Guide · Updated October 8, 2026
What Medicare does not cover
Medicare covers a lot. It does not cover everything. Here is the full list of the gaps, so nothing surprises you later.
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In short
Original Medicare (Parts A and B) pays for care that is medically necessary. Federal law excludes several common services outright. Dental, vision, hearing aids, and long-term custodial care top the list. On top of that, your share of covered costs has no yearly cap.
Services Medicare excludes
These are services Original Medicare does not pay for, no matter which doctor you see:
- Routine dental care. Cleanings, exams, fillings, crowns, root canals, extractions, dentures, and implants are all excluded. The only exception is dental work tied to a covered medical procedure.
- Routine vision care. Eye exams for glasses, eyeglasses, and contact lenses are not covered. Medical eye care is covered, including cataract surgery and treatment for glaucoma and macular degeneration.
- Hearing aids. Neither hearing aids nor routine hearing exams are covered. A hearing and balance exam is covered when a doctor orders it for a medical diagnosis.
- Long-term custodial care. Medicare pays for recovery, not residency. Help with bathing, dressing, and eating, at home or in a nursing facility, is not covered.
- Care outside the United States. Original Medicare does not pay for care received in another country, except in rare situations near the border.
- Cosmetic surgery. Procedures done only to improve appearance are excluded. Surgery to repair an injury or deformity can be covered.
- Routine foot care and most alternative care. Routine foot care is excluded. Acupuncture is covered only for chronic low back pain. Chiropractic care is covered only to correct a spinal subluxation.
The cost-sharing gaps
Even for covered services, Medicare leaves you with a share of the bill. These are the 2026 figures:
| Cost | Your share in 2026 |
|---|---|
| Part A hospital deductible | $1,736 per benefit period |
| Part B annual deductible | $283 per year |
| Part B coinsurance | 20 percent of covered services, with no yearly cap |
| Skilled nursing facility | Days 1 to 20 cost $0. Days 21 to 100 have a daily coinsurance. After day 100, you pay the full cost. A 3-day inpatient hospital stay is required first. |
| Prescription drugs | Not covered by Parts A and B. A Part D plan caps covered drug costs at $2,100 out of pocket in 2026. |
How people fill the gaps
Nobody is expected to face these gaps unprotected. Here is how people cover each one:
- Medigap pays much of the Part A and Part B cost-sharing, including the 20 percent coinsurance.
- Medicare Advantage plans have a yearly out-of-pocket maximum and add dental, vision, and hearing benefits.
- Part D covers outpatient prescription drugs with a yearly cap on your costs.
- Standalone dental and vision plans cover the routine care Medicare excludes.
- Long-term care insurance covers custodial care that Medicare never pays for.
Comparing your options side by side? Here is Medicare Advantage vs. Medigap in plain English. For the full cost picture, here is what Medicare costs.
Medicare help in your community
Common questions
- Does Medicare cover dental work like crowns or dentures?
- Original Medicare does not cover routine dental care. That includes cleanings, fillings, crowns, root canals, extractions, dentures, and implants. Coverage only applies when dental work is part of a covered medical procedure.
- Does Medicare pay for hearing aids?
- No. Original Medicare does not cover hearing aids or routine hearing exams. It covers a hearing and balance exam only when a doctor orders it to diagnose a medical condition.
- Does Medicare cover nursing home care?
- Medicare covers up to 100 days of skilled nursing after a qualifying hospital stay. It does not cover long-term custodial care, which is help with bathing, dressing, and eating at home or in a facility.
- Does Medicare cover medical care in another country?
- Original Medicare does not pay for care outside the United States except in rare border situations. Some Medigap plans include foreign travel emergency coverage. Check your plan before you travel.
- Is there a cap on what I pay with Original Medicare?
- No. Original Medicare has no yearly limit on your out-of-pocket costs. The Part B 20 percent coinsurance keeps adding up. This is why people add Medigap or choose a Medicare Advantage plan with a yearly maximum.
- Does Medicare cover prescription drugs?
- Parts A and B do not cover most outpatient prescription drugs. You need a Part D plan, either standalone or bundled with a Medicare Advantage plan. In 2026 the Part D out-of-pocket cap is $2,100 a year.
Questions about your own coverage? Call or text Christian Brinkley in Greensboro, NC at (919) 408-6671. The review is free, with no obligation.
Christian BrinkleyNC Life & Health · Greensboro, NC
Find out what your plan actually covers
Bring your current plan details. We will walk through the gaps that apply to you and what fills them, before December 7. Call or text (919) 408-6671.
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