What Medicare Still Won't Pay for in 2027 (And What Retirees Are on The Hook For Instead)

If you already have a retirement plan, you know that Medicare greatly reduces your health care bills as you get older. However, the government doesn't pay for every health-related expense.

Some of the costs that catch retirees off guard aren't unusual or exotic. They're expenses that become more likely as you get older. Medicare covers plenty of medically necessary care, but important gaps may leave you paying the entire bill or looking for other insurance.

Here are 10 things Original Medicare doesn't apply to, along with the exceptions worth knowing and what retirees may have to pay instead.

Long-term and custodial care

A huge misconception is that Medicare pays for long-term care. In reality, it doesn't cover custodial care, which is ongoing help with things like bathing, dressing, eating, or using the bathroom when that is the only type of care you need.

While it includes limited stays in skilled nursing facilities and certain in-home services, it doesn't pay for permanent care. If you need assistance at home, in an assisted living facility, or in a nursing home, you're responsible for much or all of the cost.

Dental care

Medicare doesn't reimburse cleanings, fillings, extractions, dentures, and other standard dental treatment. Dental services that are medically necessary as part of a covered procedure or treatment are exceptions, but they don't include things like a toothache or worn dentures.

You could get dental benefits through a Medicare Advantage plan. If you don't, you have to pay out of pocket or buy separate dental insurance.

Vision care and eyeglasses

Original Medicare generally doesn't include routine eye exams for glasses or contact lenses. It also doesn't usually pay for the eyewear itself.

Medicare Part B may cover certain eye exams, screenings, and treatments for specific conditions, such as glaucoma and diabetes. It may also include corrective lenses following cataract surgery when you receive an intraocular lens.

Outside these situations, vision care is one of the expenses you must budget for.

Hearing aids

Hearing loss is common as people age, but Original Medicare doesn't pay for hearing aids or routine exams. The cost of the device, fitting, and related services largely falls on the patient, even with Medicare Advantage.

Depending on the type of hearing aid and level of technology, a pair may cost hundreds or thousands of dollars. Medicare Part B may reimburse diagnostic hearing and balance exams when they're ordered to investigate a medical condition, but that's different from paying for the hearing aids themselves.

Health care abroad

If you're planning to spend part of your retirement outside the U.S., Medicare doesn't travel with you. Original Medicare doesn't apply to medical care you receive abroad, so any illness, injury, or emergency during international travel is on you.

A few narrow exceptions exist, including certain emergencies near the U.S. border or when a foreign hospital is closer than a U.S. hospital. But those exceptions are limited enough that you shouldn't expect international health coverage.

Travel insurance or other supplemental insurance may help fill that gap.

Cosmetic procedures

You may want to look your best in retirement, but Medicare doesn't pay for elective cosmetic surgery or treatments that aren't medically necessary.

On the other hand, surgery to restore function or correct damage caused by an injury, illness, or medical treatment is covered. For example, reconstructive surgery following an accident that left you injured may qualify even if it also improves your appearance.

Certain prescription drugs and treatments

While Medicare Part D offers prescription drug coverage, not every medication or treatment is automatically included. Plans use formularies to determine which drugs they reimburse, and they may impose requirements such as prior authorization, step therapy, or quantity limits.

Some drugs aren't covered by Part D because Medicare Part B pays for them when they're administered in a doctor's office or other outpatient setting. Others may fall outside both parts. Unless you qualify for another form of insurance, your only option is to appeal a coverage decision.

Over-the-counter medications and supplements

You may think Medicare drug coverage also includes the aspirin, vitamins, or allergy medication you pick off the shelf. Not so. You must pay for over-the-counter drugs and nutritional supplements yourself, even when those products are part of managing a chronic health issue.

Foot care

Routine foot care is another service that Original Medicare doesn't pay for. Patients are usually responsible for services such as removing corns and calluses or trimming nails.

Exceptions exist for people with certain medical conditions that make routine foot care medically necessary. For example, Medicare may include foot care if you have diabetes or another illness affecting circulation or nerves.

Convenience and personal-care costs during treatment

Even though Medicare may take care of your hospital stay or medical treatment, it doesn't necessarily pay for every expense that comes with being sick. Original Medicare pays for a semi-private room when hospitalization is necessary. It doesn't include personal comfort items such as television or phone chargers.

You may also face expenses outside the formal medical bill, including transportation, meals for family members, or home help after you're discharged. Medicare doesn't apply to the incidental costs of being ill.

Bottom line

Medicare is an important part of your health care plan. Still, some of the expenses you're most likely to encounter as you age may fall outside Original Medicare's standard coverage. Don't estimate retirement health care costs based solely on your Medicare premiums or expected medical bills. Instead, focus on what you spend on all types of care over the course of retirement.

To lower your financial stress, review the Medicare gaps that apply to your situation before you retire, and budget separately for expenses such as dental, vision, hearing, and long-term care. If you're considering Medicare Advantage or supplemental coverage, compare the benefits and out-of-pocket costs rather than assuming the plan includes everything that Original Medicare doesn't.

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