Original Medicare does not cover most routine dental, vision, or hearing care, it does not cover hearing aids, it does not cover long-term custodial care, and it generally does not cover care received outside the United States. It also leaves a 20% Part B coinsurance on most outpatient services and has no annual out-of-pocket maximum. People fill those gaps in different ways: a Medigap plan for Medicare cost-sharing, stand-alone dental, vision, or hearing plans, supplemental products like hospital indemnity or critical illness, and long-term care planning.
Last updated: June 2026.
Key takeaways
- Original Medicare does not cover most routine dental, vision, or hearing care, and it does not cover hearing aids.
- It does not cover long-term custodial care, the help with daily activities that drives the largest retirement expenses.
- It generally does not cover care received outside the United States, with very limited exceptions.
- It leaves a 20% Part B coinsurance on most outpatient services with no annual out-of-pocket maximum.
- Most people fill these gaps with some mix of a Medigap or Medicare Advantage plan, stand-alone dental, vision, and hearing plans, supplemental products, and long-term care planning.
Common gaps in Original Medicare
| Not covered by Original Medicare | How people usually cover it |
|---|---|
| Long-term custodial care (help with daily living) | Long-term care insurance, personal savings, or Medicaid |
| Most routine dental care | A standalone dental plan, or a Medicare Advantage plan that includes dental |
| Routine vision and eyeglasses | A vision plan, or a Medicare Advantage plan that includes vision |
| Hearing exams and hearing aids | A standalone hearing benefit, or a Medicare Advantage plan that includes hearing |
| Routine foot care | Out of pocket, or a plan that includes the benefit |
| Cosmetic surgery | Out of pocket |
| Health care while traveling outside the United States | A Medigap plan with a foreign travel emergency benefit, or separate travel medical coverage |
The Cost-Sharing Gap in Original Medicare
Before listing the service gaps, it helps to name the most expensive one: Original Medicare leaves you with cost-sharing, and there is no annual cap on what you can owe out of pocket. Part A has an inpatient deductible and per-day coinsurance after a certain number of hospital days. Part B has an annual deductible and then generally a 20% coinsurance on covered outpatient and physician services, with no out-of-pocket maximum. We do not list current-year dollar amounts here because they change every year. For current figures, see Medicare.gov.
This is the gap that Medigap plans and Medicare Advantage plans exist to address, in different ways. For a side-by-side, see Medicare Advantage vs Medicare Supplement. For a deeper look at the two most popular standardized Medigap plans, see Medigap Plan G vs Plan N.
Routine Dental
Original Medicare does not cover routine dental care: cleanings, fillings, extractions, root canals, crowns, dentures, or most other dental services. Limited dental services may be covered when they are an integral part of a Medicare-covered medical procedure (for example, a dental exam required before certain surgeries).
Common ways people fill the dental gap:
- Choose a Medicare Advantage plan that includes routine dental benefits, while accepting the network and cost-sharing rules of that plan.
- Add a stand-alone dental insurance plan.
- Use a dental discount plan, which is not insurance but provides reduced rates at participating dentists.
- Self-pay and budget for predictable cleanings and exams.
Routine Vision
Original Medicare does not cover routine eye exams for glasses or contacts, and it does not cover the glasses or contacts themselves. There are limited exceptions, such as one pair of standard eyeglasses or contact lenses after cataract surgery with an intraocular lens. Medicare does cover medically necessary eye care, such as diagnosis and treatment of eye disease.
Common ways people fill the vision gap include stand-alone vision insurance, Medicare Advantage plans that include vision benefits, and paying out of pocket for routine exams and eyewear.
Hearing and Hearing Aids
Original Medicare does not cover routine hearing exams or hearing aids. It does cover diagnostic hearing and balance exams when ordered by a doctor to find out if medical treatment is needed.
Common ways people fill the hearing gap include Medicare Advantage plans with hearing benefits and an allowance toward hearing aids, stand-alone hearing benefit programs, and self-paying with over-the-counter hearing aids that are now available without a prescription for adults with perceived mild to moderate hearing loss.
Long-Term Custodial Care
Original Medicare does not cover long-term custodial care. Custodial care is help with daily activities like bathing, dressing, eating, and transferring that does not require skilled medical care. This is one of the largest financial exposures in retirement.
Medicare does cover limited short-term skilled nursing facility care after a qualifying inpatient hospital stay, and limited home health care that meets specific criteria. Both are time-limited and skilled-care focused. They are not long-term care.
Common ways people plan for long-term care:
- Traditional long-term care insurance.
- Hybrid life or annuity policies with a long-term care rider.
- Self-funding from savings, investments, or home equity.
- Medicaid planning, which requires meeting state asset and income rules.
Care Outside the United States
Original Medicare generally does not cover health care services received outside the United States, with very limited exceptions for specific cross-border situations. Some Medigap plans include foreign travel emergency coverage up to plan limits. Some Medicare Advantage plans include limited worldwide emergency or urgent care coverage. People who travel internationally often add a travel medical policy for trips.
Cosmetic Surgery and Most Alternative Medicine
Original Medicare does not cover cosmetic surgery unless it is needed because of accidental injury or to improve the function of a malformed body part. It covers limited acupuncture for chronic low back pain under specific conditions, and it covers chiropractic manipulation of the spine to correct subluxation. It does not cover broader chiropractic or most alternative medicine services.
Other Notable Gaps
- Most over-the-counter drugs. Part D does not cover most over-the-counter medications, even with a doctor's recommendation.
- Most routine foot care. Medicare does not cover routine foot care like nail trimming for most people, with exceptions for those who have certain medical conditions.
- Private hospital rooms, unless medically necessary.
How People Typically Fill the Gaps
Most people use a combination of tools, not just one. A common layout looks like this:
- Pick a path for Medicare cost-sharing. Either Original Medicare plus a Medigap plan plus a stand-alone Part D drug plan, or a Medicare Advantage plan that usually includes drug coverage. See Medicare Advantage vs Medicare Supplement.
- Add coverage for the service gaps that matter to you. Routine dental, vision, and hearing are the most common add-ons.
- Consider supplemental coverage for hospital and critical illness risk. Hospital indemnity and critical illness products pay a benefit on top of your medical coverage to help with out-of-pocket costs.
- Make a long-term care plan early. Premiums and eligibility for long-term care insurance get more difficult with age and health changes.
- Plan for income-related premium adjustments. Higher-income beneficiaries pay IRMAA on top of Part B and Part D. See Medicare IRMAA explained.
- Get the timing right. Missing the right enrollment window can create a permanent late enrollment penalty. See Medicare enrollment periods explained.
Frequently Asked Questions
Does Medicare cover dental?
Original Medicare does not cover most routine dental care, including cleanings, fillings, extractions, dentures, or most other dental services. Limited dental services may be covered when they are part of a Medicare-covered medical procedure.
Does Medicare cover vision?
Original Medicare does not cover routine eye exams for glasses or contact lenses, and it does not cover the glasses or contacts themselves, with limited exceptions after cataract surgery.
Does Medicare cover hearing aids?
Original Medicare does not cover routine hearing exams or hearing aids.
Does Medicare cover long-term care?
Original Medicare does not cover long-term custodial care. It covers limited short-term skilled nursing facility care after a qualifying hospital stay.
Does Medicare cover care outside the United States?
Original Medicare generally does not cover care received outside the United States, with very limited exceptions. Some Medigap plans include foreign travel emergency coverage up to plan limits.
Does Medicare cover cosmetic surgery?
Original Medicare does not cover cosmetic surgery unless it is needed because of accidental injury or to improve the function of a malformed body part.
Does Medicare cover acupuncture and chiropractic?
Medicare covers limited acupuncture for chronic low back pain under specific conditions, and it covers chiropractic manipulation of the spine to correct subluxation. It does not cover broader chiropractic or alternative medicine services.
How do most people fill these gaps?
People typically combine some of: a Medigap plan, stand-alone dental, vision, or hearing plans, supplemental coverage like hospital indemnity, and long-term care planning. The right mix depends on your health, budget, and family situation.
References
We are not connected with or endorsed by the federal government or the Medicare program.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
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Written by Nick Depke, licensed independent insurance agent (NPN 19158595), Depke Insurance Agency, 17310 Wright St Ste 100, Omaha, NE 68130.