What Does Original Medicare Not Cover?

Routine dental care

Original Medicare does not cover routine dental services — cleanings, fillings, extractions, root canals, dentures, or routine exams. Dental services performed in a hospital prior to certain procedures (like organ transplant) may be covered, but routine care is not.

If you are enrolled in or considering a private Medicare plan, review the plan's official Evidence of Coverage and the plan listing on Medicare.gov for any plan-specific rules. Coverage rules vary by plan and area; do not rely on broad summaries for plan-specific details.

Routine vision care

Original Medicare covers eye exams when ordered by a doctor for a medical reason — for example, to monitor diabetic retinopathy or glaucoma. It generally does not cover routine eye exams, eyeglasses, or contact lenses. Cataract surgery is covered, and one pair of standard eyeglasses or contact lenses is covered following the surgery.

For plan-specific rules on routine vision coverage, review your plan's official materials and Medicare.gov.

Hearing aids

Original Medicare does not cover routine hearing exams or hearing aids. Diagnostic hearing exams ordered by a doctor for a medical reason are covered under Part B; the hearing aid devices themselves and routine hearing care are not. Hearing aid costs typically run several thousand dollars per pair when paid out of pocket.

For plan-specific information on hearing-related benefits, use Medicare.gov or your plan's official materials.

Prescription drugs

Original Medicare itself does not cover most outpatient prescription drugs. Prescription drug coverage is provided through Part D, which is a separate program offered through private plans approved by Medicare.

You can add a standalone Part D prescription drug plan to Original Medicare. Many Medicare Advantage plans include Part D coverage built in. Either way, drug coverage is sourced through Part D plans rather than from Parts A and B directly. Read more about how Part D works.

Long-term care

Original Medicare does not cover most long-term care. Skilled nursing facility care after a qualifying hospital stay is covered for a limited time under Part A — up to 100 days per benefit period, with cost-sharing after the first 20 days. Custodial care, which is what most long-term care needs become over time, is not covered by Original Medicare.

Long-term care is typically funded through long-term care insurance (a separate insurance product), Medicaid (for those who qualify financially), personal savings, or a combination. Long-term care planning is a distinct topic that often involves a financial planner or estate attorney rather than only an insurance advisor.

Care outside the United States

Original Medicare generally does not cover health care received outside the U.S. There are limited exceptions — certain situations near the U.S. border, on cruise ships in U.S. territorial waters, and others — but the broad rule is that international care is not covered.

People who travel internationally often supplement with travel medical insurance for the trip duration, or consider Medicare Supplement (Medigap) policies that include foreign travel emergency benefits (some Medigap plan letters include this benefit; coverage is limited and policy-specific).

Cosmetic and elective procedures

Original Medicare does not cover cosmetic procedures performed for non-medical reasons, most elective procedures without a medical necessity, weight loss surgery in many circumstances, and similar elective care. Coverage decisions in gray areas depend on documentation of medical necessity.

How to think about gaps

The gaps in Original Medicare aren't a flaw to fix with a single solution — they reflect that Medicare was designed for specific categories of medical care and other care categories live in other systems. People address gaps in different ways depending on what they use and what they value:

• Cost-sharing on covered services: Medigap (Medicare Supplement) policies fill in deductibles, coinsurance, and copays for what Original Medicare does cover.
• Prescription drugs: a standalone Part D plan added to Original Medicare, or a Medicare Advantage plan that bundles Part D.
• Services outside standard Parts A and B rules: verify through Medicare.gov, 1-800-MEDICARE, and any official plan documents before making decisions.
• Long-term care: long-term care insurance, Medicaid (if eligible), or self-funding through savings.
• International care: travel medical insurance for trips, or Medigap plan letters that include foreign travel emergency benefits.

The right combination depends on your situation and preferences. A licensed advisor can help map out what is and isn't covered by your specific configuration.