Medicare:
What's Not Covered
How to Fill the Gaps
What Does Medicare Not Cover (and How to Fill the Gaps)
If you’ve ever felt confused, overwhelmed, or worried that Medicare might leave you with surprise bills, you’re not alone. As an insurance agent who helps people every day, I can tell you this: understanding what Medicare doesn’t cover is just as important as understanding what it does.
The good news?
Once you know the gaps, filling them becomes simple and stress-free.
Let’s walk through the most common areas of confusion—clearly, calmly, and in plain English.
1. Long-Term Care (Custodial Care)
This is the biggest gap in Medicare and the one most people are shocked by.
Medicare does cover short-term skilled nursing following a hospital stay, but once you no longer need skilled care, coverage ends.
How to fill this gap:
Long-term care insurance
Hybrid life insurance + LTC riders
Annuities with long-term care benefits
Medicaid planning (for those who qualify)
If you’re planning for retirement, ignoring long-term care can create major financial strain. It’s much easier—and cheaper—to prepare early._
2. Dental, Vision, and Hearing Services
Original Medicare doesn’t cover:
Routine dental cleanings, fillings, dentures
Eye exams for glasses
Hearing exams or hearing aids
These costs can add up quickly, especially for seniors who need ongoing care.
How to fill this gap:
Medicare Advantage (MA) plans with built-in dental/vision/hearing
Standalone dental and vision plans
Discount programs or flexible benefit cards through some MA plans
A good agent can help you compare whether an Advantage plan or standalone coverage fits your needs and budget.
3. Prescription Drugs (Part D Coverage Needed)
Many people don’t realize that Original Medicare has no prescription drug coverage.
How to fill this gap:
Enroll in a Medicare Part D plan
Use an MAPD (Medicare Advantage with drug coverage)
Explore cost-savings tools like GoodRx alongside your plan (when allowed)
I can simplify comparing Part D plans—because drug plans change every year.
4. Medical Care Outside the U.S.
Original Medicare generally doesn’t cover you outside the United States or its territories.
How to fill this gap:
Medigap plans (some include foreign travel emergency benefits)
Travel medical insurance for international trips
If you’re a traveler—or want to start traveling—this is a key gap to address.
5. Routine Foot Care, Cosmetic Procedures & Some Chiropractic Services
Medicare excludes:
Routine podiatry
Cosmetic surgeries
Acupuncture (limited exceptions)
Chiropractic care beyond spinal adjustments
It also may not cover services considered “maintenance” rather than medically necessary.
How to fill this gap:
Medicare Advantage plans with expanded benefits
Supplemental insurance
Paying out of pocket (when costs are low)
6. The Gaps in What Is Covered: Deductibles, Copays & Coinsurance
Even when Medicare covers a service, you’re still responsible for cost-sharing.
Part A hospital deductible
Part B 20% coinsurance
No maximum out-of-pocket limit in Original Medicare
This is one of the biggest reasons people seek help.
How to fill this gap:
Medigap plans (excellent for predictable costs)
Medicare Advantage (includes a max out-of-pocket limit)
Savings accounts, HSAs prior to Medicare, or budgeting tools
You Can Make Medicare Simple
Medicare is confusing—there’s no denying that. But the moment you understand its gaps, you can make confident decisions about how to protect yourself.
As an insurance agent, my goal is always to help you avoid surprises, reduce your costs, and make sure you never feel alone in this process. With the right combination of Medicare, supplemental coverage, and planning, you can enjoy peace of mind knowing you’re fully protected.
Schedule a No-Cost Discovery Call
If you want help reviewing your situation or comparing your options, I’m always here to guide you step-by-step.
Serving Retirees in Greater Fredericksburg and Northern Virginia
295 Worth Ave #1052 Stafford, VA 22556
Call/Text: 540-992-0332
Medicare Disclaimer: I do not offer every plan available in your area. I represent a number of Medicare Advantage organizations, which offer products in your area. Any information I provide is limited to those plans I do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Disclaimer: I am not affiliated with or endorsed by Medicare or any US government agency. Insurance related solicitation.