Is Original Medicare Enough? 5 Essential Services It Doesn’t Cover

When you turn 65, enrolling in Medicare can feel like a huge relief. You finally have health insurance that helps cover many of the medical costs you might face in retirement. But it’s important to understand what Original Medicare (Parts A and B) actually includes, and just as importantly, what it leaves out.

While Original Medicare provides a solid foundation for your healthcare, it doesn't offer complete protection. When working with Medicare advisors, many retirees are surprised to find they still face significant out-of-pocket costs or need additional coverage for essential services. If you’re planning to rely on Medicare Parts A and B alone, here are five key services it doesn’t cover, and what that could mean for you.

5 Services Original Medicare Does Not Cover

1. Prescription Drugs

Perhaps the most well-known gap in Original Medicare is prescription drug coverage. Part A covers hospital care, and Part B covers outpatient services like doctor visits and lab work, but neither covers most prescription medications you take at home.

If you need ongoing medications for conditions like high blood pressure, diabetes, or arthritis, you’ll need to enroll in a Part D drug plan or choose a Medicare Advantage (Part C) plan that includes drug coverage. Without one, you could end up paying the full retail price for your prescriptions, which can easily run into hundreds, or even thousands of dollars per month.

2. Routine Dental Care

Original Medicare does not cover routine dental services such as cleanings, exams, fillings, root canals, crowns, dentures, or dental implants. These are considered non-medical services and are not included in Medicare Parts A or B. While Medicare Part A may cover a dental procedure if it’s medically necessary during a covered hospital stay. For example, jaw reconstruction after an accident, this is the exception rather than the rule. The everyday dental care that most seniors rely on is entirely out of pocket.

This lack of coverage is a significant concern, as poor dental health has been linked to more serious health issues, including infections and heart disease. If you want help covering dental costs, you’ll need to purchase a standalone dental insurance policy or look into a Medicare Advantage plan that includes dental benefits.

3. Vision and Hearing Services

Vision and hearing care are also missing from Original Medicare. Here’s what that means:

• Eye exams for glasses or contact lenses are not covered

• Hearing exams and hearing aids are not covered

• Eyeglasses, contacts, and hearing devices must be paid for out of pocket

This can be especially frustrating since hearing and vision often decline with age. Hearing aids alone can cost $1,000–$6,000 or more, and Medicare won’t help with that expense unless you have a supplemental plan that includes it.

Some Medicare Advantage plans offer limited vision and hearing benefits, but under Original Medicare, you’ll need to budget for these services yourself.

4. Long-Term Custodial Care

This is one of the most misunderstood gaps in Medicare coverage. While many people assume Medicare will pay for a nursing home or assisted living facility, that’s not usually the case.

Medicare only covers short-term stays in a skilled nursing facility after a qualifying hospital stay (and even then, only up to 100 days). It does not cover custodial care (such as help with bathing, dressing, or eating) if those are the only services you need.

Long-term care can be very expensive, especially if it’s needed for months or years. Without long-term care insurance or Medicaid eligibility, you may have to pay for these costs out of pocket.

5. Medical Care Outside the U.S.

If you’re planning to travel or retire abroad, you should know that Original Medicare offers very little coverage outside the U.S. In most cases, Medicare won't pay for:

• Doctor visits in other countries

• Emergency care while traveling

• Prescription drugs purchased abroad

Some Medigap (Medicare Supplement) plans offer limited foreign travel emergency coverage, but under Original Medicare alone, you’d need to purchase separate travel insurance or pay entirely out of pocket for international care.

Why This Matters

While Medicare Parts A and B offer reliable coverage for hospital stays, doctor visits, lab work, and preventive care, they leave a lot of common healthcare needs uncovered. The costs for prescription drugs, dental work, vision care, hearing aids, and long-term care can add up quickly and if you’re not prepared, they can eat into your retirement savings fast.

This is why many people choose to enhance their coverage with:

• Medicare Supplement (Medigap) insurance

• Medicare Advantage (Part C) plans

• Part D prescription drug plans

• Private dental, vision, or hearing policies

Each of these options has pros and cons, and the right combination depends on your health, budget, and lifestyle. But one thing is clear: relying on Original Medicare alone leaves serious gaps in your protection.

Don’t Forget: You’ll Still Pay 20%

In addition to these uncovered services, it’s important to know that Original Medicare only pays 80% of approved medical costs. That means you’re responsible for the remaining 20% out of pocket, with no cap on total spending. Robert Remin makes note of that here…

So even if Medicare does cover a service, like a hospital stay or doctor visit, you’re still on the hook for a portion of the bill unless you have supplemental coverage.

Final Thoughts

Original Medicare is a strong starting point for healthcare in retirement, but it’s not comprehensive. Understanding what it doesn’t cover, especially when it comes to prescriptions, dental, vision, hearing, long-term care, and international travel can help you avoid unexpected bills and make smarter choices about your healthcare planning.

If you're unsure which additional plans you may need, consider speaking with a local Medicare advisor. The better you understand your options, the better protected you'll be, both medically and financially.