What Medicare doesn't cover: dental, vision, hearing aids, nursing homes

Medicare covers a great deal, but not everything, and the gaps tend to show up at the worst moments: a cracked tooth, new glasses, a hearing aid, or a parent who can no longer live alone. Knowing where Original Medicare stops lets you plan for those costs before you need the care, and it is one of the main reasons people compare Original Medicare with Medicare Advantage, Medigap and other coverage.

This guide goes through what Original Medicare (Part A and Part B) does not pay for, the narrow exceptions inside each gap, and the preventive services it does cover at no cost to you. Everything here comes from the government's handbook, Medicare & You 2027, published by the Centers for Medicare & Medicaid Services (CMS). Where dollar amounts appear, they are the 2026 figures the handbook prints, since the 2027 amounts had not been set when it went to print.

The official list of what is not covered

CMS is direct about it: "Medicare doesn't cover everything." If you need a service that Part A or Part B does not cover, you pay for it yourself unless you have other coverage, including Medicaid, or you are in a Medicare Advantage Plan or Medicare Cost Plan that covers it. The handbook lists these among the items and services Original Medicare does not cover:

• Non-medical long-term care.
• Eye exams for prescription eyeglasses and contact lenses.
• Cosmetic surgery.
• Massage therapy.
• Routine physical exams.
• Hearing aids and exams for fitting them.
• Concierge care, also called retainer-based, boutique or direct care.
• Covered services from a doctor who has opted out of Medicare, except in an emergency or urgent need.
• Most dental care.

Each of those has details worth knowing, and a few have exceptions that can save real money. The sections below take the big ones in turn.

Dental care

In most cases, Original Medicare does not cover dental services such as routine cleanings, fillings and tooth extractions, or items like dentures. The handbook notes one exception: Original Medicare may pay for some dental services that are closely related to certain covered services, including:

• A heart valve repair or replacement.
• An organ transplant.
• Cancer-related treatments.
• Dialysis for End-Stage Renal Disease.

Outside those situations, dental care is something you plan for separately. Many Medicare Advantage Plans offer dental benefits as an extra, but CMS cautions that extra benefits are generally limited, so read what a plan actually covers before counting on it. Medigap does not fill this gap; the handbook says Medigap generally does not cover vision or dental services. Our Original Medicare vs Medicare Advantage guide compares the two paths in detail.

Vision: exams, glasses and the cataract exception

Original Medicare does not cover eye exams for prescription eyeglasses or contact lenses, and it does not usually cover the glasses or contacts themselves. There is one notable exception. After each cataract surgery that implants an intraocular lens, Medicare covers one pair of eyeglasses with standard frames, or one set of contact lenses. They have to come from a supplier enrolled in Medicare, and after the Part B deductible you pay 20% of the Medicare-approved amount.

Medicare does cover some eye care tied to disease. A glaucoma screening is covered once every 12 months if you are at high risk, which the handbook defines as having diabetes or a family history of glaucoma, being African American and 50 or older, or being Hispanic and 65 or older. An eye doctor legally allowed to do glaucoma screenings in your state must do or supervise it. For this screening you pay 20% of the Medicare-approved amount, the Part B deductible applies, and there is a copayment in a hospital outpatient setting.

Hearing: exams yes, hearing aids no

Original Medicare does not cover hearing aids or exams for fitting them. It does cover diagnostic hearing and balance exams when your doctor orders them to find out whether you need medical treatment. You can also see an audiologist once every 12 months without a doctor's order, but only for non-acute hearing conditions, such as hearing loss that develops over many years, and for diagnostic services related to hearing loss treated with surgically implanted hearing devices. For these exams you pay 20% of the Medicare-approved amount after the Part B deductible, plus a copayment in a hospital outpatient setting.

So the exam that tells you whether you have hearing loss can be covered; the hearing aid and the fitting appointment are not. As with dental care, some Medicare Advantage Plans offer hearing benefits as an extra, and Medigap generally does not cover hearing aids.

Long-term care and nursing homes

This is the largest gap, and the one most often misunderstood. In the handbook's words, Medicare and most health insurance, including Medigap, do not pay for non-medical long-term care, whether in a nursing home or in the community. That includes personal care such as help with dressing, bathing and using the bathroom. It can also include adult day health care, transportation, home-delivered meals and other home- and community-based services.

What Medicare does cover is short-term skilled care, under strict conditions. The difference between the two is the single most important thing to understand before a hospital stay.

Skilled nursing facility care

Medicare covers short-term care in a skilled nursing facility only after a qualifying inpatient hospital stay: a medically necessary stay of 3 days in a row or more, counting from the day the hospital formally admits you as an inpatient and not counting the day you leave. Your doctor must also certify that you need daily skilled care, such as intravenous medications or therapy, that as a practical matter you can only get as an inpatient in a skilled nursing facility. For each benefit period, the 2026 amounts were:

A benefit period ends once you have gone 60 days in a row without skilled nursing facility care. You may get skilled care or therapy to improve or to maintain your condition, and the handbook gives a specific example of when to appeal: if you are discharged only because you are not improving but still need skilled care to keep your condition from getting worse.

Some doctors in an Accountable Care Organization approved for a Skilled Nursing Facility 3-Day Rule Waiver can skip the 3-day stay requirement, and Medicare Advantage Plans may also waive it. Ask your provider or plan.

Inpatient or outpatient? Ask every day

The 3-day rule counts inpatient days only, and that is where many families get caught. You are an inpatient when the hospital formally admits you with a doctor's order. You are an outpatient if you are getting emergency or observation services, lab tests or X-rays without a formal admission, even if you spend the night in the hospital. CMS's advice is that each day you stay, you or your caregiver should ask the hospital or your doctor whether you are an inpatient or an outpatient.

If you are kept under observation for more than 24 hours, the hospital must give you a Medicare Outpatient Observation Notice, or MOON, explaining why you are an outpatient and how that affects what you pay in the hospital and for care afterward. You also have appeal rights, under certain conditions, if a hospital changes your status from inpatient to outpatient.

Home health care

Medicare covers home health services under Part A and/or Part B for people who are "homebound" and need part-time or intermittent skilled care, such as skilled nursing, physical therapy or speech-language pathology. Homebound means you have trouble leaving home without help, such as a cane, wheelchair, special transportation or another person, because of an illness or injury; or leaving home is not recommended because of your condition; or you are normally unable to leave home because it is a major effort.

"Part-time or intermittent" has a specific meaning: skilled nursing and home health aide services together of up to 8 hours a day, with a maximum of 28 hours a week (up to 35 hours in some limited situations). A doctor or certain other providers must see you in person, confirm you need the care and order it, and a Medicare-certified home health agency must provide it. You pay nothing for covered home health services, but you pay 20% of the Medicare-approved amount for durable medical equipment, after the Part B deductible.

Hospice care

Hospice is covered when a hospice doctor and your primary care doctor, if you have one, certify that you are terminally ill with a life expectancy of 6 months or less, and you choose comfort care instead of care to cure the illness. You pay nothing for hospice care itself, a copayment of up to $5 per prescription for drugs for pain and symptom management, and 5% of the Medicare-approved amount for inpatient respite care, which lets a caregiver rest for up to 5 days at a time. Medicare will not pay room and board in a facility unless the hospice team decides you need short-term inpatient care. If you are in a Medicare Advantage Plan, Original Medicare is billed for hospice, and you do not have to switch back to Original Medicare to get it.

Planning for long-term care

Since Medicare will not pay for custodial care over the long run, the handbook points to the ways people do pay for it: Medicaid, if you meet your state's eligibility rules; private long-term care insurance; or your own money. Care can be provided at home, in the community, in an assisted living facility or in a nursing home, and CMS encourages starting to plan now. It lists these resources:

• ACL.gov/ltc for long-term care planning information.
• The Eldercare Locator, 1-800-677-1116 or eldercare.acl.gov, to find help in your community.
• Your Long-Term Care Ombudsman, through ltcombudsman.org, for help with services and your rights.
• Your State Medical Assistance (Medicaid) office, through the map at Medicaid.gov.
• Your State Insurance Department for information on long-term care insurance, through content.naic.org/state-insurance-departments.
• "A Shopper's Guide to Long-Term Care Insurance" from the National Association of Insurance Commissioners.

Routine physicals vs the wellness visits

Original Medicare does not cover routine physical exams. What it covers instead are two preventive visits that are easy to confuse with a physical:

• The "Welcome to Medicare" preventive visit, available during your first 12 months with Part B. It reviews your medical and social history and includes education and counseling about preventive services, screenings and vaccines, plus referrals if needed.
• The yearly "Wellness" visit, once every 12 months after you have had Part B for more than 12 months. It develops or updates a personalized prevention plan, starts with a Health Risk Assessment questionnaire, and includes a cognitive assessment to look for signs of dementia. Your first one cannot take place within 12 months of your Part B enrollment or your "Welcome to Medicare" visit.

You pay nothing for either visit if the provider accepts assignment. The catch the handbook warns about: if your doctor performs additional tests or services during the visit that are not covered under the preventive benefit, you may owe coinsurance and the Part B deductible may apply, and if Medicare does not cover them at all, like a routine physical exam, you may pay the full amount. When you book, say you want the "Welcome to Medicare" visit or the yearly "Wellness" visit by name.

Preventive services covered at no cost

On the other side of the ledger, Part B covers many preventive services, and you pay nothing for most of them when your provider accepts assignment. A few of the most common, with the handbook's conditions:

Lung cancer screening, for example, requires that you have no symptoms, currently smoke or quit within the last 15 years, have at least a 20 "pack-year" history, and have an order from your provider, plus a visit beforehand to discuss the benefits and risks. Other vaccines are handled through drug coverage: the handbook says Part D generally covers all other adult vaccines recommended by the Advisory Committee on Immunization Practices, such as shingles, tetanus, diphtheria, pertussis and RSV, at no cost to you.

Other limits worth knowing

• Care outside the U.S. Medicare generally does not cover health care while you travel outside the U.S., with limited exceptions. Some Medigap plans pay 80% of foreign travel emergency care up to plan limits, and some Medicare Advantage Plans offer it as an extra.
• Chiropractic care is covered only for manual adjustment of the spine to correct a subluxation. You pay 20% after the Part B deductible.
• Acupuncture is covered only for chronic low back pain: up to 12 visits in 90 days, and 8 more if you improve, for a maximum of 20 treatments in 12 months.
• Foot care is covered for diabetes-related nerve damage and for medically necessary treatment of injuries or diseases such as hammer toe, bunions and heel spurs.
• In the hospital, Medicare does not cover private-duty nursing, a separately charged television or phone, personal care items, or a private room unless it is medically necessary.
• Telehealth: through December 31, 2027, you can get Medicare telehealth services at any location in the U.S., including your home. You generally pay the same 20% you would in person, after the Part B deductible.

Ways to fill the gaps

The handbook's own answer to "what isn't covered" is that you pay unless you have other coverage. The main options:

• A Medicare Advantage Plan may include extra benefits like vision, hearing and dental care and fitness programs. Check the details, since CMS says these extras are generally limited.
• Medigap helps with Original Medicare's deductibles and coinsurance, but generally not with long-term care, vision, dental, hearing aids, eyeglasses or private-duty nursing.
• Medicaid can cover long-term care if you meet your state's rules, and the Medicare Savings Programs help with Medicare costs for people with limited income and resources.
• Employer, retiree, union or military coverage. Military retirees should read our TRICARE For Life guide, and anyone with other insurance can use the who pays first checker.
• Long-term care insurance or savings, for custodial care Medicare will not pay for.

If you are not sure whether Medicare covers a service, the handbook suggests checking Medicare.gov/coverage, calling 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048), or asking your provider before you get the service. Your State Health Insurance Assistance Program offers free, personalized help; find yours at shiphelp.org. For what you will pay for the services Medicare does cover, see our Part A costs and Part B premium pages.