What Medicare Doesn’t Cover (And How to Fill the Gaps)

💬 What Medicare Doesn’t Cover (And How to Fill the Gaps)

Navigating Medicare on your own can feel overwhelming.

But you don’t have to figure it out alone.

At Palmetto Mutual, we’ve helped thousands of seniors across the country avoid costly gaps in coverage and get the benefits they deserve.

This guide gives you the facts, the solutions, and the local help you need. ✅

🟦 Services Medicare Doesn’t Cover

Original Medicare (Parts A and B) helps with hospital and doctor bills—but it leaves out some big things many seniors need.

Let’s look at what’s not included and how you can protect yourself from surprise costs.

🟩 Dental, Vision, and Hearing Care

Medicare doesn’t cover most of the everyday care we need to stay healthy and independent.

• ❌ No dental cleanings, exams, or fillings
• ❌ No dentures or gum treatments
• 👓 No routine eye exams or eyeglasses
• 👂 No hearing tests or hearing aids

These aren’t small expenses either. For example, many North Carolina seniors have told us they’ve paid over $3,000 out-of-pocket just for dentures.

And hearing aids can easily cost $2,000 per ear!

💡 Tip: Many Medicare Advantage or standalone dental, vision, and hearing plans can help cover these gaps—often for just a few dollars a month.

🟩 Long-Term Care (Nursing Homes, Assisted Living)

This is one of the biggest misunderstandings about Medicare.

Many people think Medicare will pay for a nursing home if they ever need help with daily activities like bathing, dressing, or eating.

But that’s not the case.

• 🏥 Medicare only pays for short-term care after a hospital stay (like rehab or physical therapy)
• ❌ It does not cover custodial care, which includes help with everyday tasks
• 🏡 Assisted living and long-term nursing home stays are usually not covered

In West Virginia, for example, many seniors pay 70% or more out of pocket for long-term care, which can add up to tens of thousands of dollars over time.

💡 Tip: Planning with long-term care insurance or Medicaid planning can help protect your savings—and your peace of mind.

🟩 Prescription Drugs (Outside of Part D)

Here’s another surprise: Original Medicare doesn’t cover most prescription drugs you pick up at the pharmacy.

That’s where Medicare Part D comes in. Part D is a separate drug plan you can buy to help pay for medications.

But even with Part D, it’s important to understand how it works:

• 💊 Every plan has a formulary (a list of covered drugs)
• 📚 Medications are placed in tiers—lower tiers cost less, while higher tiers can cost more
• 💵 You may still have copays, deductibles, or coinsurance, depending on the drug

Many seniors in states like Arizona and Ohio have found affordable Part D plans that cover generics for as little as $0–$5 per month, depending on their medications.

But not every plan covers every drug, so it’s essential to compare.

💡 Tip: Every year during Open Enrollment, you can review your drug plan and switch if needed.

A quick review can save you hundreds.

🟩 Foreign Travel Emergencies

Planning a vacation outside the U.S.?

✈️ Don’t count on Medicare to come with you.

• ❌ Original Medicare does not cover emergency care when you’re outside the United States
• This includes doctor visits, hospital stays, or ambulance services in another country

That’s why many seniors choose Medigap plans (also called Medicare Supplement plans).

Some of these plans—like Plan G and Plan N—include limited emergency coverage abroad.

🧳 For example, retired Texans who winter in Mexico often choose Medigap plans with foreign travel benefits in case something unexpected happens while they’re away.

💡 Tip: If you travel often or have family overseas, ensure your Medicare coverage includes foreign emergency protection—or consider a separate travel medical plan.

🟦 Hidden Costs That Catch Seniors Off Guard

Even when you think you’re covered, Medicare can surprise you with unexpected bills.

Let’s look at two common ways seniors get caught off guard—how to avoid it.

🟩 Hospital Observation vs. Admission

You might think staying overnight in the hospital means you’ve been admitted—but that’s not always true.

• 🏥 If you’re under “observation status,” Medicare sees you as an outpatient
• This means you could face higher out-of-pocket costs
• ❗ Worst of all, Medicare won’t pay for rehab or skilled nursing care afterward unless you were formally admitted for at least 3 full days

💡 Tip: Always ask your doctor or nurse, “Am I admitted or just under observation?”

It can make a big difference in what Medicare will cover.

🟩 Excess Charges and Out-of-Network Providers

Not all doctors accept Medicare’s full payment rates.

Some charge extra, and if you’re not protected, you pay the difference.

• 💵 These are called “excess charges”
• Medigap Plan G is one of the few plans that covers these extra fees
• Going out-of-network can also lead to surprise bills, especially with Medicare Advantage plans

🏥 In Indiana, many seniors living in rural areas face this problem.

Local hospitals might not be in-network for every plan, so a short visit could lead to big costs if you’re not careful.

💡 Tip: If you see a specialist or visit a smaller hospital, double-check that they accept Medicare. If you’re on Advantage, make sure they’re in your network.

🟦 How to Fill the Gaps Medicare Leaves Behind

Now that you know what Medicare doesn’t cover, let’s discuss your options.

The good news? There are ways to protect yourself, without breaking the bank.

🟩 Medigap Plans (Medicare Supplement Insurance)

Medigap plans (also called Medicare Supplement Insurance) help cover the “gaps” in Original Medicare, like deductibles, copays, and coinsurance.

There are a few popular options to choose from:

• 🛡️ Plan G: The most complete coverage available for new enrollees. It covers everything Medicare doesn’t—except the small Part B deductible.
• 💲 High-Deductible Plan G: Same benefits as Plan G, but with a much lower monthly premium. You’ll pay more up front if you need care, but it’s a smart option if you’re healthy and budget-conscious.
• 🔄 Plan N: Lower premium than Plan G. You pay small copays at the doctor and ER, but still get strong coverage with no excess charges if used wisely.

📍States like Michigan and Pennsylvania are known for having very competitive Medigap pricing, which means seniors there can often get strong coverage at a great rate.

💡 Tip: Medigap plans work nationwide and let you see any doctor who accepts Medicare—no referrals, no networks, no surprises.

🟩 Medicare Advantage Plans (Part C)

Medicare Advantage (Part C) is another way to get your Medicare benefits.

Private insurance companies offer these plans and often bundle extra services into one plan.

Here’s what they typically cover:

• 🏥 Hospital care (Part A)
• 👩‍⚕️ Medical services (Part B)
• 💊 Prescription drugs (most include Part D)
• 😁 Extras like dental, vision, hearing, and even over-the-counter allowances

📍In places like North Carolina, Tennessee, and Georgia, many Medicare Advantage plans offer $0 premiums and added perks like grocery cards or gym memberships.

These extras can really help seniors living on a fixed income.

But there’s a trade-off:

• ✅ Pros: More benefits, low or no monthly cost, one easy-to-manage card
• ❌ Cons: Network restrictions—you may be limited to certain doctors and hospitals

💡 Tip: If you prefer extra benefits and don’t mind using in-network providers, Medicare Advantage can be a great fit.

But a Medigap plan might be better if you travel or want total doctor freedom.

🟩 Ancillary Plans (Dental, Vision, Hearing, Cancer, Hospital Indemnity)

Even with a Medigap or Medicare Advantage plan, some important gaps remain. That’s where ancillary plans come in.

These are extra insurance plans that help cover:

• 😁 Dental work (like cleanings, crowns, and dentures)
• 👓 Vision care (exams and glasses)
• 👂 Hearing services (hearing tests and hearing aids)
• 🎗️ Cancer plans that pay you cash during treatment
• 🏥 Hospital indemnity plans that help pay if you’re admitted

📍In Ohio, seniors often get under $30/month dental plans covering major services like root canals and extractions.

And in Arkansas, many cancer plans start around $20/month and provide a lump sum cash payout if you’re diagnosed.

💡 Tip: Ancillary plans are easy to add, affordable, and can protect your finances when life takes an unexpected turn.

🟦 How to Know What Gaps You Have

Every senior’s situation is a little different—and that’s why it’s so important to review your Medicare coverage every year.

Here’s what to keep in mind:

• 🔍 You might be missing key benefits like dental, hearing aids, or prescription drug coverage
• 🏡 Your ZIP code affects which plans are available and what they cost
• 💰 Your income can unlock extra help, discounts, or special plans you didn’t know you qualified for

At Palmetto Mutual, we offer a free Medicare checkup to help you:

• Find out what’s missing from your current plan
• See if you qualify for extra help or better coverage
• Get honest, no-pressure advice—no spammy calls, no obligation

💡 Tip: A quick review could save you thousands—or help you get better care for you and your family.

🟦 FAQs About What Medicare Doesn’t Cover

1. Does Medicare cover dental or vision?

Nope—Original Medicare doesn’t cover routine dental or vision care like cleanings, glasses, or dentures.

You’ll need to add a separate dental/vision plan or choose a Medicare Advantage plan that includes these benefits.

2. Will Medicare pay for a nursing home?

Only in some instances. Medicare covers short-term rehab, like physical therapy, after a hospital stay.

But it doesn’t pay for long-term nursing home care or help with daily activities like bathing or eating.

3. How can I get help paying for hearing aids?

Medicare won’t help here either—but some Medicare Advantage plans do.

You can also get a standalone hearing plan or bundle it with dental and vision coverage for better value.

4. What if I travel outside the U.S.?

Original Medicare doesn’t cover care outside the country.

Some Medigap plans offer limited emergency travel coverage, and you can also get a travel medical plan for extra peace of mind.

5. Is Medigap better than Advantage?

It depends on what you need.

• ✅ Medigap = more provider freedom, fewer bills, no networks
• ✅ Advantage = lower premiums, extras like dental and vision, but limited to local networks
  Talking with a licensed advisor can help you choose what fits your lifestyle and budget.

6. How do I know if I have the right coverage?

That’s what we’re here for.

At Palmetto Mutual, we’ll walk you through your current plan and check for any missing benefits, with no cost and no pressure.

We help seniors nationwide get the right fit, one person at a time. 😊

Who This Article Is For

If you’ve ever felt confused, overwhelmed, or frustrated by Medicare… you’re not alone.

This guide was written with you in mind. 💙

It’s especially helpful for:

• 🎉 Seniors turning 65 and new to Medicare who want to get started the right way
• ❓ People already on Medicare but wondering if they’re missing out on important benefits
• 👨‍👩‍👧 Caregivers and family members helping loved ones figure out the best coverage
• 📵 Anyone tired of spam calls, confusing websites, and pushy sales tactics

💡 Whether you’re in South Carolina, Ohio, Georgia, or anywhere else in the U.S., the team at Palmetto Mutual is here to guide you with clear answers and friendly help—no pressure, just honest support.

🟦 Why Palmetto Mutual Is the Right Agency to Help You

Forget the spammy telemarketers and the maze of confusing websites like Medicare.gov. At Palmetto Mutual, we do things differently.

We’re your trusted, local Medicare experts and here to make the process simple, clear, and stress-free.

Here’s how we help:

✅ Free plan reviews to find any gaps in your coverage
✅ Local knowledge of plans across North and South Carolina
✅ No high-pressure sales, ever
✅ One-on-one support from someone who cares

We’ve helped thousands of seniors nationwide—and we’re ready to help you.

📞 Call now or schedule your free Medicare Gap Checkup today.
Let’s ensure you’re not missing out on the benefits you deserve.

🔗 Internal Linking Suggestions

1. Medigap Section (H3: Medigap Plans)
👉 Want a deeper breakdown of supplement options? [What Is Medigap?] and [Best Medicare Supplement Plans for 2025] explain how these plans work and which one might be right for you.

2. Medicare Advantage Section (H3: Medicare Advantage Plans)
👉 Still comparing options? Read our guide: [What Is Medicare Advantage?] to see the pros, cons, and whether it fits your lifestyle.

3. Ancillary Plans Section (H3: Ancillary Plans)
👉 Want coverage for dental, vision, cancer, or hospital stays? We’ve got a full breakdown here: [Cancer, Dental, and Hospital Plans Explained].

4. Location-Based Help (Conclusion or “Who This Article Is For” section)
👉 If you live in the Carolinas, check out our state-specific guides for local plans: [Medicare in North Carolina] and [Medicare in South Carolina].