INSURANCEONE AMERICA’S GUIDE TO BETTER COVERAGE
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The last piece

What doesn't Medicare cover?

The short answer

Medicare was built around hospitals and doctors. Teeth, eyes, ears and long-term care were left outside it — and those are the bills that catch people off guard, because they feel like ordinary health care.

The last step. It ends with a summary of everything you've been through.

Don't know a word? Press any purple word to see what it means. They're all listed at the bottom of the page.

Meet Carol

A short story. It stops before the ending.

Read the script

    The one picture to remember

    Where the line actually falls.

    Medicare is built for this
    • Hospital stays
    • Doctor visits and specialists
    • Tests, scans and surgery
    • Short-term rehab after a hospital stay
    • Equipment like wheelchairs and oxygen
    And leaves these outside
    • Routine dental — cleanings, fillings, dentures
    • Routine eye exams and glasses
    • Hearing aids and the exams to fit them
    • Long-term care — help with daily living
    • Most care outside the United States
    Not a gap anyone chose. It's just where the program's edges were drawn.

    What's left out, and what to do about it

    Four short cards. Open "Going deeper" only if you want the detail.

    Teeth, eyes, ears

    The everyday three

    Cleanings, fillings, dentures, routine eye exams, glasses and hearing aids are not covered by Original Medicare. For most people these are small bills that arrive often, rather than one big one.

    There's a line worth knowing, though: Medicare does step in when the problem is medical rather than routine. Eye surgery, an injury to the mouth that lands you in the hospital, a hearing test your doctor orders to diagnose something — those are treated as medical care.

    Going deeper — where the line falls

    The test is usually "is this treating an illness or injury?", not "which part of the body is it?". A dental problem treated in the hospital as part of another covered procedure can be covered, while the same tooth filled at the dentist is not.

    If you're unsure which side of that line your situation sits on, ask before the appointment rather than after the bill.

    The big one

    Long-term care is not covered, and people assume it is

    Medicare covers short-term skilled care.

    It does not cover long-term help with daily living: an assisted living home, or a caregiver coming in each day to help with dressing, bathing and meals. That's the single most expensive assumption in Medicare, and the one families discover at the worst possible moment.

    It's a separate kind of insurance, and it's worth understanding well before anyone needs it.

    Two ways people fill the gaps

    Some plans include a little. Separate plans cover more.

    Built into an Advantage planMany include some dental, vision and hearing, usually with a yearly allowance. Helpful for routine care; a big dental job can use it up.
    A separate dental, vision or hearing planStands on its own, so it works with either route — including a Supplement, which doesn't cover these at all.

    Neither is automatic. Both are a choice you make on top of the decision you've already made.

    Traveling

    Medicare mostly stops at the border

    Care outside the United States generally isn't covered, with narrow exceptions. Some Supplements include limited foreign travel emergency coverage, and some Advantage plans cover emergencies abroad.

    If you travel or spend part of the year overseas, it's worth checking before you go rather than assuming.

    Try it

    Nothing you tap is saved.

    Is this covered?

    Tap one to see where it sits.

    Tap a situation to see whether Medicare covers it.

    Not sure which of these apply to you?

    A licensed support agent can look at your situation — your teeth, your eyes, your travel, your family — and tell you which gaps are worth covering and which aren't.

    No obligation. You can request help from one of our licensed support agents at any time.

    How Carol's story ends

    The same cracked tooth, seen from each route.

    Read the script

      Your summary

      Everything you've been through, in one place.

      What you now know

      The shape of itMedicare covers 80%. The other 20% has no limit, which is why people add a second plan.
      Your timingYour window opens three months before the month you turn 65 — or runs from the day your work coverage ends.
      Your two routesA Supplement pays your share, costs more monthly, goes to any doctor who takes Medicare. An Advantage plan costs little monthly, uses a network, and caps what a bad year can cost you.
      Still yours to plan forTeeth, eyes, ears and long-term care.
      What's nextCompare the real plans where you live, or have someone check your doctors and medications with you.
      Last section Ready to sign up? The Enrollment Guide walks you through it Open it →

      Words on this page

      Short-term skilled care
      Nursing or rehab after a hospital stay, for a limited time while you're getting better.