7 Things Medicare Won’t Pay For (And What to Do Instead)

Medicare covers a lot, but it doesn’t cover everything. And for many retirees, the biggest surprises aren’t hospital bills or doctor visits. The real shock comes from the everyday services people assume are included: eye exams, dental work, hearing aids, and even routine physicals. Understanding what Medicare doesn’t pay for is one of the fastest ways to avoid costly mistakes and protect a retirement budget. Below are seven common items Medicare typically won’t cover, plus the best alternatives to consider.

1) Preventive Eye Exams (Routine Vision Checks)

Original Medicare generally does not cover routine eye exams for glasses or contact lenses. That means annual vision checks for prescription updates usually come out of pocket. However, Medicare does cover eye exams when they are medically necessary, such as evaluating vision changes, eye disease symptoms, or injuries. There is also a major exception for diabetes: Medicare covers one diabetic eye exam each year to check for diabetic retinopathy, as long as the exam is performed by an eligible eye doctor. For anyone who wants help paying for routine exams and eyewear, a standalone vision plan is often the simplest solution. Many retirees add a separate vision plan to cover routine eye exams, frames, lenses, and contact benefits.

2) Hearing Exams and Hearing Aids

Original Medicare does not cover routine hearing tests or hearing aids. This is one of the most expensive gaps in retirement healthcare because hearing aids can cost thousands of dollars, and many people need them for quality of life, safety, and cognitive health. Medicare may cover certain hearing-related services when tied to medical treatment, such as issues connected to the inner ear or conditions that require physician evaluation. But routine hearing exams and hearing aids are generally excluded. Some Medicare Advantage plans offer hearing benefits, and in many cases those benefits include hearing exams and hearing aid allowances. Costs vary widely, but some plans offer hearing aids with copays that can range in the hundreds per device depending on the plan and network. Another option is purchasing a standalone hearing plan or using discount programs through major hearing providers.

3) Routine Dental Care (Fillings, Crowns, Cleanings)

Original Medicare does not cover routine dental care. That includes cleanings, fillings, extractions, crowns, root canals, and dentures. Dental work is one of the most common retirement budget busters because even a “small” issue can turn into a multi-thousand-dollar treatment plan quickly. Medicare may cover dental services in very limited situations when they are tied to a covered medical procedure, such as certain jaw surgeries or medically necessary dental work related to radiation treatments. But for everyday dental care, Medicare is not the payer. Many retirees solve this gap by purchasing a standalone dental plan. Typical plans may provide annual benefit maximums and can help reduce costs for cleanings and basic services, but it’s important to read the fine print especially waiting periods, coverage limits, and exclusions for major work.

4) Routine Physical Exams

Many people assume Medicare covers an annual physical the same way employer insurance often does. But Original Medicare generally does not cover routine physical exams. What Medicare does cover instead are two specific preventive visits: a one-time “Welcome to Medicare” visit during the first 12 months of Part B enrollment, and an Annual Wellness Visit each year after that. These visits are not traditional physicals. They focus more on health risk assessments, preventive screenings, vaccinations, and planning not a head-to-toe exam with full lab panels. Some Medicare Advantage plans may include more robust annual checkups or expanded wellness visits at no additional cost, depending on the plan.

5) Most Chiropractic Care (And Limited Acupuncture Coverage)

Medicare’s chiropractic coverage is extremely limited. It typically covers only manual manipulation of the spine to correct a subluxation, and it must be medically necessary. Medicare does not cover maintenance chiropractic care, and it does not cover many other chiropractic services that people often receive as part of ongoing wellness routines. Acupuncture coverage is also limited. Medicare covers acupuncture only for chronic low back pain under specific rules, and there are limits on the number of treatments allowed in a year unless improvement is documented. Some Medicare Advantage plans may offer additional chiropractic or alternative therapy benefits with copays, but coverage and availability vary by plan and county.

6) Long-Term Nursing Home Care

This is one of the biggest Medicare misconceptions. Medicare does not cover long-term nursing home care or custodial care in a long-term care facility. That type of care is usually paid through personal savings, long-term care insurance, or Medicaid for those who qualify financially. Medicare can cover skilled nursing facility care in limited situations, typically after a qualifying hospital stay and when skilled rehab services are needed. This is short-term recovery care, not long-term residence. The rules can be strict, and coverage is not automatic. Many people find out too late that Medicare is not designed to fund long-term nursing home stays. This is why retirement planning needs to include a realistic long-term care conversation, especially for people with family history, chronic conditions, or limited caregiver support.

7) Medical Care During Foreign Travel

Original Medicare generally does not cover medical care outside the United States and its territories. That means an emergency overseas can become financially devastating fast. Medical bills abroad can reach tens of thousands, or far more, especially if hospitalization or emergency transport is involved. Some Medicare Supplement (Medigap) plans offer limited foreign travel emergency coverage, but it’s typically capped and comes with deductibles and lifetime maximums. That’s why many retirees choose travel medical insurance when leaving the country, especially for cruises, Europe trips, or extended international travel. Travel health coverage can be the difference between a manageable emergency and a life-changing financial hit.

The Bottom Line

Medicare is a strong foundation for healthcare in retirement, but it is not an all-inclusive plan. The biggest uncovered costs tend to come from vision, hearing, dental, long-term care, and travel. The best retirement healthcare strategy is not guessing it’s building a plan that accounts for these gaps early, before they turn into expensive surprises.