What Medicare doesn’t cover
Teeth, eyes, ears — and the very large one most people don’t discover until a parent needs it. Worth knowing before you’re planning around an assumption that isn’t true.
Medicare is a good programme. It is also, in a few specific places, not the programme people assume it is — and the gaps tend to be discovered at the worst possible moment, usually in a hospital corridor.
None of this is hidden. It's just that nobody sits you down at 65 and reads you the list.
The big one: long-term care
If you take one thing from this page, take this. Medicare does not pay for long-term custodial care. Not in a nursing home, not assisted living, not a home aide who helps with bathing, dressing, meals and medication.
This is the single most consequential misunderstanding in American retirement planning, and it's easy to see how it arises, because Medicare does cover something that looks similar.
| What’s covered | Short-term skilled care — rehabilitation and nursing after a qualifying hospital stay. Recovery, not residence. |
|---|---|
| The entry requirement | Generally a qualifying inpatient hospital stay of at least three days. Being held “under observation” rather than admitted does not count — a distinction that has cost families a great deal. |
| Days 1–20 | $0 per day, after the $1,736 Part A deductible for the benefit period. |
| Days 21–100 | $217.00 per day in coinsurance. |
| Day 101 onward | You pay everything. |
| Custodial care | Not covered at any point, at any duration, if that’s all you need. |
So the maximum is 100 days, it's conditional, and it's for getting better rather than for living somewhere. The care most people picture when they think “nursing home” is paid for privately, by long-term care insurance, or — once savings are largely gone — by Medicaid, which is a separate programme with strict income and asset rules.
Medicare covers getting better. It does not cover needing help. Those are different things, and the second one is far more expensive.
Teeth, eyes and ears
Original Medicare covers essentially none of the routine care in these three areas:
- Dental. No cleanings, fillings, extractions, dentures, root canals or implants. Very narrow exceptions exist where dental work is integral to a covered medical procedure.
- Vision. No routine eye exams for glasses, and no glasses or contacts. Medical eye conditions — cataract surgery, glaucoma screening for those at risk, macular degeneration — are covered, and one pair of corrective lenses after cataract surgery.
- Hearing. No routine hearing exams and no hearing aids. Diagnostic hearing tests ordered by a doctor are covered.
Medicare Advantage plans commonly include these as extras, which is a genuine selling point — but the benefits are typically capped at modest annual amounts. Enough for a cleaning and a pair of glasses; not enough for implants or premium hearing aids. Read the cap, not the headline.
One bright spot worth knowing: since 2022, hearing aids have been available over the counter in the US for mild to moderate hearing loss, without a prescription or an audiologist visit. That has pulled prices from many thousands of dollars down to the hundreds for a lot of people. Medicare still won't pay, but the number it isn't paying is much smaller than it used to be.
The rest of the list
- Care outside the United States, with narrow exceptions. Covered in our travel insurance piece — this is the gap that catches travellers.
- Routine foot care such as toenail clipping and callus removal, unless you have a qualifying condition like diabetes.
- Cosmetic surgery, other than reconstruction after injury or covered surgery.
- Most chiropractic care beyond spinal manipulation to correct subluxation.
- Concierge or retainer fees charged by a practice for access. Medicare pays the covered services; the membership fee is yours.
And a few things people don’t realise are covered
The list runs both ways, and this side is under-used:
- An annual wellness visit at no cost — not a physical, but a planning and screening appointment. Widely under-claimed.
- A long list of preventive screenings at $0: cardiovascular, diabetes, several cancers, bone density, depression.
- Vaccines — ACIP-recommended ones are $0 under Part D, including shingles, which used to run a couple of hundred dollars.
- Diabetes supplies and self-management training, plus therapeutic shoes for those who qualify.
- Mental health care, including therapy, and since 2024 marriage and family therapists and mental health counsellors can bill Medicare directly.
- Telehealth, though the rules have shifted repeatedly since 2020 — check current terms rather than assuming.
The gaps are real, but the useful reaction isn't alarm. Three of them — dental, vision, hearing — are budgetable annoyances of a few hundred to a couple of thousand a year. The fourth, long-term care, is a genuinely large financial risk, and it's the one worth thinking about deliberately rather than discovering.
Everything else on this page is footnotes by comparison.
This is general information, not personal advice. We report the rules, the numbers and the deadlines as clearly as we can. We don't know your income, your state, your health or your family — and all four can change the answer. Treat this as a good place to find the right questions, not a substitute for someone looking at your actual situation.
Where these facts come from
Checked against primary sources on 10 August 2026. Dollar limits and program rules change — if you're reading this well after that date, verify the numbers at the links below.
- Medicare — What Part A & Part B don’t cover — https://www.medicare.gov/what-medicare-covers/what-part-a-covers
- Medicare — Skilled nursing facility care — https://www.medicare.gov/coverage/skilled-nursing-facility-care
- Medicare — 2026 costs at a glance — https://www.medicare.gov/basics/costs/medicare-costs
- FDA — Over-the-counter hearing aids — https://www.fda.gov/medical-devices/hearing-aids/otc-hearing-aids-what-you-should-know
Edward Silva
Edward spent more than forty years as a computer professional — long enough to pick up one useful occupational habit: when somebody hands you a summary, go and read the actual documentation. He started The Second Half Guide after noticing that most writing aimed at people his age was either talking down to him or quietly selling him something, and that the plain facts — the dates, the thresholds, the dollar figures — were somehow the hardest part to find.
He's married, with two grown sons, both married themselves. He is not a financial adviser, an attorney or an insurance agent, and this site doesn't tell you what to do with your money. It tells you what the rules actually say, and links to where he checked.