One of the biggest surprises people face after enrolling in Medicare is discovering how much it does not cover. Original Medicare — Parts A and B — is built around hospital and medical care. Routine dental cleanings, eyeglasses, and hearing aids are largely outside its scope, and millions of Medicare beneficiaries pay out of pocket every year for things they assumed were covered.
Here is what falls through the gap and what you can do about it.
Original Medicare does not cover routine dental care — cleanings, X-rays, fillings, extractions, crowns, bridges, dentures, or implants. The exception is dental work that is "medically necessary" as part of a covered procedure — for example, certain dental work required before a covered cardiac surgery. But your standard twice-a-year cleaning and any restorative work? Not covered.
This matters because dental health at 65 and beyond can be expensive. A crown can cost $1,000–$2,000. Implants run $3,000–$6,000 per tooth. Dentures can cost $2,000–$5,000 per arch.
Your options: purchase a standalone dental insurance policy (typically $30–$60/month with annual benefit caps), join a dental discount plan (flat annual fee for discounted rates), look for a Medicare Advantage plan that includes dental benefits, or budget to pay out of pocket at a dental school clinic, which offers significantly discounted rates.
Original Medicare covers medically necessary eye care — treating glaucoma, cataracts, and diabetes-related eye conditions. What it does not cover: routine eye exams for glasses or contacts, eyeglasses (except for the first pair after cataract surgery), and contact lenses.
A routine eye exam runs $100–$200. Glasses can add several hundred dollars more. If your vision is changing as you age — and for most people it will — these costs add up annually.
Your options: many Medicare Advantage plans include vision benefits with annual exam coverage and eyewear allowances. Retailers like Costco and Walmart Optical offer lower prices for those paying out of pocket. VSP and similar standalone vision plans cost around $15–$25/month.
Original Medicare does not cover routine hearing exams or hearing aids. This is a significant gap — approximately two-thirds of adults over 70 have some degree of hearing loss, and hearing aids can cost $1,000–$7,000 per pair. Medicare does cover a diagnostic hearing exam if ordered by your doctor to determine whether medical treatment is needed — but not if the purpose is just to fit you for hearing aids.
Your options: some Medicare Advantage plans include hearing benefits or discounts on hearing aids. Over-the-counter hearing aids became available in the U.S. without a prescription in 2022 and represent a significantly less expensive option for mild to moderate hearing loss (prices starting around $200–$1,500 for a pair). Veterans may be eligible for hearing aids through VA benefits.
Medicare covers short-term skilled nursing facility stays after a qualifying hospital stay — up to 100 days under specific conditions, with copays after day 20. It does not cover custodial care: help with daily activities like bathing, dressing, and eating at home or in an assisted living facility when no skilled nursing is needed. Long-term care insurance, Medicaid (for those who qualify), and personal savings are the primary ways people cover these costs.
Original Medicare generally does not cover medical care received outside the United States. If you plan to travel internationally, this is worth addressing before you go. Some Medigap plans (Plans C, D, F, G, M, and N) include a foreign travel emergency benefit — 80% of covered foreign emergency care costs after a $250 deductible, up to a lifetime maximum of $50,000. Travel health insurance is another option for extended international trips.
The most cost-effective way to address dental, vision, and hearing gaps at 65 is often a Medicare Advantage plan that bundles these benefits. The key is to compare what specific benefits the plan actually provides — eyewear allowance amounts, dental coverage limits, hearing aid benefits — before enrolling, because plans vary significantly.
Reminder: Ready at 65 is not affiliated with Medicare, CMS, the SSA, or any government agency. This article is general educational information, not financial, legal, medical, or insurance advice. Rules, costs, and deadlines change — verify current details at Medicare.gov or by calling 1-800-MEDICARE before making any decision. Full disclaimer →