even though nearly all older Americans have Medicare, they still pay more out-of-pocket and are more likely to skip needed care due to costs than their friends in 10 other wealthy countries. Think about that. Almost a quarter of older adults in the U.S. spent $2,000 or more on healthcare in the past year, a figure that is striking in places like France or the Netherlands, where less than 5% of seniors spent that much.
Let’s quickly clear up one thing. When you sign up for Medicare, you face a big choice. You can opt for Original Medicare (Parts A and B), the government’s plan, which provides you with the freedom to see any doctor in the country who accepts it. Or, you can choose a Medicare Advantage (Part C) plan, which is run by a private insurance company.
These plans bundle everything together and often throw in extra perks like dental and vision, but they usually limit you to a network of doctors and require you to get permission—called prior authorization—for certain services.
Here are the 12 biggest expenses that Medicare surprisingly leaves for you to handle.
Long-Term Care (The Big One)
This is, without a doubt, the single most financially devastating gap in the Medicare system. It’s the one that can wipe out a lifetime of savings in a shockingly short time. Here’s the critical distinction you need to understand: Medicare does NOT pay for long-term “custodial care.” That’s the non-medical help with daily activities like bathing, dressing, eating, or getting in and out of bed. It’s the type of care most people need as they become frail.
Medicare may cover short-term, medically necessary “skilled nursing” care in a facility, provided it follows a qualifying hospital stay of at least three days. Think wound care or physical therapy, not long-term assistance.
The cost of the care Medicare won’t cover is astronomical and climbing fast. According to the 2024 Genworth Cost of Care Survey, the national median cost for a private room in a nursing home is a breathtaking $127,750 per year. An assisted living facility isn’t much cheaper, coming in at $70,800 annually. These costs are soaring, jumping 9% and 10% in just one year, respectively, thanks to inflation and a shortage of care workers.
This creates a brutal financial trap. Because Medicare won’t pay for this care, and the costs are too high for most families to bear, many people are forced to spend down their entire life savings until they are poor enough to qualify for Medicaid, the only government program that does cover long-term custodial care. It’s a bureaucratic line in the sand—the difference between “skilled” and “custodial”—that can strip a family of its financial security and generational wealth.
Routine Dental Checkups & Fillings
Remember those twice-a-year dental visits for a cleaning and checkup? Or that time you needed a filling for a cavity? Forget about it. Original Medicare does not cover the basic, routine dental care that you’ve relied on your whole life.
The statistics are grim. Nearly every adult over 65 (a whopping 96%) has had a cavity, and one in five has untreated tooth decay right now. About two-thirds have gum disease. This issue hits minority communities hardest, with 41% of non-Hispanic Black seniors having untreated decay, compared to just 16% of their non-Hispanic white peers.
What’s truly baffling is the medical contradiction at the heart of this policy. We know that oral health is directly linked to overall health. Poor dental hygiene can worsen conditions like heart disease, diabetes, and even dementia. Medicare will pay hundreds of thousands of dollars to treat the long-term complications of these diseases, but it won’t pay a few hundred dollars for the preventive dental care that could help keep them in check.
It’s a policy that is penny-wise and pound-foolish, leading to worse health for seniors and, ultimately, higher costs for the very system that refuses to pay for a simple cleaning.
Dentures & Dental Implants
If Medicare won’t cover a simple filling, you can bet it won’t cover major restorative work like dentures or dental implants. And you’d be right. These crucial items, which can restore the ability to eat and speak properly, are firmly on the “not covered” list for Original Medicare.
The human cost of this gap is immense. The American Dental Association reports that nearly one in five adults over 65 has lost all their teeth, a condition known as edentulism. For those over 75, that number climbs to one in four. This isn’t just a cosmetic issue. It directly impacts nutrition by making it painful or impossible to eat healthy foods like fresh fruits and vegetables, and it can lead to social withdrawal and a loss of self-esteem.
To get coverage, you have to turn to the private market. A dental insurance plan can run you anywhere from $32 to over $52 a month. But even then, the coverage is often limited. Many plans have long waiting periods (9-12 months) for major services and still require you to pay 50% of the bill for things like dentures or implants.
This is where many people get lured in by Medicare Advantage plans, which famously advertise “free” dental benefits. It’s a significant reason why over half of all beneficiaries have opted for these private plans. But here’s the catch: that “free” coverage is often a mirage.
When you actually need it for something expensive, you discover the restrictive annual caps (averaging just $1,300), high copayments, and limitations that may not even cover implants at all. For many, the promise of dental coverage turns out to be a bait-and-switch that leaves them with huge bills right when they’re most vulnerable.
Routine Eye Exams & Eyeglasses
Need to update your glasses prescription? Prepare to open your wallet. That routine eye exam, known as a refraction, and the eyeglasses themselves are not covered by Original Medicare.
The costs can add up quickly. The average price for a routine eye exam without insurance is about $136, but it can easily top $250 in some areas. In big cities, expect to pay around $200. Then come the glasses. The frames alone average $230, with another $107 for basic single-vision lenses. That puts a simple pair of glasses in the $300 to $400 range, or even higher.
But the real loss here isn’t just about the money for glasses; it’s about the missed opportunity for a crucial health screening. As ophthalmologist Dr. Vinay Gutti explains, “Eye exams for seniors are essential not only for your vision but also for your overall health. Many systemic diseases, such as diabetes, high blood pressure, stroke, and cancer, can affect your eyes or be detected through your eyes”.
Think about it: the eye is the only place in the body where a doctor can look directly at your blood vessels and nerves without making a single cut. This makes a comprehensive eye exam a powerful, non-invasive diagnostic tool. It can spot the earliest signs of major diseases that Medicare will have to pay dearly to treat later on. By creating a cost barrier to this simple exam, Medicare is ignoring a low-cost “check engine light” for the entire body, choosing instead to wait for a catastrophic and far more expensive breakdown.
Hearing Aids & Exams
Hearing loss is incredibly common among seniors. About one-third of Americans between 65 and 74, and nearly half of those over 75, have some degree of hearing loss. A 2023 survey found that the number was closer to two-thirds for adults over 71. Yet, Original Medicare will not pay for hearing aids or the exams needed to fit them.
This creates a massive barrier to care because hearing aids are expensive. The average price for a pair of prescription hearing aids is around $3,300, with high-end models easily costing $7,000 or more. It’s no wonder that despite how common hearing loss is, only about 29% of those who could benefit from hearing aids actually use them.
Untreated hearing loss is the third most common chronic physical condition among seniors and is strongly linked to a cascade of other devastating and costly problems, including a higher risk of dementia, cognitive decline, depression, anxiety, and dangerous falls.
Medicare may not pay for the hearing aids, but it ends up paying for the consequences: the hospital bills from a broken hip after a fall, the long-term care for a person with dementia, and the psychiatric treatment for depression.
Most Prescription Drugs (Without a Part D Plan)
This is one of the most misunderstood parts of Medicare. Original Medicare (Parts A and B) does not cover the prescription drugs you pick up from your local pharmacy. Zero. For that, you must enroll in a separate, private insurance plan called Medicare Part D.
This isn’t an optional add-on for most people; it’s a necessity. In fact, 76% of all Medicare beneficiaries are enrolled in a Part D plan. But it’s not simple. It’s a dizzying marketplace where the average person has to choose from among 24 different plans, each with its own premium, deductible, and list of covered drugs (called a formulary).
The good news is that, thanks to the Inflation Reduction Act of 2022, there is now a $2,000 annual cap on out-of-pocket drug costs for people with Part D, which started in 2025. This is a historic change that finally closes the dreaded “donut hole” that used to expose seniors to unlimited spending.
However, even with the cap, the monthly burden can still be substantial. As one AARP member shared, “I’m still getting hit with single prescriptions costing more than $200 a month…Coming up with those surprise hundreds of dollars when I roll up to my pharmacy is painful”.
Routine Foot Care
If you’re looking for Medicare to cover a simple trip to the podiatrist to trim your toenails or remove a few calluses, you’ll be disappointed. This kind of care is considered “routine” and is not covered. However, this is a perfect example of an important Medicare rule: it’s not always the service that matters, but the medical reason for it.
The rules change completely if you have a systemic medical condition that puts your feet at high risk, with the most common example being diabetes. For a person with diabetes, a simple callus or ingrown toenail can quickly become a non-healing ulcer, leading to severe infection and even amputation.
Because of this risk, Medicare makes a critical exception. It will cover services such as nail trimming and callus removal if a doctor deems them medically necessary due to conditions like diabetes, poor circulation, or nerve damage.
It will even help cover the cost of one pair of therapeutic shoes each year for individuals with severe diabetic foot disease. This shows how a doctor’s ability to document and justify the medical necessity of a service is one of the most powerful tools a patient has for securing coverage.
Cosmetic & Plastic Surgery
It probably won’t surprise you to learn that Medicare won’t pay for plastic surgery that’s done purely for cosmetic reasons. If you want a facelift, a tummy tuck, or a nose job just to improve your appearance, you’ll be paying 100% of the cost yourself.
But Medicare does draw a line between “form” and “function.” It will cover procedures that are considered reconstructive rather than cosmetic. This includes surgery to:
- Improve the function of a malformed body part, such as a rhinoplasty to correct a deviated septum that causes difficulty breathing.
- Repair damage from an accident or trauma.
- Provide breast reconstruction after a mastectomy due to breast cancer.
Some procedures live in a gray area, and for these, you and your doctor will have to get prior authorization from Medicare. This means proving the procedure is for health, not vanity. For example, Medicare might cover eyelid surgery (blepharoplasty) if your droopy eyelids are actually blocking your vision, or surgery to remove an apron of abdominal skin (panniculectomy) if it’s causing chronic infections and rashes.
This reveals the bureaucratic hurdles in the system, where the burden is on you and your doctor to prove a procedure is truly necessary to an administrator who holds the purse strings.
Most Alternative & Complementary Medicine
If you’re a fan of alternative therapies like massage, naturopathy, or herbal medicine, know that these are generally not on Medicare’s list of covered services.
There is one fascinating and very specific exception: acupuncture. But the rules are incredibly strict. Medicare will only cover acupuncture for one condition: chronic low back pain. And it has to be pain that has lasted for at least 12 weeks with no other known cause (like cancer or surgery).
Even then, the coverage is limited to 12 sessions within a 90-day period. You can only get more if you show documented improvement. This coverage was only added in 2020, largely as a reaction to the opioid crisis, as health officials searched for non-drug pain therapies.
This reveals a great deal about how Medicare operates. It’s not a trendsetter. It’s a slow-moving institution that is very conservative about adopting new or “alternative” treatments. It often acts in a limited, reactive manner when faced with a massive public health crisis or long after private insurers have already taken the lead.
Medical Care Outside the U.S.
Planning that dream retirement trip to Italy or a cruise through the Caribbean? Make sure you pack travel insurance, because your Medicare card will be little more than a souvenir.
Original Medicare provides virtually no coverage for healthcare you receive outside the United States. The U.S., for Medicare’s purposes, includes the 50 states, Washington, D.C., Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Anywhere else is considered foreign soil.
The only exceptions are so rare and specific they’re almost comical. Medicare might pay if you’re in the U.S., but the closest hospital in an emergency is in Canada or Mexico; if you have an emergency while driving through Canada on a direct route to or from Alaska; or if you’re on a cruise ship and still within six hours of a U.S. port.
For everyone else, the only real options are private insurance. Some Medigap plans offer a foreign travel emergency benefit, but it’s limited. It typically covers 80% of costs after a $250 deductible, but only for the first 60 days of a trip and with a lifetime maximum of just $50,000.
A Full, Head-to-Toe Annual Physical
Here’s another one that often trips up many people. The traditional annual physical you might be used to—a comprehensive, hands-on, head-to-toe examination—is not covered by Medicare.
What Medicare does cover is a yearly “Wellness Visit”.This is not the same thing. The Wellness Visit is primarily a conversation. You’ll sit down with your doctor to review your medical history, update your list of providers, and create a personalized prevention plan. They’ll check your height, weight, and blood pressure and screen you for cognitive issues and depression. But it doesn’t involve the kind of hands-on physical exam most people expect.
The term “Wellness Visit” sounds so much like a physical that it can create a false sense of security. A person might leave the doctor’s office thinking they’ve been given a clean bill of health, when in reality, a comprehensive physical examination may never have even occurred. It’s a dangerous misunderstanding that could cause someone to miss the very preventive care the visit is supposed to promote.
Concierge Medicine & Membership Fees
In recent years, a new model of primary care has emerged: “concierge” or “boutique” medicine. These practices charge patients a monthly or annual membership fee in exchange for perks like 24/7 access to their doctor, longer appointment times, and same-day visits.
If you decide to join one of these practices, be aware that Medicare will not pay for that membership fee.
Medicare will still pay its normal share for the actual medical services you receive during a visit, but the retainer fee, which can be thousands of dollars a year, is entirely on you. The rise of this model is a symptom of a strained primary care system, where doctors are rushed and patients feel like they can’t get the attention they need.
This coverage gap highlights a growing two-tiered system of access, where those who can afford to pay extra get premium service, while everyone else is left in an increasingly crowded traditional system.
Key Takeaway
So, what’s the bottom line? Original Medicare is an essential foundation for healthcare in retirement, but it is not a blank check. It leaves behind significant and potentially catastrophic costs, especially for the “big three” that almost everyone will need eventually: dental, vision, and hearing care, as well as the astronomical expense of long-term care.
The data from KFF is clear: Medicare households spend 13.6% of their total budget on healthcare, more than double the 6.5% spent by non-Medicare households. Relying solely on the government plan can leave your life savings dangerously exposed.
This means proactive planning is not optional; it’s essential. You must actively investigate the options available to fill these gaps. This could mean choosing a Medicare Advantage (Part C) plan, which bundles benefits but restricts you to a specific network, or sticking with Original Medicare and adding a Medigap supplemental insurance policy to cover deductibles and coinsurance, resulting in more predictable costs.
Don’t wait for a medical crisis to find out what your insurance doesn’t cover. The time to understand these gaps and make a plan is now.
Disclaimer – This list is solely the author’s opinion based on research and publicly available information. It is not intended to be professional advice.
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