Medicare guide
What Medicare Doesn’t Cover, and How to Fill the Gaps
What Medicare doesn’t cover can cost more than what it does. Original Medicare leaves out most dental, vision, and hearing care, long-term custodial care, and nearly all care abroad, and it has no cap on what you pay out of pocket. Here is the official list and the coverage people use to fill each gap.
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Medicare.gov’s list
Medicare.gov lists these among the items and services Original Medicare doesn’t cover:
- Eye exams for prescription eyeglasses
- Most dental care, such as cleanings, fillings, extractions, and dentures
- Hearing aids and exams for fitting them
- Non-medical long-term care (custodial care)
- Routine physical exams
- Cosmetic surgery
- Massage therapy
- Concierge care
- Care from providers who have opted out of Medicare, except emergencies
- Most care outside the United States
Dental, vision, and hearing
Medicare.gov notes that Original Medicare doesn’t cover most dental care, but may cover some dental services closely tied to certain covered treatments, such as heart valve surgery, organ transplants, cancer treatment, or dialysis. Many Medicare Advantage plans include some dental, vision, and hearing benefits, and standalone dental and vision plans are another option.
Long-term custodial care
Original Medicare doesn’t pay for non-medical long-term care, such as help with bathing and dressing in a nursing home or at home. It covers skilled nursing facility care only after a qualifying hospital stay and for limited periods, with a $217 daily coinsurance for days 21 through 100 in 2026. Long-term care insurance, hybrid life policies, and Medicaid are the usual ways to plan for custodial care.
Out-of-pocket costs
| Item | 2026 amount |
|---|---|
| Part A hospital deductible | $1,736 per benefit period |
| Part A coinsurance, days 61–90 | $434 per day |
| Skilled nursing facility, days 21–100 | $217 per day |
| Part B standard premium | $202.90 per month |
| Part B deductible | $283 per year |
| Part D deductible (maximum) | $615 |
| Part D out-of-pocket cap | $2,100 |
| Insulin | No more than $35 for a month’s supply |
Sources: CMS (Nov. 2025, Apr. 2025) and Medicare.gov. 2027 Part A and B amounts had not been announced as of Oct. 22, 2026; CMS usually publishes them in mid-November. Higher-income beneficiaries pay more for Parts B and D.
Medicare Advantage plans must cap in-network out-of-pocket costs for Part A and B services. For 2026, KFF reports the federal limit is $9,250 in network and $13,900 combined for in- and out-of-network services in PPOs, and that the average plan’s in-network limit is about $5,421. Original Medicare has no out-of-pocket cap, which is one reason people pair it with Medigap.
Care outside the U.S.
Original Medicare generally doesn’t cover care outside the U.S., Part D doesn’t cover drugs bought abroad, and Medigap Plans C, D, F, G, M, and N include a limited foreign travel emergency benefit. Some Medicare Advantage plans cover emergencies abroad; check your plan.
Ways to fill the gaps
| Gap | Options |
|---|---|
| Deductibles and coinsurance | Medigap, or a Medicare Advantage plan’s cost structure |
| Prescription drugs | Part D plan, or Medicare Advantage with drug coverage |
| Dental, vision, hearing | Medicare Advantage extras, or standalone plans |
| Long-term custodial care | Long-term care insurance, hybrid policies, or Medicaid if eligible |
| Travel abroad | Medigap foreign travel benefit or travel medical insurance |
Summary only. The plan documents control coverage, limits, and exclusions.
Help with costs
If your income and savings are limited, Extra Help lowers Part D costs, and Medicare Savings Programs can help pay Part B premiums. Your State Health Insurance Assistance Program can help you apply. Ask about both programs when you review coverage.
How Medigap fills cost gaps
Medigap policies are standardized and sold by private insurers to help pay Original Medicare’s deductibles, coinsurance, and copays. The lettered plans are A, B, C, D, F, G, K, L, M, and N, and a plan with the same letter has the same basic benefits from any company. Plans C and F aren’t available to people new to Medicare on or after January 1, 2020; Plans D and G offer the same benefits except the Part B deductible. Medigap doesn’t work with Medicare Advantage and generally doesn’t include drug coverage, so most people pair it with a Part D plan.
When you can change coverage
| Period | When | What you can do |
|---|---|---|
| Initial Enrollment Period | 7 months around your 65th birthday month | Sign up for Parts A and B, and join a plan |
| Annual Open Enrollment | October 15 – December 7 | Join, switch, or drop Medicare Advantage or drug plans; coverage starts January 1 |
| Medicare Advantage Open Enrollment | January 1 – March 31 | One change: switch MA plans or return to Original Medicare (and add a drug plan) |
| General Enrollment Period | January 1 – March 31 | Sign up for Parts A and B if you missed your IEP; penalties may apply |
| Special Enrollment Periods | After qualifying events | For example, moving or losing employer coverage |
| Medigap Open Enrollment | 6 months from the first month you have Part B and are 65+ | Buy any Medigap policy sold in your state without health questions |
Source: Medicare.gov, October 2026.
Medicare Advantage in 2027
KFF counts 35.2 million Medicare Advantage enrollees in 2026, about 55% of eligible beneficiaries. For 2027, KFF’s analysis of CMS data found the average beneficiary can choose from 28 Medicare Advantage plans with drug coverage, but several large insurers are leaving some counties: UnitedHealth is exiting 228 counties, Humana 62, and Centene, Wellcare’s parent, 359 while entering 15. If your plan is leaving, you have a Special Enrollment Period and may have Medigap guaranteed issue rights.
Checking a plan and insurer
- Networks. Confirm your doctors and hospitals are in the plan’s network.
- Drugs. Check each prescription on the plan’s formulary and its tier.
- Costs. Compare premiums, deductibles, copays, and the out-of-pocket maximum.
- Agent license. Confirm the agent is licensed in your state through your state insurance department.
- Star Ratings. Review the plan’s rating on Medicare.gov’s Plan Finder.
What an independent agency does
An independent insurance agency is licensed to sell policies from several insurance companies. Instead of quoting one company's products, an independent agent can compare options from the insurers the agency represents, explain the differences in coverage, and help you re-shop at renewal. The insurance company, not the agent, makes underwriting and claim decisions.
Blake Insurance Group is an independent agency. We work with clients by phone, email, and online in states where we are licensed, and we will tell you which insurers we can quote for your situation.
How we work
Blake Insurance Group serves clients by phone, email, and online in states where we are licensed. The insurers and plans we can offer depend on our appointments and your location; a company named on this page may not be available through us.
How to verify an insurer or agency
Before buying through any website or app, confirm who is selling you the policy and who will issue it:
- Find the licensed agency or insurer named in the site's footer, terms, or license page.
- Look up the agency or producer on your state insurance department's license search, or through the National Insurance Producer Registry (NIPR).
- Look up the insurer on your state insurance department's company search to confirm it is authorized in your state.
- Save the insurer's name and policy number once issued, since that is who handles claims.
A legitimate service will make this information easy to find. Be cautious if you cannot identify the licensed entity.
Sources
We checked the facts on this page against the sources below in October 2026. Plans, prices, and rules change, so confirm current terms before you buy.
- Medicare.gov: What Original Medicare doesn't cover
- CMS: 2026 Medicare Parts A & B premiums and deductibles (Nov. 2025)
- CMS: Final CY 2026 Part D redesign program instructions
- Medicare.gov: Insulin
- KFF: Medicare Advantage out-of-pocket limits
- Medicare.gov: Travel outside the U.S.
- AARP: Does Medicare cover me outside the U.S.?
- ACL: State Health Insurance Assistance Program (Mar. 2026)
- Medicare.gov: Compare Medigap plan benefits
- Medicare.gov: Choosing a Medigap Policy (Mar. 2026)
- Medicare.gov: When does Medicare coverage start?
- Medicare.gov: Joining a health or drug plan
- Medicare.gov: Ready to buy a Medigap policy
- KFF: Medicare Advantage plan availability for 2027 (Oct. 2026)
What to have ready for a Medicare review
These details help an agent quote accurately.
- Medicare card. Your Medicare number and Part A and B start dates.
- Doctors. Names of doctors and hospitals you want to keep.
- Prescriptions. Drug names, doses, and pharmacies.
- Current coverage. Any plan, employer, or Medicaid coverage you have.
- ZIP code. Plans differ by county.
What Medicare doesn’t cover FAQs
Does Medicare cover dental?
Original Medicare doesn’t cover most dental care. Many Medicare Advantage plans and standalone plans do.
Does Medicare pay for nursing homes?
Not for long-term custodial care. It covers limited skilled nursing care after a qualifying hospital stay.
Does Medicare cover hearing aids?
Original Medicare doesn’t cover hearing aids or exams for fitting them.
Is there a limit on what I pay with Original Medicare?
No. Original Medicare has no out-of-pocket maximum; Medigap or Medicare Advantage can limit your costs.
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Important information
Compensation. Links in the partner section of this page are sponsored, and Blake Insurance Group may be paid if you make a purchase. Sponsored placement does not affect the other information on this page.
Independent agency. Blake Insurance Group LLC is an independent insurance agency. Licensed insurance producer NPN 16117464. Licensed states: AZ, AL, TX, CA, NY, OH, FL, NC, VA, GA, OK, NM, IA, KS, MI, NE, SC, SD, WV, IL, NJ, PA, TN, and WA. Which insurance companies we can quote depends on our current appointments, the product, and your state. Mentioning a company on this page does not mean we represent it.
Medicare disclaimer. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE (TTY users 1-877-486-2048), or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.
Medicare figures. Costs, limits, and rules on this page were checked against CMS, Medicare.gov, and the other listed sources in October 2026. 2027 Part A and B amounts had not been announced. Confirm current figures at Medicare.gov.
Coverage terms. Descriptions are general. The policy contract controls what is covered.
Availability. Coverage, prices, and eligibility vary by company, state, and applicant, and are subject to underwriting. The issued policy controls.
Your next step
Request a quote, and a licensed agent will compare options available to us for your situation.
