You’ve been paying into Medicare for decades, and now that you’re eligible, it feels like a huge relief to have healthcare coverage in retirement. But here’s what many people discover after they sign up: Medicare isn’t the comprehensive safety net they expected. While your premium covers many essential services, there are significant gaps that can lead to unexpected expenses when you need care most.

Understanding these coverage gaps now can help you plan better and avoid financial surprises down the road. Let’s explore what Medicare leaves out and what you can do about it.

The Big Three: Dental, Vision, and Hearing

Perhaps the most surprising exclusions for new Medicare beneficiaries are routine dental care, vision care, and hearing aids – all services you’re likely to need more frequently as you age.

Dental Care Gaps

Medicare Parts A and B generally do not cover routine dental exams, cleanings, fillings, crowns, bridges or dentures, leaving you responsible for most dental work unless it’s medically necessary because of another covered procedure. With the average cost of a dental crown running between $800 to $2,500 and dental implants costing several thousand dollars per tooth, dental maintenance can quickly become expensive.

Medicare will only cover dental services if they’re part of a covered medical procedure, such as jaw surgery in a hospital setting. Everything else – from your twice-yearly cleanings to more complex procedures like root canals – falls on you to pay.

Vision Care Limitations

While Medicare covers some vision-related services like cataract surgery and annual glaucoma screenings for high-risk patients, it doesn’t cover routine eye exams for glasses or contact lenses. The program also won’t pay for prescription eyeglasses or contact lenses unless you’ve had cataract surgery. For most seniors who simply need updated prescriptions or new frames, these costs add up year after year.

Hearing Aid Expenses

Medicare excludes coverage for hearing aids and routine hearing exams, though it will cover hearing and balance exams if needed to diagnose another health condition. Since quality hearing aids can cost several thousand dollars and typically need replacement every five to seven years, this represents a substantial ongoing expense for many seniors.

Long-Term Care: The Biggest Financial Risk

The most significant coverage gap in Medicare may be long-term custodial care. Medicare covers short-term skilled nursing or rehab stays after a hospitalization, but it does not pay for long-term care if you need help with activities of daily living, like bathing, dressing or eating, due to aging, dementia or disability.

What Medicare Does Cover

Medicare Part A will cover skilled nursing facility care, but only under very specific conditions. You must have had a qualifying hospital stay of at least three consecutive days, and you must need skilled medical care related to that hospitalization. Medicare only pays for up to 100 days of care in a skilled nursing facility during each benefit period.

For the first 20 days, Medicare covers the full cost. After that, patients without supplemental coverage pay $209.50 in coinsurance for every covered day between 21 and 100 in 2025. After 100 days, you’re responsible for all costs.

The Long-Term Reality

According to Genworth’s latest cost of care survey, the average cost of a private room in a nursing home exceeds $120,000 per year in 2025, and assisted living and in-home care can also come with very hefty monthly bills. The average cost of a home health aide is nearly $7,000 per month, making long-term care one of the largest potential expenses in retirement.

Since most long-term care is considered custodial rather than medical, Medicare simply won’t pay for it. This includes help with bathing, dressing, eating, and other activities of daily living that many seniors eventually need.

Medicare’s 2025 Cost Increases

Even for covered services, Medicare costs continue to rise. The standard monthly premium for Medicare Part B enrollees is $185.00 for 2025, an increase of $10.30 from $174.70 in 2024. The annual deductible for all Medicare Part B beneficiaries is $257 in 2025, an increase of $17 from the annual deductible of $240 in 2024.

For Part A hospital coverage, the Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital is $1,676 in 2025, an increase of $44 from $1,632 in 2024.

No Annual Out-of-Pocket Limit

Unlike many private insurance plans, Original Medicare doesn’t have an annual out-of-pocket maximum. There’s no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage, like a Medicare Supplement Insurance (Medigap) policy, or you join a Medicare Advantage Plan.

This means that if you face serious health issues requiring multiple hospitalizations or expensive treatments, your costs can continue climbing throughout the year without any cap.

Travel Limitations

If you love to travel, you’ll want to know that Medicare coverage is generally limited to the United States. If you need emergency medical care while traveling abroad, Original Medicare typically won’t cover those expenses, leaving you potentially responsible for significant medical bills in foreign countries.

Filling the Coverage Gaps

Fortunately, you have several options to address these Medicare limitations:

Medicare Advantage Plans

Of the available plans, more than 97% include dental, vision, and hearing benefits. These private plans contract with Medicare to provide at least the same coverage as Original Medicare, often with additional benefits. The out-of-pocket maximum for Part C plans is $9,350 for approved services, but individual plans can set lower limits if they wish in 2025. You can explore available Medicare Advantage plans in your area on Medicare.gov.

Medigap Insurance

Medicare Supplement Insurance can help cover some costs that Original Medicare doesn’t pay, such as deductibles, coinsurance, and copayments. Some Medigap policies also include limited foreign travel emergency coverage.

Long-Term Care Insurance

Since Medicare won’t cover extended custodial care, many financial planners recommend considering long-term care insurance while you’re still healthy. These policies can help cover the costs of nursing home care, assisted living, or in-home care services.

Health Savings Accounts

If you’re still working and have access to a Health Savings Account (HSA), you can use these tax-advantaged funds to pay for qualified medical expenses that Medicare doesn’t cover.

Planning Ahead Makes a Difference

Understanding Medicare’s limitations helps you make informed decisions about supplemental coverage and retirement planning. Consider your family health history, current health status, and financial situation when deciding which additional coverage options make sense for your circumstances. For personalized guidance, contact your local State Health Insurance Assistance Program (SHIP) for free Medicare counseling.

Many people find that the cost of supplemental insurance is worth the peace of mind, especially when compared to the potential out-of-pocket expenses for uncovered services. The key is researching your options before you need care, when you have time to compare plans and costs carefully. The Medicare Plan Finder can help you compare different options in your area.

Key Takeaways

• Medicare doesn’t cover routine dental care, vision care, or hearing aids – expenses that often increase with age

• Long-term custodial care represents the largest coverage gap, with nursing home costs exceeding $120,000 annually

• Medicare has no annual out-of-pocket maximum, meaning costs can continue climbing without limit

• International travel medical expenses are generally not covered by Original Medicare

• Medicare Advantage plans often include dental, vision, and hearing benefits that Original Medicare lacks • Medigap insurance can help cover deductibles, coinsurance, and some services Original Medicare excludes

• Long-term care insurance should be considered while you’re healthy to protect against potentially devastating expenses

• Planning for these gaps before you need care gives you more options and better financial protection