One of the biggest surprises for people new to Medicare is discovering what it does not cover. Medicare is good insurance, but it has real gaps that can lead to unexpected bills if you are not prepared. Here is a straightforward look at what is covered, what is not, and how to fill the holes.
What Medicare Part A Covers
Part A is your hospital insurance. It covers inpatient hospital stays, including a semi-private room, meals, nursing care, and medications you receive while admitted. It also covers skilled nursing facility care for up to 100 days following a qualifying hospital stay, hospice care for people who are terminally ill, and some home health care services when ordered by a doctor.
Part A has a deductible of $1,676 per benefit period in 2026. A benefit period starts when you are admitted to the hospital and ends when you have been out for 60 consecutive days. If you are admitted again after that, a new benefit period begins with a new deductible.
What Medicare Part B Covers
Part B is your medical insurance. It covers doctor visits, outpatient care, preventive services, lab tests, X-rays, MRIs, physical therapy, mental health services, durable medical equipment like wheelchairs and walkers, and ambulance services when medically necessary.
Part B also covers many preventive services at no cost to you, including annual wellness visits, flu shots, mammograms, colonoscopies, and cardiovascular screenings. These are valuable benefits that many people do not take advantage of.
Part B has a monthly premium of $185 in 2026 and an annual deductible of $257. After the deductible, you typically pay 20 percent of the Medicare-approved amount for most services.
What Medicare Does NOT Cover
This is where it gets important. Original Medicare does not cover dental care, including cleanings, fillings, extractions, and dentures. It does not cover routine vision care like eye exams for glasses or contact lenses. It does not cover hearing aids or exams for fitting hearing aids. It does not cover long-term custodial care in a nursing home or assisted living facility. It does not cover most care received outside the United States.
Medicare also does not cover cosmetic surgery, acupuncture in most cases, or most chiropractic services beyond manual spinal manipulation.
How to Fill the Gaps
There are several ways to cover what Medicare leaves out. A Medigap supplement plan covers your share of Medicare-approved costs like deductibles, copays, and coinsurance. This protects you from big bills when you need hospital care or ongoing treatment. However, supplements do not add dental, vision, or hearing coverage.
A Medicare Advantage plan replaces Original Medicare and often includes dental, vision, and hearing benefits in addition to your medical coverage. Many Advantage plans in Arizona also include gym memberships and over-the-counter allowances.
For dental and vision specifically, you can also buy standalone plans if you are on Original Medicare with a supplement. Several companies offer affordable dental and vision plans designed for seniors.
For long-term care, neither Medicare nor most Advantage plans provide meaningful coverage. Long-term care insurance is a separate product that you can purchase to protect against the cost of nursing home or assisted living care. If your income and assets are limited, Arizona’s AHCCCS Medicaid program may help cover long-term care costs.
The 20 Percent Problem
The 20 percent coinsurance on Part B services is something that catches a lot of people off guard. There is no cap on Original Medicare’s out-of-pocket costs. If you have a $100,000 surgery, your 20 percent share is $20,000. That is why most Medicare advisors recommend either a supplement plan (which covers that 20 percent) or a Medicare Advantage plan (which has an annual out-of-pocket maximum).
Going with Original Medicare alone, with no supplement and no Advantage plan, is risky for most people.
Want a Personalized Breakdown?
If you want to understand exactly what your Medicare coverage looks like and where your gaps are, I am happy to walk you through it. I will look at your current situation and show you the best ways to fill any holes in your coverage.
Call me at 480-296-5804 or request a free coverage review.