What does Original Medicare not cover?
Original Medicare (Parts A and B) does not cover routine dental care, routine vision or eyeglasses, hearing aids, long-term custodial care, or most care outside the United States. It also leaves you paying significant cost-sharing on covered care: for 2026 that includes a $1,736 hospital deductible per benefit period, a $283 Part B deductible, and 20% of most outpatient costs with no annual cap.
Last reviewed August 17, 2026 · Published August 17, 2026 · Mere Benefits Data Desk
“Not covered” comes in two flavors, and they call for different fixes. Some services are excluded entirely, so no Medicare paperwork will ever pay for them. Other services are covered, but Original Medicare leaves you a meaningful share of the bill with no out-of-pocket maximum. Medigap policies address the second problem, not the first. Medicare Advantage plans often bolt on dental, vision, and hearing extras, but the details and limits vary widely by plan.
The gaps, in one table
| Gap | Status in Original Medicare | Notes for 2026 |
|---|---|---|
| Routine dental (cleanings, fillings, dentures) | Excluded | Medicare pays only for narrow medically necessary dental tied to a covered procedure |
| Routine vision, eyeglasses, contacts | Excluded | Exception: one pair of glasses after cataract surgery with an implanted lens |
| Hearing aids and fitting exams | Excluded | Diagnostic hearing exams your doctor orders can be covered |
| Long-term custodial care | Excluded | Help with bathing, dressing, eating; nursing home room and board when that is the only need |
| Most care outside the U.S. | Excluded | Limited exceptions near borders and on some cruises; some Medigap plans add 80% foreign emergency coverage |
| Part A hospital cost-sharing | You pay | $1,736 deductible per benefit period in 2026, plus daily coinsurance on long stays |
| Part B cost-sharing | You pay | $283 annual deductible in 2026, then generally 20% coinsurance, with no yearly cap |
On custodial care, the detail that surprises families: Medicare’s skilled nursing facility benefit only follows a qualifying hospital stay, only while skilled care is needed, and only for a limited number of days per benefit period. Ongoing help with daily living is not a Medicare benefit at any age.
What the 20% really means
The absence of an out-of-pocket cap is the quiet one. Example: a $60,000 course of outpatient cancer treatment in 2026 leaves a beneficiary with Original Medicare alone owing the $283 deductible plus roughly 20% of the Medicare-approved amounts, which can run into five figures in a single year. That exposure, more than any excluded service, is why most people pair Original Medicare with either a Medigap policy or an employer or retiree plan, or choose a Medicare Advantage plan, which must include an annual out-of-pocket maximum for covered medical services.
Prescription drugs are their own lane: Original Medicare does not include routine outpatient prescriptions, which is what Part D exists for. For 2026, Part D plans carry a $2,100 annual cap on out-of-pocket drug costs.
Here’s what I tell clients: list what you actually use, dentures, hearing aids, winters abroad, then match the fix to the gap. No single product patches all of these at once.
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