Many seniors don’t realize how many things not covered by Medicare could affect their budget, from eye exams to prescription drugs. We’ll walk you through what’s missing and how to pay for it. Luckily, there are smart tricks to pay for them, and we’ll walk you through each one.
What Medicare Is and What It Covers
Medicare is the U.S. government’s health insurance program for people 65 and older—or for certain younger people with disabilities. Think of it as the foundation of your healthcare coverage. That said, while Medicare covers many essential services, it doesn’t cover everything you might expect.
Original Medicare—Part A (Hospital Insurance) and Part B (Medical Insurance)—takes care of things like hospital stays, doctor visits, lab tests, and some preventive services. That’s great, but there are gaps. Here’s something important to clarify: even if Medicare covers a service, it usually doesn’t pay 100% of the cost—typically it covers about 80%. That means, in general, you’re responsible for the remaining 20% of all your medical costs. That’s why we strongly recommend getting a Medigap plan to help cover these out-of-pocket costs.
👉Want an accurate Medsup price for your area? Use our Instant Medigap Quote Tool—it’s free, private, and shows real rates from top insurers in your ZIP code, no email needed.
10 Unexpected Things Not Covered by Medicare
Understanding the things not covered by Medicare isn’t just about knowing your financial responsibility. It’s also about planning smart, protecting your finances, and finding stress-free ways to pay these costs. In this guide, we’ll walk you through 10 surprise costs, explain why they aren’t covered, and strategies—from Medigap plans to discounts and state programs—that can help you manage them.
By the end, you’ll feel more confident about your coverage, make informed decisions, and avoid the kind of financial surprises that can turn a routine medical visit into a headache:
1) Prescription Drugs
With Medicare Part A and B, most prescription drugs you get filled at the pharmacy are not covered.
Part B covers only certain outpatient prescription drugs, such as…
- Injectable or infused drugs given by a licensed healthcare provider
- Some oral anti-cancer medications
- Drugs used with certain durable medical equipment (like nebulizers or infusion pumps)
- Intravenous Immune Globulin for home use
- FDA-approved HIV prevention medication (PrEP)
- Some drugs received in hospital outpatient settings (in very limited cases)
- Most renal dialysis drugs and biological products
Want to go deeper? Our article “What Medigap Plans Cover Prescription Drugs?” has all the info you need.
💡 So, what can you do? Enroll in a Medicare Part D plan to help cover prescription drugs at the pharmacy.
Another tip: if your drug is not covered under your Part D plan, see if your pharmacy offers discount programs or manufacturer coupons. Little steps like this can save you big money and reduce stress. For example, using CleverRX through Senior65.com gives you a prescription discount card to show your pharmacist at checkout.
2) Cosmetic Surgery
Medicare generally considers plastic surgery elective if it’s purely for appearance, so you’d typically pay out-of-pocket. Medicare (and Medigap plans) never cover elective surgeries.
Reconstructive surgery is treated differently that Cosmetic Surgery. If surgery is medically necessary—like repairing damage after an accident, correcting a birth defect, or reconstructing a breast after a mastectomy—Medicare may cover part or all of the costs. Even then, deductibles and coinsurance can apply, so it’s important to plan ahead with a Medigap plan to avoid surprise costs.
Exploring Medigap plans AKA supplemental coverage can help reduce coinsurance on Medicare approved procedures, letting you focus on recovery.
There are certain hospital outpatient procedures that sometimes—but not always—require prior authorization because they may be considered cosmetic. If Medicare says they are Medically necessary then they will pay for typically 80% of the percedure. Here are some examples.
- Blepharoplasty – eyelid surgery to remove droopy or excess tissue.
- Botulinum toxin injections – often for muscle spasms or twitches.
- Panniculectomy – removal of extra skin from the lower abdomen.
- Rhinoplasty – Nose reshaping surgery.
- Vein ablation – procedure to close off problematic veins.
📌Curious if your upcoming surgery could be covered by Medicare or Medigap? Check out our article: “Do Medigap Plans Help Pay for Surgeries?“.
3) Weight Loss Options
Recently, weight loss medications such as Ozempic, Wegovy, and Mounjaro have gained popularity—but Medicare does not cover them. However, Medicare can support other obesity treatments:
A) Obesity Behavioral Therapy
If your BMI is 30 or higher, Medicare Part B covers obesity screenings and behavioral counseling. Counseling happens in your doctor’s office, where they help create a personalized plan for diet and exercise. Sessions include dietary assessment and guidance to help you reach your weight-loss goals.
📌Also, since obesity is a risk factor for diabetes, Medicare also offers free screenings. Read more in our article: “Diabetes Screening $0 With Medicare.“
B) Bariatric Surgery
Medicare covers some bariatric surgeries, such as gastric bypass or laparoscopic banding, if you meet specific morbid obesity criteria. Costs can be unpredictable, as you may not know all the services needed until your doctor evaluates you. Always ask your doctor, hospital, or surgical center for an estimate, including follow-up care.
Important: Medicare does not cover transportation to or from a bariatric surgery center. (Surce: Medicare.gov)
👉 As a rule, if Medicare covers the procedure, Medigap will typically cover the remaining costs. Still, confirm coverage in advance. Get an Instant Free Medigap Quote here.
4) Deductibles
Even with Medicare, out-of-pocket costs can surprise you. One of the biggest surprises? Deductibles. A deductible is the amount you pay for covered services before Medicare starts paying. For example, Medicare Part A has a hospital deductible for each benefit period. Part B has an annual deductible for outpatient services, like doctor visits and tests. Check the numbers here.
Without Medigap, you could be responsible for these costs. They can add up quickly, especially if you need multiple hospital stays. If you’re admitted to the hospital and pay your Part A deductible, you might have to pay it again if you’re admitted a second time after more than 60 days—each “benefit period” has its own deductible.
This is where Medicare Supplement Plans comes in. Medigap policys, like Plan G, cover Part A and Part B deductibles. That means your out-of-pocket costs could drop to just the monthly premium.
💡 Choosing the right Medigap plan ensures you won’t be surprised by deductibles and can focus on your health, not bills. Read more about Medigap Plan G here.
5) Long-Term Care
Even with Medicare—or a Medigap plan—you won’t be covered for long-term care, sometimes called custodial care or long-term services and support. This type of care isn’t about medical treatments; it’s about everyday help for people with chronic illnesses or disabilities.
Long-term care can include:
- Assistance with personal care, like dressing, bathing, or using the bathroom
- Home-delivered meals
- Adult day health programs
📌These services can take place at home, in the community, an assisted living facility, or a nursing home. Medicare won’t pay for these non-medical services. Want to be prepared for the future? Read more in our article: “Should I Purchase Medigap or Long-Term Care Insurance?“.
6) Concierge Care
You might have heard about concierge care—sometimes called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care. The idea sounds appealing: personalized attention, same-day appointments, longer visits, and a doctor who really knows you. However, tere’s a catch: Medicare generally doesn’t pay for these extra perks.
Why? Concierge practices often charge an annual or monthly fee for services beyond standard medical care. Medicare only covers medically necessary services, so anything above that—like extended check-ins, 24/7 direct phone access, or special wellness programs—is usually out-of-pocket.
💡Some seniors combine original Medicare with a Medigap plan to cover standard medical costs while still paying for the personalized perks of a concierge practice. This approach can make high-touch, attentive care more manageable financially, giving you both peace of mind and convenience.
Get a Medigap Quote Enroll in Medigap
7) Dental Care
Most people are surprised to learn that Original Medicare doesn’t cover routine dental care. That means cleanings, fillings, tooth extractions, and dentures usually aren’t included. However, there are exceptions when dental care is medically necessary or connected to another covered treatment.
Medicare may help pay in these cases:
- Hospital stays for dental procedures: If you need a dental procedure while admitted as a hospital inpatient—due to your health condition or treatment complexity—Medicare can cover it.
- Dental care linked to major medical treatments: Some dental procedures are essential for your overall treatment plan. For example:
- Oral exams or dental work before a heart valve replacement or organ transplant.
- Tooth extractions or infection treatment before chemotherapy or other cancer treatments.
- Dental care needed for complications during head or neck cancer treatment.
- Exams and infection treatment for people on Medicare-covered dialysis due to End-Stage Renal Disease (ESRD).
On the other hand, routine dental care—like cleanings, fillings, dentures, or root canals—is not covered under Original Medicare. Some Medicare Advantage plans include dental benefits.
As a general rule, if Medicare doesn’t cover a service, Medigap usually won’t either. However, many Medigap plans let you add dental coverage when you first enroll, helping you protect your smile and save on future expenses. Read more about Senior Dental and request a quote here.
8) Vision & Hearing Care
We all love hearing our favorite music or seeing the world clearly, but here’s the thing: Medicare doesn’t cover most hearing aids or routine eye exams for glasses or contacts. That means new hearing aids or stylish glasses usually come out of your own pocket.
- Hearing: Part B covers hearing and balance exams if your doctor needs to check for medical issues. You can also see an audiologist once a year for certain non-urgent hearing problems or tests related to surgically implanted hearing devices—though you’ll pay 20% of the Medicare-approved amount after your Part B deductible. Small copays may apply in hospital outpatient settings. We cover everything step-by-step in this article “What Medigap Plan Covers Dental, Vision and Hearing?“.
- Vision: Part B covers one yearly eye exam for diabetic retinopathy if you have diabetes. Exams for glasses or contacts aren’t included. Make sure your eye doctor is licensed in your state. Still have questions? Check out our full article for more details: “Does Medicare Cover Vision?“
(Source: Medicare.gov)
👉Looking for the full picture? You’ll find it in our complete article: “I Have Medicare But Want Drugs, Hearing, Dental, And Vision“.
9) Incontinence Supplies & Adult Diapers
Let’s talk about something many of us might need but rarely discuss: incontinence supplies and adult diapers. Unfortunately, Medicare doesn’t cover these items, which means you’ll need to budget for them on your own.
Some Medicare Advantage (Part C) plans provide coverage for certain incontinence products, so it’s worth checking your plan. You can also explore discount programs or online retailers offering subscriptions, bulk discounts, or free shipping.
Learn More about Medicare Advantage Get a MA Quote
10) Massage Therapy
Looking for ways to ease aches, pains, or tension? Medicare doesn’t cover massage therapy.
Acupuncture is a bit more nuanced. Medicare Part B can help cover acupuncture for chronic low back pain—but only under specific conditions. Your pain must last 12 weeks or longer, have no known cause, and not be related to surgery or pregnancy. Medicare covers up to 12 treatments in 90 days, and if you’re improving, you may get an additional 8 sessions (a total of 20 in a year). Otherwise, any extra sessions are 100% out-of-pocket. Ready for the details? Read our article “Does Medicare Cover Acupuncture or Chiropractic?“.
📌Luckily, there are already some specific Medigap plans that cover additional acupuncture treatment. Want to learn more? Check out our article “First Medigap to Cover Acupuncture and Chiropractic.“
A Few More Surprises: Things Not Covered by Medicare
Even after you’ve checked all the usual boxes, there are still some services Medicare doesn’t cover—and they can sneak up on you. Examples include:
- Non-medical transportation to appointments
- Certain experimental treatments
- Excess charges at the doctor’s office
- Non-donated blood
- Alternative therapies like reflexology or aromatherapy
- Health emergencies outside the U.S. and its territories (including cruises)
📌 Need more info? Read our article “Does Medicare Cover You When Traveling?“.
👉With so many gaps in coverage it’s important to choose the right Medigap policy, Medicare Part D (prescriptions), or Medicare Advantage plan. Have questions or just want to chat? Call us at 800-930-7956 or leave a comment below. Our team will guide you—no pressure, no cost—just helpful support from Senior65.com.
Still not sure if you need extra coverage to protect your back—and your wallet? Check out: “How Much Do Seniors Typically Pay for Medical Costs Not Covered by Medicare?“.
Next Steps: Protect Yourself and Your Wallet
We know Medicare can be confusing, and those “unexpected” costs add up fast. The good news? You don’t have to face them alone.
- Check your coverage: Review what your Original Medicare plan covers and what it doesn’t.
- Consider Medigap: Supplemental insurance can fill in most gaps, like deductibles, coinsurance, and certain therapies. Get your Free Quote here.
- Talk to experts: Our team at Senior65.com can guide you for free—helping you compare plans and find the one that fits your needs. Just call us at 800-930-7956.