What Medicare Doesn't Cover: Dental, Vision, Long-Term Care

Last reviewed: July 2026

The coverage gaps that surprise people most

Many people reach 65 assuming Medicare works like the employer insurance they had before: one card, most things covered. It doesn't. Original Medicare (Part A and Part B) was designed in 1965 around hospital and doctor care, and several everyday categories were left out entirely — most dental work, eyeglasses, hearing aids, long-term custodial care, and almost all care outside the United States. If you're new to how the parts fit together, start with our guide to Medicare's parts. This guide covers what's missing, what genuinely fills the gaps, and where marketing overpromises.

Routine dental, vision, and hearing

Original Medicare does not pay for routine dental care — cleanings, fillings, most extractions, dentures, or implants. It does not pay for routine eye exams for glasses, or for eyeglasses or contact lenses. And it does not pay for hearing aids or the exams to fit them.

There are narrow exceptions worth knowing:

• Dental: Medicare can pay for dental services that are "inextricably linked" to a covered medical treatment. Rules finalized by CMS for 2023 and 2024 spelled this out for situations such as dental exams and treatment before an organ transplant or cardiac valve replacement, and dental care connected to head and neck cancer treatment or certain chemotherapy and CAR T-cell therapies. A further rule added, starting in 2025, dental exams and treatment connected to Medicare-covered dialysis for end-stage renal disease.
• Vision: Medicare covers cataract surgery and, after surgery that implants an intraocular lens, one pair of eyeglasses with standard frames or one set of contact lenses. It also covers medically necessary eye care — glaucoma tests for people at high risk, yearly diabetic eye exams, and treatment for macular degeneration. See our preventive benefits guide for the screening details.
• Hearing: Diagnostic hearing and balance exams are covered when a provider orders them to diagnose a medical problem. The hearing aid itself is not. Since 2022, lower-cost over-the-counter hearing aids have been available without a prescription for adults with mild to moderate hearing loss, though Medicare doesn't pay for those either.

Long-term custodial care — the biggest gap of all

Medicare does not pay for custodial care: help with bathing, dressing, eating, toileting, or moving around, when that's the only care you need. That means it does not pay for ongoing nursing home stays, assisted living, or around-the-clock help at home — the kind of care many people eventually need for years.

What Medicare does cover is short-term skilled care. After a qualifying inpatient hospital stay, Part A covers up to 100 days of skilled nursing facility care per benefit period: in 2026, you pay $0 for days 1–20, $217 per day for days 21–100, and everything after day 100. Home health coverage is similarly limited to part-time or intermittent skilled nursing and therapy — not daily homemaker or personal care services on their own. For the full cost picture, see our 2026 Medicare costs guide.

Care outside the United States

Original Medicare generally pays nothing for care outside the U.S. and its territories, with three narrow exceptions: a medical emergency in the U.S. when a foreign hospital is closer than the nearest U.S. hospital; traveling between Alaska and another state through Canada by the most direct route when a Canadian hospital is closest; and living in the U.S. near the border when a foreign hospital is closer to your home. Care on a cruise ship can qualify only when the ship is in or near U.S. territorial waters — within six hours of a U.S. port. Part D plans don't cover drugs you buy abroad.

Some Medigap policies (Plans C, D, F, G, M, and N) include a foreign travel emergency benefit: after a $250 annual deductible, they pay 80% of billed charges for emergency care that begins during the first 60 days of a trip, up to a $50,000 lifetime maximum. Frequent travelers often also look at separate travel medical insurance. Our Medigap basics guide explains how these policies work.

Medicare Advantage "extras": what the ads leave out

Medicare Advantage plans can — and almost universally do — offer benefits Original Medicare lacks. KFF's analysis of 2026 plans finds that virtually all enrollees in individual Medicare Advantage plans are in plans offering some dental, vision, and hearing benefit, and three-quarters of enrollees in individual plans with drug coverage pay no plan premium beyond the standard Part B premium. These extras are financed by federal rebate payments to plans, which average nearly $2,400 per enrollee in 2026 for individual plans, according to MedPAC figures cited by KFF.

The catch is in the word "some." A dental benefit can mean preventive cleanings only, or it can include fillings, dentures, and crowns — usually subject to an annual dollar cap on what the plan will pay, coinsurance, and a restricted network of dentists. An ad touting "$2,000 in dental coverage" typically describes a maximum allowance, not money you receive. KFF also notes that data on how much enrollees actually use and receive from supplemental benefits are not available to researchers or consumers, so there's no public way to compare advertised generosity with real-world value. Meanwhile, some of the flashier extras are receding: KFF found the share of enrollees in individual plans with access to transportation, meal benefits, and over-the-counter allowances all declined from 2025 to 2026, and only about 10% of enrollees in individual plans are in plans offering in-home support services. One thing no plan's "extras" include: ongoing long-term custodial care.

Before choosing or switching plans based on extras, read the plan's Evidence of Coverage for the actual caps and networks, and compare the trade-offs in our Medicare Advantage vs. Original Medicare guide. If a TV ad or cold call promises benefits that sound too good, see avoiding Medicare scams — and remember that plan changes are only possible during certain enrollment periods.

Standalone dental and vision options

People who stay with Original Medicare (with or without Medigap) have several routes to dental and vision care:

• Individual dental or vision insurance, sold directly by insurers. Watch for waiting periods on major work and annual maximums that may be lower than the cost of a single crown.
• Dental discount programs — membership arrangements, not insurance, that offer reduced fees at participating dentists.
• Dental schools and hygiene programs, which often provide supervised care at reduced cost.
• Community health centers, which offer dental services on a sliding fee scale based on income.
• State Medicaid programs, which in some states include adult dental benefits for those who qualify.

Whether any of these is worth the premium depends on your teeth, your budget, and your state — a genuinely personal calculation. A free session with your State Health Insurance Assistance Program (SHIP) counselor can help you run the numbers.

Medicaid: the long-term-care payer of last resort

Because Medicare doesn't cover long-term custodial care, the program that actually pays for most of it in the U.S. is Medicaid. KFF reports Medicaid is the primary payer for about six in ten nursing facility residents. But Medicaid is means-tested: you qualify only after your income and countable assets fall below your state's limits, which is why many families "spend down" savings on care before Medicaid takes over. Two mechanisms matter here. First, states apply a 60-month look-back: assets given away or sold below fair value in the five years before applying can trigger a penalty period of ineligibility. Second, federal law requires states to pursue estate recovery — seeking repayment from the estates of enrollees 55 and older who received long-term services and supports. Many states also run home- and community-based services waivers that pay for care at home instead of in a facility, often with waiting lists.

The rules are state-specific and unforgiving of mistakes, so families planning for long-term care often consult their state Medicaid office or an elder law attorney. If your income is limited now, our guide to help paying for Medicare covers Medicaid, Medicare Savings Programs, and Extra Help.

Where to get trustworthy help

What to do about these gaps depends on your health, finances, family situation, and state — there is no one right answer, and no article (including this one) should pick a plan for you. For free, unbiased help: compare plans at medicare.gov, call 1-800-MEDICARE (1-800-633-4227), or contact your State Health Insurance Assistance Program (SHIP) at shiphelp.org for one-on-one counseling. And if a plan denies a service you believe should be covered, you have appeal rights — see our appeals and denials guide.

Sources

• Medicare.gov — What's Not Covered by Part A & Part B
• Medicare.gov — Dental Services
• Medicare.gov — Travel Outside the U.S.
• Medicare.gov — Medicare Coverage Outside the United States (PDF)
• CMS — 2026 Medicare Parts A & B Premiums and Deductibles
• CMS — Medicare Dental Coverage
• KFF — Medicare Advantage in 2026: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization
• KFF — 5 Key Facts About Nursing Facilities and Medicaid
• KFF — What Is Medicaid Estate Recovery?
• Medicare Rights Center — New Rules Expand Medicare Dental Coverage for Some

This guide is for general education only and is not medical, legal, insurance, or financial advice. For decisions about your own coverage, use official sources or free help from your SHIP counselor.