What are the 6 things that Original Medicare won't cover?

While Original Medicare helps to cover a lot of necessary healthcare expenses during retirement, it won't cover everything. Prapass Pulsub/Getty Images

Original Medicare, which includes Part A for hospital coverage and Part B for medical services, forms the backbone of health insurance for more than 68 million retired Americans right now. This essential coverage was created to pay for seniors' hospital stays, doctor visits and preventive services, and many soon-to-be retirees assume that it's an all-in-one plan, given the coverage it provides. In reality, though, there are significant gaps in what Original Medicare will pay for, which can create unexpected out-of-pocket costs for routine care and specialized services. 

Nearly 90% of Medicare beneficiaries supplement their Original Medicare with additional coverage, according to data from the Kaiser Family Foundation (KFF), which highlights just how common it is for retirees on Medicare to face uncovered expenses. Without any extra coverage in place, many seniors find themselves stuck paying out of pocket for many of the common services Original Medicare won't pay for. Knowing these gaps ahead of time, though, can help you avoid these types of financial headaches while ensuring your healthcare needs are fully protected.

Find out how to ensure that your healthcare costs are covered in retirement.

What are the 6 things that Original Medicare won't cover?

Original Medicare covers a lot, but there are several key areas where it falls short. Here are six common services and expenses that typically aren't covered:

• Regular dental care: Routine dental services, like cleanings, fillings, crowns, dentures, and orthodontics, are generally not covered by Original Medicare. While some medically necessary dental procedures related to surgery or trauma may qualify, preventive and everyday dental care usually comes out of pocket.
• Vision and hearing care: Eye exams for prescription glasses, contact lenses and routine hearing exams or hearing aids are not included under Original Medicare. Exceptions are made for specific conditions like cataract surgery, but everyday vision and hearing needs require alternative coverage.
• Prescription drugs: Original Medicare doesn't cover most outpatient prescription medications. For seniors taking multiple medications, this gap can quickly become costly. Medicare Part D plans, offered through private insurers, are designed specifically to fill this void.
• Long-term care: Nursing home stays, assisted living and custodial care for chronic conditions are largely excluded from Original Medicare. While Medicare generally covers skilled nursing facility care for a limited period after hospitalization, long-term residential care for ongoing support must usually be paid out of pocket or through long-term care insurance.
• Care while overseas: Original Medicare generally does not cover health care services received outside the United States. Travelers needing international care often purchase separate travel insurance or Medicare supplement plans that extend coverage abroad.
• Certain preventive and alternative treatments: While Original Medicare covers some preventive services like screenings and vaccines, it may not cover other recommended preventive measures or alternative treatments, such as acupuncture for chronic pain or comprehensive wellness programs.

Learn more about your Medicare Supplemental coverage options online now.

How to get more Medicare coverage

Fortunately, there are ways to address these coverage gaps. Both Medicare Advantage (Part C) and Medicare Supplement (Medigap) plans offer additional protection. Here's what these plans offer:

• Medicare Advantage plans: Medicare Advantage plans combine Part A and Part B coverage and often include prescription drug coverage (Part D), vision, dental and hearing benefits. These plans are offered by private insurers approved by Medicare and can provide more predictable costs for routine care.
• Medicare Supplemental plans: Medicare supplemental plans are intended to cover some of the out-of-pocket costs that Original Medicare doesn't, such as copayments, coinsurance and deductibles. While they generally don't cover dental, vision or prescription drugs, pairing a Medigap plan with a standalone Part D prescription plan can fill in many financial gaps.

Choosing supplemental coverage depends on your personal healthcare needs, budget and lifestyle. For example, seniors who travel internationally might prioritize a Medicare Advantage plan with overseas emergency coverage, while those with chronic conditions requiring frequent doctor visits may benefit more from Medigap coverage to reduce out-of-pocket costs.

The bottom line

Original Medicare provides a strong foundation of hospital and medical coverage, but it has notable blind spots. Dental care, routine vision and hearing care, prescription drugs, long-term care, international care and certain preventive or alternative treatments are not typically covered, leaving beneficiaries potentially vulnerable to high expenses.

Don't wait until you need care to discover these coverage gaps, however. During your next Medicare enrollment period, carefully evaluate Medicare Advantage plans in your area, consider supplemental coverage options and factor in the true cost of services that Original Medicare doesn't cover. With proper planning, you can avoid being caught off guard by unexpected healthcare expenses for services that are essential to maintaining your quality of life as you age.