Medicare Covers a Lot -- But Not Everything
Most people assume that once they turn 65 and get Medicare, their healthcare is fully covered. It is not. Medicare has significant gaps that can cost thousands of dollars per year if you are not prepared for them. Knowing what is excluded is just as important as knowing what is included.
Some of these gaps can be filled with additional coverage. Others are simply expenses you need to budget for out of pocket. Either way, the earlier you understand them, the fewer surprises you will face in retirement.
Dental Care
Original Medicare does not cover routine dental care. That means cleanings, fillings, extractions, dentures, and most other dental work are entirely out of pocket. The only exception is dental care that is directly related to a covered medical procedure -- for example, if you need a tooth extracted before a heart valve replacement.
This catches a lot of retirees off guard because employer dental coverage is common during working years. Once you retire and move to Medicare, that dental coverage disappears unless you buy a standalone dental plan or enroll in a Medicare Advantage plan that includes dental benefits. Dental costs in retirement are a real budget item -- a single crown can cost $1,000 or more, and dentures can run several thousand dollars.
Vision Care
Medicare does not cover routine eye exams, glasses, or contact lenses. It will cover eye exams and treatment for medical conditions like glaucoma, macular degeneration, or cataracts, but the yearly eye checkup where they update your glasses prescription is not included.
As with dental, some Medicare Advantage plans include routine vision benefits. If you stick with Original Medicare, you will need a separate vision plan or plan to pay out of pocket. A pair of prescription glasses can easily run $200 to $500 depending on your prescription and frames.
Hearing Aids
Original Medicare does not cover hearing aids or the exams needed to fit them. Hearing loss is extremely common as people age -- roughly one in three people over 65 has some degree of hearing loss. A pair of hearing aids can cost $2,000 to $7,000 depending on the technology. Some Medicare Advantage plans now include hearing aid benefits, and over-the-counter hearing aids (available since 2022) have brought some costs down, but this remains a significant out-of-pocket expense for many retirees.
Long-Term Care
This is the biggest and most expensive gap in Medicare. Medicare does not cover long-term custodial care -- the kind of care you need if you can no longer perform daily activities like bathing, dressing, eating, or using the bathroom on your own. This includes most nursing home stays, assisted living facilities, and in-home care aides who help with daily tasks.
Medicare covers skilled nursing facility care only for up to 100 days after a qualifying 3-day hospital stay, and the cost-sharing after day 20 is substantial. Once those 100 days are up, or if your stay does not follow a hospital admission, Medicare pays nothing. The average cost of a private room in a nursing home is over $100,000 per year. This is a risk that requires separate planning -- either through long-term care insurance, personal savings, or understanding how Medicaid works as a safety net.
Care Outside the United States
If you travel internationally, Medicare generally does not cover healthcare received outside the United States. There are very limited exceptions -- emergency care in Canada under specific circumstances, or care on a cruise ship within six hours of a U.S. port. But in practice, if you get sick or injured abroad, you are paying out of pocket unless you have travel insurance or a Medigap plan that includes foreign travel emergency coverage (some do, with limits).
Cosmetic Surgery and Elective Procedures
Medicare does not cover cosmetic surgery unless it is needed for reconstruction after an accident or to improve the function of a malformed body part. Elective procedures like most weight-loss surgeries, cosmetic dental work, and similar services are excluded. If a procedure is considered medically necessary, Medicare may cover it, but the definition of medical necessity is determined by Medicare, not your doctor.
What This Means for Your Retirement Budget
The average retired couple can expect to spend a significant amount on healthcare costs that Medicare does not cover. Dental, vision, hearing, supplemental premiums, and out-of-pocket costs for prescriptions all add up. If long-term care enters the picture, the numbers can become overwhelming without a plan.
The takeaway is not that Medicare is bad -- it is a strong foundation. But treating it as complete coverage is a mistake that can derail a retirement budget. Understanding the gaps early gives you time to plan for them, whether that means buying supplemental coverage, setting aside dedicated savings, or adjusting your overall retirement income needs.
This content is for general educational purposes only and does not constitute medical or financial advice. Medicare rules and costs change annually. Visit medicare.gov or speak with a licensed insurance counselor for guidance specific to your situation.