What Medicare Doesn’t Cover — And How to Plug the Gap

The Truth: Medicare Isn’t Designed to Cover Everything

Think of Medicare as a 🪜 ladder that gets you partway up the wall of healthcare coverage — but not all the way to the top. You’ll need extra rungs to reach complete protection, and knowing what’s missing is the first step to avoiding painful (and costly) surprises.

✅ What Original Medicare Actually Covers

💬 Testimonial — Kathy (Mall Walker)
“I thought my plan would cover me everywhere. Then I found out it didn’t include anything when I visited my daughter out of state. I learned the hard way that Medicare has limits — and you have to plan for what it doesn’t cover.” — Kathy

Original Medicare (Parts A and B) does cover a lot:

• 🏥 Hospital stays (inpatient care)
• 👩‍⚕️ Doctor visits and outpatient care
• 🧪 Lab tests and preventive screenings
• ⚕️ Surgeries and medically necessary equipment
• 🏡 Some home health and hospice care

👉 But here’s where the ladder stops: dental, vision, and hearing are the “big three” that Medicare does not pay for. That leaves many seniors in places like ZIP 29582 North Myrtle Beach, SC or ZIP 29340 Gaffney, SC paying out of pocket for essential care like glasses, hearing aids, and cleanings.

🚫 The Shocking Reality of Coverage Limits

Even when Medicare covers something, there are gaps:

• Part A deductible in 2025 = $1,632 per hospital stay
• Part B deductible in 2025 = $240
• After that? A flat 20% coinsurance on most Part B services
• ❌ And no out-of-pocket maximum

That means if you need surgery in Florence, SC or a joint replacement in Myrtle Beach, you could still face bills of $8,000+ even though Medicare “covered” the procedure.

💡 Why These Gaps Exist in the First Place

When Medicare started back in 1965, it was built to protect seniors from catastrophic hospital bills — not everyday health costs. Back then, routine dental, vision, and hearing care weren’t seen as essential. Today, we know they’re critical for staying independent and healthy — but Medicare’s rules haven’t caught up.

✅ That’s why it’s so important to learn what’s missing and explore smart options to plug these gaps.

Dental Care Costs Not Covered by Medicare

Put yourself in the shoes 👟 of a 72-year-old retiree in ZIP 29577 Myrtle Beach, SC who just learned they need a crown. The dentist quotes $1,400, and Medicare won’t pay a dime. Now imagine needing dentures at $3,000 or root canal therapy at $1,200. This is the reality for thousands of seniors in Horry and Georgetown Counties who assume their Medicare will handle dental care the same way their old job insurance once did.

🦷 Routine Cleanings and Exams — All Out of Pocket

Medicare does not cover:

• Cleanings
• Exams
• Fillings
• Tooth extractions
• Dentures

The only exception is if dental work is tied to a covered medical procedure — for example, jaw reconstruction after an accident. Otherwise, that twice-yearly cleaning at a local dentist in Conway or Murrells Inlet costs $200–$400 per year straight from your pocket.

💰 Major Dental Work Can Break Your Budget

Here’s what seniors in ZIP 29582 North Myrtle Beach often face:

*Unless part of a covered medical procedure

👉 With dental insurance or a Medicare Advantage plan that includes dental, you can save $400+ annually on routine care alone — and thousands on major work like crowns or dentures.

🔍 Options to Add Dental Coverage

Seniors in Georgetown, Florence, and Charleston have three main choices:

1. 🦷 Standalone dental insurance: $15–$50/month
2. 🦷 Medicare Advantage plans with dental benefits
3. 🦷 Dental discount plans

✅ A couple from ZIP 29440 Georgetown, SC saved $2,400 on implants by adding dental coverage during the Annual Enrollment Period.

📢 Mid-Article CTA #1
Dental, vision, and hearing aren’t part of Original Medicare — Palmetto Mutual can show you affordable ways to add them.

Vision Exams, Glasses, and Eye Care Left Out

Like a 🌟 glow stick that only lights up once you snap it, Medicare’s vision coverage only “turns on” in certain medical situations. For most seniors in ZIP 29505 Florence, SC or ZIP 29582 North Myrtle Beach, SC, routine check-ups, glasses, and contacts are left in the dark. Unless you have diabetes, glaucoma, or macular degeneration, you’ll be paying for vision care yourself.

💬 Story Block — Dorothy (Former Truck Driver)
“I drove trucks for decades and thought Medicare worked like my job insurance. My first dental visit cost me $900 out-of-pocket, and that’s when I realized dental and vision weren’t included. I added a plan that covered all three and finally felt like I was protected from head to toe.” — Dorothy

👓 Routine Eye Care Is Your Responsibility

💬 Testimonial — Laura (Chess Club Veteran)
“My grandson asked me why I didn’t get extra coverage for dental and vision. I told him Medicare didn’t include it, and I thought I’d missed my chance. Turns out, there are ways to add coverage later. I wish I’d asked sooner.” — Laura

Medicare doesn’t cover:

• Routine eye exams 👁️
• Glasses 👓
• Contact lenses 👀

Seniors in ZIP 29340 Gaffney, SC typically spend $200–$300 annually on exams and another $400–$600 for glasses — costs that climb fast on a fixed income.

🏥 When Medicare Does Cover Eye Care

Medicare does help when it’s tied to certain conditions:

• Eye exams for diabetic retinopathy
• Glaucoma tests (for high-risk individuals)
• Macular degeneration tests and treatments
• Cataract surgery (plus one set of glasses or contacts afterward)

👉 Preventive and routine care? That’s all on you.

📊 The Hidden Cost of Neglecting Vision

Not keeping up with vision care can cause bigger problems:

• Seniors with poor vision have a 40% higher risk of falls
• Falls often lead to hospital stays, rehab, or even assisted living

And here’s the scary part: Medicare does not cover long-term custodial care. In South Carolina, assisted living can run $4,500+ per month, quickly draining retirement savings.

✅ Planning ahead with supplemental coverage for vision care isn’t just about glasses — it’s about protecting your independence and your wallet.

Hearing Aids and Hearing Services You’ll Pay For

Here’s the 🧮 broken calculator math of Medicare and hearing care:

• 👂 1 in 3 seniors has hearing loss
• 💸 Average cost of hearing aids = $4,000–$6,000 per pair
• ❌ Medicare coverage = $0
• ⏳ Most people wait 7–10 years before getting help
• 🧾 Out-of-pocket cost over 10 years = $12,000–$20,000

The “calculator” is broken because Medicare’s formula hasn’t been updated since hearing aids were considered a luxury instead of a medical necessity.

🔊 Hearing Aids — A Major Expense Medicare Ignores

Medicare does not cover:

• Hearing exams for fitting hearing aids
• The hearing aids themselves
• Fittings, cleanings, or adjustments

In ZIP 29588 Myrtle Beach, SC, quality hearing aids cost $2,000–$3,000 per ear. Many seniors skip them entirely, which can lead to isolation, strained relationships, and even faster cognitive decline.

💵 The Real Cost Impact by Age and Location

[Cost Format #35 — ZIP + Age Delta Format]

• In ZIP 29340 Gaffney, SC:
  • At age 65 → Plan G premium = $118/month
  • At age 70 → Same coverage = $144/month

📈 As premiums rise, adding hearing aid costs on top can overwhelm a fixed budget. That’s why many seniors in North Myrtle Beach and Florence are turning to:

• Medicare Advantage plans with hearing allowances ($500–$2,000 per year)
• Standalone hearing insurance
• Hearing aid discount programs

👉 Together, these can cut hearing costs by 40–60%.

🎯 Smart Ways to Reduce Hearing Care Costs

Practical solutions include:

• Medicare Advantage plans with built-in hearing aid benefits
• 💳 Discount programs through groups like AARP
• 🛒 Over-the-counter hearing aids now available for mild-to-moderate loss ($200–$800)

✅ For seniors in Horry County, these options can mean the difference between staying connected to family conversations — or feeling left out at every holiday dinner.

Long-Term Care and Assisted Living Expenses

Medicare acts like a 🔌 surge protector — it shields you from sudden power surges like hospital stays and surgeries, but it doesn’t guard against the steady drain of long-term care costs. For seniors in ZIP 29582 North Myrtle Beach or ZIP 29506 Florence, SC, this gap can quickly wipe out savings.

🏡 The $100,000+ Gap Nobody Talks About

💬 Testimonial — Linda (Retired Factory Worker)
“I signed up for Plan G thinking it covered everything. When I went to the pharmacy in town, I was shocked to learn prescriptions weren’t included. I had to add a Part D plan later. It taught me: Medicare has holes, and you need to fill them.” — Linda

Medicare covers up to 100 days in a skilled nursing facility — but only after a 3-day hospital stay and only for skilled care.

❌ Custodial care (help with bathing, dressing, or eating) isn’t covered.

💰 The average cost for a private nursing home room in South Carolina is $9,034/month. That means a year of care can exceed $100,000.

📈 Assisted Living vs. Skilled Nursing — Both Expensive

🦶 Even Routine Foot Care Falls Through the Cracks

Beyond nursing homes, Medicare leaves out smaller but important services.

• Routine foot exams
• Corn and callus removal
• Nail trimming

Unless you have diabetes or circulation issues, these are not covered. A retired nurse in Florence reported paying $75 every six weeks for basic foot care — adding up to $650+ per year.

📢 Mid-Article CTA #2
Long-term care isn’t covered by Medicare — Palmetto Mutual’s experts will help you plan ahead so your savings don’t get drained by surprise.

Routine Foot Care and Other Everyday Health Needs

Medicare coverage is like a 🧩 puzzle with missing pieces. You’ve got the big parts — hospital care, doctor visits, and surgeries — but the smaller pieces that make your health picture whole aren’t always included.

Some of the missing puzzle pieces for seniors in ZIP 29505 Florence, SC and ZIP 29582 North Myrtle Beach include:

• 🦶 Routine foot care (unless you have diabetes)
• 😷 Cosmetic procedures
• 🌿 Acupuncture (limited coverage)
• 🌀 Most chiropractic care
• 📋 Routine physical exams
• 🦷 Dental and 👓 vision care

Without these pieces, your coverage picture will always feel incomplete.

🦶 Foot Care Adds Up Fast for Seniors

Unless you have diabetes or circulation problems, Medicare won’t cover nail trimming, corn removal, or basic podiatry.

In areas like Georgetown County, seniors pay $50–$100 per visit — meaning monthly care can cost $600–$1,200 per year. That’s a big bite out of a fixed retirement budget.

🌍 Travel Coverage Stops at the Border

Here’s another puzzle piece missing: medical care abroad.

• Medicare generally does not cover care outside the U.S.
• Rare exceptions: emergencies near the Canadian or Mexican borders

Example: A couple from Horry County went on a Caribbean cruise and faced a $15,000 ER bill after a sudden illness — completely uncovered by Medicare.

👉 Some Medigap plans include foreign travel emergency coverage, but Original Medicare leaves you unprotected overseas.

💊 Alternative Treatments Usually Not Covered

Seniors in ZIP 29340 Gaffney, SC often ask if services like chiropractic or acupuncture are covered.

The answer is mostly ❌ no:

• Chiropractic care (beyond manual manipulation)
• Massage therapy
• Acupuncture (except chronic low back pain)
• Many alternative therapies

For many, these services are key to staying active and pain-free, yet they can cost $2,000–$3,000 annually out of pocket.

✅ Medicare’s puzzle has big gaps, but with the right planning, you can find the missing pieces before they cause financial strain.

Overseas Medical Care and Travel Emergencies

Like a 🔍 magnifying mirror, taking a closer look at Medicare’s travel coverage reveals a glaring flaw: once you leave U.S. soil, your protection almost disappears. For retirees in ZIP 29582 North Myrtle Beach or ZIP 29440 Georgetown, SC who love cruises or overseas trips, this gap can be devastating.

💬 Story Block — Elaine (Retired School Bus Driver)
“I thought long-term care was included in Medicare. Then my friend had to move into a nursing home and paid over $6,000 a month. That’s when I realized how wrong I was. I got coverage to fill that gap because I don’t want my family to face that kind of bill.” — Elaine

✈️ Why Your Medicare Card Is Useless Abroad

Medicare does not cover most medical services outside the U.S. The only exceptions are:

• Emergency care in Canada or Mexico if closer than a U.S. hospital
• Traveling through Canada on your way to or from Alaska

👉 A European vacation, Caribbean cruise, or trip to Costa Rica? You’re completely on your own.

💰 Cross-Border Cost Comparisons Reveal the Risk

[Cost Format #36 — Cross-Border Price Check]

• In ZIP 29341 Gaffney, SC, Plan N premiums are often $10–$15 cheaper than in nearby ZIPs. That small difference shows how geography shapes your costs.
• But once you cross an international border, the risk skyrockets:
  • A heart attack treated in South Carolina → Covered by Medicare
  • The same emergency in Costa Rica → $30,000+ out-of-pocket

👉 Some Medigap plans (C, D, F, G, M, N) include foreign travel emergency coverage:

• Up to $50,000 lifetime benefit
• After a $250 deductible

💊 Don’t Forget: Prescriptions Aren’t Covered Either

Another hidden danger: Original Medicare doesn’t include prescription drug coverage.

• You’ll need either a standalone Part D plan or a Medicare Advantage plan with drug coverage.
• Without it, common prescriptions like Eliquis can cost $550 per month.

Example: A retired firefighter from Pennsylvania skipped Part D because he didn’t need many meds. Two years later, a new prescription cost him $400 monthly, plus a late enrollment penalty that lasts for life.

✅ If you love to travel or cruise out of Charleston or Wilmington, make sure your Medicare plan includes the right protection before you leave the dock.

Cosmetic Procedures and Non-Essential Services

The Mistake Multiplier effect happens when seniors assume switching plans is too complicated — so they stick with coverage that doesn’t fit. One wrong assumption can snowball into thousands lost. For seniors in ZIP 29582 North Myrtle Beach or ZIP 29405 North Charleston, this mistake can be costly.

Here’s how it multiplies:

• ❌ Mistake 1: Assuming cosmetic procedures are covered (they’re not)
• ❌ Mistake 2: Skipping annual plan reviews (missing new benefits or rising costs)
• ❌ Mistake 3: Ignoring Medicare Advantage (which may include extras Original Medicare never will)
  ➡️ Result: $3,000 for a cosmetic mole removal + $2,400 in unnecessary premiums + $1,800 in missed benefits = $7,200 lost

🏥 The Fine Line Between Medical and Cosmetic

Medicare only covers what’s considered medically necessary.

• ✅ Suspicious mole removal (possible skin cancer) → Covered
• ❌ Mole removal for appearance only → Not covered

Many seniors discover this too late when their doctor recommends a treatment Medicare won’t pay for.

📋 Real Examples of Coverage Denials

🔄 Annual Review Prevents Multiplying Mistakes

The biggest mistake? ❌ Not checking your plan each year.

Plans change — premiums rise, networks shrink, drug lists shift.

📍 Example: A woman in Florence County, SC stayed in the same plan for 5 years. When she finally reviewed her options, she found a nearly identical plan for $60 less per month. That’s $3,600 wasted.

📢 Mid-Article CTA #3
Don’t get caught off guard by out-of-pocket costs — Palmetto Mutual can help you find options that close the gaps.

How Seniors Can Fill the Biggest Medicare Gaps

Medicare’s uncovered costs act like hidden tripwires along your retirement path. You’re walking along just fine until suddenly—💥—a big bill knocks you off balance. For seniors in ZIP 29505 Florence, SC or ZIP 29340 Gaffney, SC, knowing how to protect yourself is the difference between peace of mind and financial stress.

🛡️ Medigap Plans — Your First Line of Defense

Medigap (Medicare Supplement) plans are designed to pay what Medicare doesn’t:

• ✅ Part A and B deductibles
• ✅ Part B’s 20% coinsurance
• ✅ Part A hospital coinsurance
• ✅ Skilled nursing coinsurance
• ✅ Even foreign travel emergencies with certain plans

👉 Plan G is the most popular. It covers everything except the small Part B deductible, giving seniors predictable costs instead of unlimited surprises.

🎯 Medicare Advantage — Different Approach, Different Benefits

Medicare Advantage works differently. Instead of supplementing Original Medicare, it replaces it and often includes:

• 🦷 Dental
• 👓 Vision
• 👂 Hearing
• 💊 Prescription drug coverage
• 🏋️ Gym memberships or OTC allowances

📍 Example: A retired accountant in Virginia switched from Medigap to Medicare Advantage. He saved $200/month and gained dental + vision coverage, though he had to accept provider networks.

💡 How Medigap Fills the Biggest Out-of-Pocket Costs

The biggest “tripwire” is the 20% Part B coinsurance. Without Medigap:

• Cancer treatment costing $50,000 → You owe $10,000
• Heart surgery costing $100,000 → You owe $20,000

A couple in North Carolina faced $15,000 in uncovered bills after a stroke. They enrolled in Plan G the next year and now pay $280/month combined for complete peace of mind.

✅ Whether you choose Medigap or Medicare Advantage, the key is plugging the gaps before you trip over them.

Steps to Take Now to Protect Yourself from Surprise Costs

Think of this like the Coverage Championship 🥊 — where different Medicare choices face off head-to-head. The winner depends on your needs, but knowing the matchups helps you avoid costly surprises.

Round 1: Original Medicare vs. Original Medicare + Medigap

• 🏥 Original Medicare alone → Unlimited 20% coinsurance exposure
• 🛡️ With Medigap → Predictable monthly costs, no surprise bills

✅ Winner: Medigap combo for financial protection

Round 2: Medigap vs. Medicare Advantage

• 🛡️ Medigap → Higher premiums, any doctor, no networks
• 🌟 Medicare Advantage → Lower premiums, extras (dental, vision, hearing), but with networks & authorizations

⚖️ Winner: Depends on your priorities (flexibility vs. benefits)

Round 3: Part D vs. Medicare Advantage with Drugs

• 💊 Standalone Part D → Works with Original Medicare, flexible pharmacy choice
• 💊 MAPD (Medicare Advantage with drugs) → One-stop coverage, but may limit pharmacies

📌 Winner: MAPD for simplicity, Part D for flexibility

✅ Immediate Actions to Take Today

• 📋 List your doctors, medications, and likely procedures
• 🧾 Compare your yearly out-of-pocket costs under different plans
• 📅 Review your plan during Annual Enrollment (Oct 15–Dec 7) — switching can save thousands

📅 Critical Enrollment Deadlines to Remember

• Initial Enrollment Period: 3 months before → month of → 3 months after turning 65
• Medigap Open Window: First 6 months after enrolling in Part B → no health questions asked
• Annual Enrollment Period: Oct 15–Dec 7 → change Medicare Advantage or Part D

🎯 Understanding How Medicare Advantage Can Fill Some (But Not All) Gaps

Medicare Advantage is great at filling certain holes:

• 🦷 Dental
• 👓 Vision
• 👂 Hearing
• 🛒 OTC and gym benefits

But it can also add new challenges:

• Prior authorizations ⏳ (delays care)
• Network restrictions 🚫 (doctor choice limited)
• Out-of-pocket maximums = $4,500–$7,500 annually

📍 Example: A retired teacher in Florida loved her $0 premium Advantage plan with dental — until she needed a specialist out-of-network. One hospital stay maxed her out at $6,700.

✅ The key is reviewing your needs now — before the bills arrive.