Original Medicare provides essential health coverage for millions of Americans. However, it does not cover every healthcare service.

Original Medicare includes:

• Part A (Hospital Insurance) – helps pay for inpatient hospital care and skilled nursing facility stays.
• Part B (Medical Insurance) – covers outpatient services, preventive care, doctor visits, and medical supplies.

While these benefits are significant, several common services — including vision, hearing, and dental care — are generally not covered.

Many people fill these coverage gaps with Medicare Advantage plans or supplemental coverage.

Understanding Medicare Costs

Before exploring what Medicare doesn’t cover, it’s helpful to understand a few key terms used in Medicare plans.

Out-of-Pocket Costs

These are healthcare expenses you pay yourself when Medicare doesn’t cover the full cost. They include premiums, deductibles, coinsurance, and copayments.

Premium

The monthly payment required to maintain your Medicare coverage.

Deductible

The amount you must pay out of pocket each year before Medicare begins covering services.

Coinsurance

Your share of the cost for a service. For example, under Medicare Part B, you usually pay 20% of the approved amount.

Copayment

A fixed dollar amount you pay for certain services or medications.

1. Vision Care

Original Medicare generally does not cover routine vision services, including:

• Routine eye exams
• Prescription eyeglasses
• Contact lenses

This means beneficiaries typically pay 100% of the cost for these services.

When Vision Care May Be Covered

There is one important exception.

If you undergo cataract surgery with an intraocular lens, Medicare Part B may cover one pair of prescription glasses or contact lenses.

After meeting your Part B deductible, you usually pay 20% of the Medicare-approved amount.

The condition treated during this surgery is known as Cataracts.

2. Hearing Care

Original Medicare does not cover hearing aids or exams for fitting hearing aids.

As a result, beneficiaries usually pay the full cost of hearing aids.

What Medicare Does Cover

Medicare Part B may cover hearing or balance exams if your doctor determines they are medically necessary for diagnosis or treatment.

You may also qualify for a yearly audiologist visit without a referral if you:

• Have long-term hearing loss
• Have hearing loss after receiving a hearing implant

After the Part B deductible is met, you typically pay 20% of the approved cost.

3. Dental Services

Routine dental care is another major coverage gap in Original Medicare.

The following services are generally not covered:

• Routine cleanings
• Fillings
• Tooth extractions
• Dentures

Patients typically pay 100% of these costs.

When Dental Care May Be Covered

Medicare may provide coverage when dental services are directly related to a covered medical procedure, such as:

• Dental exams before a heart valve replacement
• Dental treatment before an organ transplant
• Tooth extraction required before cancer treatment

For covered outpatient dental services, you typically pay 20% of the Medicare-approved amount after meeting the Part B deductible.

4. Foot Care (Podiatry)

Routine foot care is not covered unless it is medically necessary.

Coverage may apply if you have conditions such as:

• Diabetes-related nerve damage
• Foot injuries
• Structural foot problems like bunions or heel spurs

After meeting the Part B deductible, you generally pay 20% of the approved treatment cost.

5. Routine Physical Exams

Original Medicare does not cover traditional annual physical exams.

However, Medicare Part B does provide annual wellness visits.

During a wellness visit, your doctor may:

• Review your medical and family history
• Check your weight, height, and blood pressure
• Review medications
• Assess cognitive health
• Create a personalized prevention plan

These visits help identify risks for conditions such as Dementia.

6. Cosmetic Surgery

Cosmetic or aesthetic procedures are generally not covered by Original Medicare.

Examples include:

• Eyelid surgery
• Nose reshaping
• Removal of excess abdominal skin

However, procedures may be covered if they are medically necessary or reconstructive.

For example, Medicare typically covers breast reconstruction surgery after a mastectomy for Breast Cancer.

7. Chiropractic Services

Medicare Part B does cover a limited chiropractic service.

It pays for manual spinal manipulation to correct a spinal misalignment called a vertebral subluxation.

However, Medicare does not cover other chiropractic services, such as:

• X-rays ordered by chiropractors
• Massage therapy
• Additional therapies

8. Massage Therapy

Massage therapy is not covered under Original Medicare — even if recommended by a doctor.

Patients must pay 100% of the cost for massage services.

9. Long-Term Care

Original Medicare does not cover long-term custodial care.

Examples of non-covered services include:

• Assistance with dressing or bathing
• Meal preparation or delivery
• Adult day care services
• Community-based personal care

Some people may qualify for long-term support through Medicaid or specialized programs such as Program of All‑Inclusive Care for the Elderly (PACE).

However, Medicare may cover short-term skilled care, including:

• Up to 100 days in a skilled nursing facility after hospitalization
• Home health services such as physical therapy
• Hospice care for terminal illnesses

10. Healthcare Outside the United States

Original Medicare generally does not cover healthcare services outside the U.S.

However, a few exceptions exist:

• A foreign hospital is closer during a medical emergency
• You are traveling through Canada and an emergency occurs
• You are on a ship within U.S. territorial waters

Coverage may include emergency treatment or ambulance transport to a foreign hospital.

The Bottom Line

Original Medicare provides important healthcare coverage but does not pay for many common services, including:

• Vision care
• Hearing aids
• Dental services
• Long-term care
• Routine physical exams
• Cosmetic procedures

To fill these gaps, many beneficiaries enroll in additional coverage options such as Medicare Advantage plans, supplemental insurance, or Medicaid programs.

Understanding what Medicare covers — and what it doesn’t — can help you make better decisions about your healthcare and financial planning.