In short
- Original Medicare doesn't cover routine dental care, dentures, eye exams for glasses, hearing aids or the exams to fit them.
- Medicare doesn't pay for long-term custodial care, such as help with bathing and dressing, at home or in a nursing home.
- There's no yearly limit on what you pay out of pocket in Original Medicare unless you have other coverage like Medigap.
- Most outpatient prescriptions need Part D, and most care outside the U.S. isn't covered at all.
- Medigap fills cost gaps, not benefit gaps. It generally doesn't add dental, vision, hearing aids or long-term care.
Original Medicare, meaning Part A (hospital) and Part B (medical), covers a lot. It doesn't cover everything, and the gaps tend to show up at the worst time: a cracked tooth, new hearing aids, or a parent who needs help at home.
Here is what Medicare.gov lists as not covered, why each gap exists, and how people in Nebraska usually fill it.
What does Original Medicare not cover?
Medicare.gov lists these items and services as not covered by Part A and Part B:
- Most dental care, including routine cleanings, fillings, tooth extractions and dentures
- Eye exams for prescription eyeglasses
- Hearing aids and the exams to fit them
- Non-medical long-term care, also called custodial care
- Cosmetic surgery
- Massage therapy
- Routine physical exams
- Concierge care, meaning retainer or membership fees some practices charge
- Services from providers who have opted out of Medicare, except in emergencies
Two more gaps aren't on that list but catch people off guard. Parts A and B don't cover most outpatient prescription drugs, which is what Part D is for. And Medicare generally doesn't cover health care while you're traveling outside the U.S.
Why does Medicare skip dental, vision and hearing?
Medicare was built to cover medical care, and routine dental, vision and hearing care fall outside it. There are narrow exceptions. Original Medicare may cover dental services linked to certain medical treatments, such as a heart valve repair or replacement, an organ transplant, cancer treatment, or dialysis for end-stage renal disease. Part B also covers some medical care for eyes and ears, like glaucoma screenings for people at high risk, one pair of eyeglasses after cataract surgery with a lens implant, and diagnostic hearing and balance exams your doctor orders.
Day to day, though, cleanings, crowns, dentures, glasses and hearing aids are on you unless you add coverage.
| Gap | Original Medicare | Where people usually get coverage |
|---|---|---|
| Routine dental and dentures | Not covered | Medicare Advantage extras, or a standalone dental policy |
| Eye exams for glasses, eyeglasses | Not covered | Medicare Advantage extras, or a standalone vision policy |
| Hearing aids and fitting exams | Not covered | Medicare Advantage extras, or a hearing policy or discount plan |
| Outpatient prescriptions | Mostly not covered | Part D, or a Medicare Advantage plan with drug coverage |
| Long-term custodial care | Not covered | Savings, long-term care insurance, Medicaid if eligible |
| Emergency care abroad | Generally not covered | Some Medigap plans (80% after a $250 yearly deductible), travel insurance |
| Your 20% share, with no yearly cap | You pay it | Medigap, or a Medicare Advantage plan's out-of-pocket maximum |
Medicare Advantage extras are real, but they vary by plan and by county, and they change every year. A dental benefit might cover two cleanings and little else, or it might include a yearly allowance for bigger work. Read the details. Our page on dental, vision and hearing coverage compares standalone policies with plan extras. Lincoln-based Ameritas and Delta Dental of Nebraska are two of the companies that sell individual dental and vision coverage in the state.
Does Medicare pay for long-term care?
No, not the kind most families mean. Medicare.gov is blunt: "Medicare doesn't pay for long-term care." Long-term care, or custodial care, is help with daily activities like bathing, dressing and eating. Medicare doesn't cover it at home, in assisted living or in a nursing home when that's the only care you need.
What Medicare does cover is short-term skilled care. After a qualifying hospital stay of at least 3 days in a row as an inpatient, Part A can cover up to 100 days in a skilled nursing facility per benefit period. In 2026 you pay $0 for days 1 to 20, $217 a day for days 21 to 100, and everything after day 100.
Medigap doesn't fill this gap either. People pay for long-term care with savings, long-term care insurance, or Nebraska Medicaid if they qualify. Our guide to Medicare and long-term care explains skilled versus custodial care in detail, with Nebraska costs.
What about the costs Medicare leaves you?
Even for covered services, Original Medicare leaves you a share, and there's no yearly limit on it. Medicare & You 2027 puts it plainly: there's no limit to what you'll pay out of pocket in a year unless you have other coverage.
Here is what that share looks like in 2026:
- Part A hospital deductible: $1,736 per benefit period
- Hospital days 61 to 90: $434 a day
- Skilled nursing days 21 to 100: $217 a day
- Part B deductible: $283 a year
- Part B coinsurance: 20% of the Medicare-approved amount, with no ceiling
A $50,000 course of outpatient treatment billed under Part B leaves you a 20% share of $10,000. That math is why most people add a Medicare Supplement, which pays some or all of these costs, or choose Medicare Advantage, which must cap your yearly medical spending. Our side-by-side of Medigap vs Medicare Advantage covers the trade-offs.
Does Medicare cover a yearly checkup?
It covers prevention, not a routine physical. In your first 12 months with Part B, you can get a one-time "Welcome to Medicare" preventive visit. After that, you can get a yearly "Wellness" visit to update a prevention plan. You pay nothing for either when your provider accepts assignment.
Neither is a head-to-toe physical. If your doctor adds tests or treats a new problem during the visit, those parts may carry the usual Part B costs. Ask when you book.
What about care outside the U.S.?
Medicare generally doesn't cover health care outside the U.S. The U.S. here includes the 50 states, Washington, D.C., Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands and American Samoa. There are a few narrow exceptions, such as a foreign hospital that is closer than the nearest U.S. hospital in an emergency.
Medicare drug plans don't cover prescriptions bought abroad. Medigap Plans C, D, F, G, M and N cover 80% of emergency care abroad, up to plan limits. Some Medicare Advantage plans offer a travel benefit. Our guide to Medicare and travel covers snowbirds and trips overseas.
How do you find the gaps that matter to you?
Start with how you actually use care. Do you wear hearing aids? Need dental work soon? Spend winters away? Take a high-cost medication? Each answer points to a different fix.
For unbiased help, call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, 7 days a week (TTY 1-877-486-2048), or Nebraska SHIP at 1-800-234-7119. Our Medicare parts explained guide is a good refresher on what each part does. If you'd like to go through your own list with a local agent, talk to me.
Frequently asked questions
Original Medicare doesn't cover most dental care, including routine cleanings, fillings, tooth extractions and dentures. It may cover dental services tied to certain medical treatments, such as care needed before a heart valve replacement, an organ transplant, cancer treatment, or dialysis for kidney failure. Many Medicare Advantage plans include some dental coverage, and you can also buy a standalone dental policy.
No. Original Medicare doesn't cover hearing aids or the exams to fit them. Part B covers diagnostic hearing and balance exams when your doctor or other provider orders them. Some Medicare Advantage plans offer hearing benefits, and some standalone policies cover hearing aids. Benefits and allowances vary by plan and county and change each year.
Original Medicare doesn't cover routine eye exams for prescription glasses or contacts, and it generally doesn't pay for eyeglasses. It does cover some medical eye care, such as yearly glaucoma screenings for people at high risk, and one pair of standard eyeglasses after cataract surgery with a lens implant. Many Medicare Advantage plans and standalone vision policies cover routine exams and an allowance for glasses.
Medicare doesn't cover a routine physical exam. It does cover a one-time Welcome to Medicare preventive visit in your first 12 months with Part B, and a yearly Wellness visit after that. Those visits focus on prevention and planning, not a hands-on physical. You pay nothing for them when your provider accepts assignment, though extra tests during the visit may cost something.
Generally no. Medicare Supplement (Medigap) policies help pay your share of costs for services Original Medicare covers, such as the Part A deductible and Part B coinsurance. According to Medicare & You 2027, Medigap generally doesn't cover long-term care, vision or dental services, hearing aids, eyeglasses or private-duty nursing. People with Medigap often add a separate dental and vision policy.
No. Original Medicare has no yearly out-of-pocket maximum. After the 2026 Part B deductible of $283, you generally pay 20% of the Medicare-approved amount with no ceiling. That is the main reason people buy a Medigap policy or choose a Medicare Advantage plan, which must have a yearly limit on covered medical costs.
Sources
- Medicare.gov: What's not covered by Part A and Part B (opens in a new tab)
- Medicare.gov: Long-term care coverage (opens in a new tab)
- Medicare & You 2027 handbook (CMS Product No. 10050) (opens in a new tab)
- Medicare.gov: Travel outside the U.S. (opens in a new tab)
- CMS: 2026 Medicare Parts A and B premiums and deductibles (opens in a new tab)
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 or 1-800-MEDICARE to get information on all of your options. 1-800-MEDICARE (1-800-633-4227) is available 24 hours a day, 7 days a week. TTY users can call 1-877-486-2048.
