Key Takeaways

• Medicare doesn’t cover everything, and some gaps in coverage may leave you with unexpected out-of-pocket costs. Understanding these limitations can help you prepare financially and avoid surprises.

• There are steps you can take to fill coverage gaps, including choosing the right supplemental options and knowing when to seek professional guidance.

Expecting Full Coverage? Think Again

Many people assume that once they enroll in Medicare, all their healthcare needs will be covered. However, that’s not the case. There are several situations where Medicare might not pay for the care you expect. These gaps can lead to unexpected expenses, which is why it’s important to understand the limitations of your coverage and explore ways to protect yourself from high costs.

1. Long-Term Care Isn’t Covered

One of the biggest misconceptions about Medicare is that it covers long-term care, but that’s not true. Medicare only pays for short-term stays in a skilled nursing facility if you meet specific conditions, such as a qualifying hospital stay. However, it does not cover custodial care, which includes assistance with daily activities like bathing, dressing, or eating.

What You Can Do:

• Look into long-term care insurance if you want coverage for extended stays in a nursing home or assisted living facility.

• Consider Medicaid if you meet the income and asset requirements, as it does provide long-term care benefits.

2. Routine Dental, Vision, and Hearing Care Are Limited

Medicare typically does not cover routine dental cleanings, eye exams for glasses, or hearing aids. While some medically necessary procedures may be covered, routine care is not included.

What You Can Do:

• Consider a separate dental, vision, and hearing plan to cover these services.

• Check if you qualify for state programs that offer assistance with dental and vision care.

3. Prescription Drug Coverage Requires Separate Enrollment

Original Medicare does not cover most prescription drugs. If you need medications, you must enroll in a separate Medicare drug plan to receive coverage.

What You Can Do:

• Sign up for a Medicare Part D plan as soon as you become eligible to avoid late enrollment penalties.

• Review your drug plan annually to make sure it still covers your medications at a reasonable cost.

4. Overseas Medical Care is Usually Not Included

If you travel outside the U.S., don’t expect Medicare to cover your healthcare costs. Medicare generally does not provide coverage for medical care received in foreign countries, except in very limited situations.

What You Can Do:

• Consider purchasing a travel medical insurance policy before leaving the country.

• Look into supplemental coverage options that offer emergency medical benefits abroad.

5. Some Medical Services Require Out-of-Pocket Costs

Even when Medicare covers a service, you may still have out-of-pocket costs such as deductibles, copayments, and coinsurance. For example:

• The standard deductible for Medicare Part B in 2025 is $257 before coverage kicks in.

• Part A has a hospital deductible of $1,676 per benefit period.

What You Can Do:

• Plan for these costs by budgeting accordingly.

• Consider options that help reduce out-of-pocket expenses, such as supplemental coverage.

6. Home Health Care Coverage is Limited

Medicare does cover some home health care services, but only under specific conditions. If you require ongoing home care that is not considered medically necessary, Medicare will not pay for it.

What You Can Do:

• Check if you qualify for home healthcare coverage under Medicare by speaking with your doctor.

• Explore community programs that provide assistance with in-home care needs.

Be Proactive About Medicare Coverage Gaps

Understanding where Medicare coverage falls short can help you plan ahead and avoid unexpected expenses. Take the time to review your healthcare needs, compare coverage options, and seek expert advice when necessary. If you’re unsure about your options, consider reaching out to a licensed agent listed on this website for professional guidance on choosing the right plan for your situation.