Key Takeaways

• Medicare doesn’t automatically cover many commonly assumed benefits, including long-term care, dental, vision, and hearing services.

• Understanding what’s excluded from your Medicare plan helps you avoid major out-of-pocket surprises and plan better with supplemental options.

Why Knowing What Medicare Doesn’t Cover Matters More in 2025

If you assume Medicare covers every healthcare need in retirement, you’re not alone. But the truth is, many essential services aren’t part of Original Medicare—and this misunderstanding could lead to costly gaps in your coverage.

In 2025, with healthcare expenses rising and more retirees relying solely on Medicare, knowing what isn’t covered is just as important as knowing what is. Planning ahead can help protect your health, your budget, and your peace of mind.

Long-Term Care Services: Not What You Think

One of the most misunderstood exclusions is long-term care. Medicare does not pay for custodial care, which includes help with daily activities like bathing, dressing, and eating—unless it is part of a short-term rehabilitation stay following hospitalization.

What Medicare Will Cover:

• Short-term skilled nursing care (up to 100 days) after a qualifying hospital stay of at least 3 days.

• Certain home health services if deemed medically necessary.

What Medicare Does Not Cover:

• Assisted living facilities

• Nursing home stays for custodial care

• In-home personal aides for non-medical care

Many retirees discover too late that these costs, which can run into the tens of thousands annually, aren’t covered. Planning for long-term care through other means is essential.

Routine Dental Care: A Major Blind Spot

It’s surprising how many people don’t realize that Medicare doesn’t include routine dental coverage.

Excluded Dental Services:

• Cleanings and exams

• Fillings and root canals

• Dentures, bridges, and implants

In 2025, dental care remains an out-of-pocket expense unless you have additional coverage through other plans. Routine dental services are only covered if they are an integral part of a Medicare-covered procedure, like jaw reconstruction after trauma or surgery.

Vision Services: Only the Basics

Medicare Part B will help if you have a medical condition like glaucoma or macular degeneration, but it won’t help with routine vision care.

Covered by Medicare:

• Eye exams for diabetic retinopathy

• Glaucoma tests once a year if you’re at high risk

• Certain treatments for eye diseases

Not Covered:

• Routine eye exams for glasses or contacts

• Prescription eyewear (except after cataract surgery)

• LASIK or other vision correction surgery

In 2025, glasses and eye exams remain out-of-pocket unless you’re recovering from cataract surgery. If you rely on eyeglasses or have worsening vision, this gap can be expensive.

Hearing Aids: Still Not Included

Hearing loss is common among seniors, but you’ll have to pay out of pocket for hearing aids unless you have separate coverage. This continues to surprise many Medicare beneficiaries.

What’s Not Covered:

• Hearing aids and fittings

• Routine hearing exams

• Ongoing hearing aid maintenance

Medicare Part B may cover diagnostic hearing exams if your doctor orders them to investigate a medical condition, but not the devices themselves. Hearing aid costs can exceed thousands of dollars, which can be a major burden without additional coverage.

Prescription Drug Coverage: Not in Original Medicare

Original Medicare (Parts A and B) does not cover most outpatient prescription drugs. You must enroll in a separate Part D plan if you want prescription drug coverage.

In 2025, here’s what you need to know:

• Part D includes a $590 deductible.

• After reaching the $2,000 annual out-of-pocket cap, you pay nothing for covered drugs for the rest of the year.

• Not all medications are included in every plan’s formulary.

If you skip Part D enrollment when first eligible, you could face lifelong late penalties unless you have other creditable coverage.

Overseas Medical Care: Limited to Emergencies

If you travel outside the U.S., don’t count on Medicare to protect you. Original Medicare offers extremely limited international coverage.

What’s Generally Excluded:

• Routine medical care abroad

• Non-emergency hospitalizations outside the U.S.

What May Be Covered:

• Emergency services within the U.S. territories

• Emergency care in Canada while traveling directly between U.S. states

• Care within the first 60 days of a foreign trip if enrolled in some Medigap plans

If international travel is part of your retirement lifestyle, supplemental travel insurance or specific Medicare-related policies are necessary.

Alternative Therapies: Rarely Covered

Many assume that treatments like acupuncture or chiropractic care are part of Medicare, but in most cases, they aren’t.

Limited Coverage Includes:

• Manual manipulation of the spine by a chiropractor for active back pain (must be medically necessary)

• Acupuncture only for chronic lower back pain, limited to 12 sessions initially

Not Covered:

• Massage therapy

• Aromatherapy

• Homeopathy and naturopathy

If you depend on alternative therapies to manage chronic conditions or pain, be prepared for out-of-pocket expenses.

Foot Care and Orthotics: Only for Specific Diagnoses

Routine foot care is another commonly misunderstood area. Medicare generally does not cover foot exams, nail trimming, or orthotics unless tied to a medical condition.

Covered Only If:

• You have diabetes with complications or circulatory problems

• Foot care is deemed medically necessary and prescribed

Orthotics for general support or comfort are not covered. This can be a notable expense if you require custom insoles or podiatric visits.

Custodial and Personal Care at Home: Largely Excluded

While Medicare covers some home health care under strict medical guidelines, it does not pay for help with daily living unless it is part of a skilled care plan.

Not Covered:

• Cooking, cleaning, or laundry

• Personal hygiene assistance

• Companion care or supervision

Many people confuse “home health” with “home care.” In 2025, the distinction still matters: Medicare supports medical needs, not personal assistance.

Over-the-Counter (OTC) Medications and Supplies: Not Reimbursed

You’ll pay out of pocket for most non-prescription products, including common items many retirees use regularly.

Typically Not Covered:

• OTC pain relievers and cold medicine

• Bandages, first aid kits, or thermometers

• Vitamins and supplements (unless prescribed and medically necessary)

Some Medicare Advantage plans offer OTC allowances, but these are not part of Original Medicare and vary significantly.

Cosmetic Procedures: Always Excluded

Medicare is designed to cover medically necessary services, not elective treatments.

Not Covered:

• Cosmetic surgery (e.g., facelifts, liposuction)

• Botox (unless for medical conditions like migraines)

• Teeth whitening

Even when a procedure improves confidence or quality of life, it must meet strict clinical necessity to qualify for Medicare coverage.

Ambulance Services: Not Always Fully Covered

Emergency ambulance transport is typically covered, but non-emergency medical transportation is often denied if not deemed necessary.

What’s Covered:

• Emergency transport to a hospital or skilled nursing facility when other transport would endanger your health

Not Covered:

• Non-emergency rides without medical justification

• Transportation to doctor’s appointments without specific pre-approval

Documentation matters. In 2025, Medicare continues to deny many claims due to lack of supporting evidence for necessity.

What You Can Do to Fill These Gaps

Understanding these exclusions helps you prepare financially and medically. If you’re relying solely on Original Medicare, consider:

• Enrolling in a Part D plan for drug coverage

• Exploring Medigap or other supplemental plans for broader coverage

• Budgeting separately for dental, vision, and hearing needs

• Talking to a licensed agent to evaluate add-on options or benefits

How to Be Better Prepared in 2025

Medicare’s coverage still leaves room for significant out-of-pocket costs. Many of the benefits you may assume are included—like dental checkups, hearing aids, or long-term care—simply aren’t. This makes reviewing your coverage and options in 2025 more critical than ever.

Don’t wait until a medical need arises. Get in touch with a licensed agent listed on this website to evaluate your current Medicare coverage and discuss options that address these hidden gaps.