What Medicare Doesn't Cover: Gaps a Medigap Plan Can Fill

Services Original Medicare Does Not Cover

Original Medicare (Parts A and B) is designed around hospital and medically necessary outpatient care. A long list of common services falls outside that scope, and you pay 100% of the cost unless you have other coverage.

Here are the biggest service gaps to know about in 2026:

• Routine dental care. Cleanings, fillings, extractions, root canals, crowns, and dentures are not covered.
• Routine vision care. Eye exams for prescription glasses, eyeglasses, and contacts are excluded.
• Hearing aids. Both the devices and the fitting exams are not covered.
• Long-term custodial care. Help with bathing, dressing, eating, and other activities of daily living in a nursing home, assisted living facility, or at home is not covered when that is the only care you need.
• Overseas care. Medicare generally does not pay for care received outside the United States, with very narrow exceptions.
• Cosmetic surgery. Procedures done purely for appearance are excluded.
• Routine foot care. Trimming corns, calluses, and toenails is not covered unless it is medically necessary (for example, for diabetes-related complications).
• Acupuncture beyond limits. Medicare only covers acupuncture for chronic low back pain, and only up to 12 visits in 90 days (with up to 8 more if you show improvement). Anything else, like acupuncture for migraines or knee pain, is on you.
• Routine physical exams, massage therapy, and concierge care are also generally excluded.

The Cost-Sharing Gaps That Hurt the Most

Even for the services Medicare does cover, the program leaves you on the hook for meaningful deductibles, coinsurance, and copays. Unlike most employer plans, Original Medicare has no annual out-of-pocket maximum, which is the single biggest financial risk for beneficiaries.

Here are the 2026 cost-sharing figures to plan around:

The benefit period trap

The Part A hospital deductible is not annual. A new benefit period starts each time you are admitted as an inpatient and ends only after you have been out of the hospital or skilled nursing facility for 60 consecutive days. Two unrelated hospital stays in the same year can mean paying the $1,736 deductible twice.

The 20% problem

Part B's 20% coinsurance sounds manageable until you face a serious illness. For a $200,000 cancer treatment course, your share could be $40,000 with no upper limit. There is no out-of-pocket maximum in Original Medicare, which is precisely the gap most Medigap plans are designed to close.

Which Gaps a Medigap Plan Fills

Medigap (Medicare Supplement Insurance) plans are standardized by letter (A, B, D, G, K, L, M, N, plus F for those eligible before 2020). Each letter offers the same federally defined benefits no matter which carrier sells it. Medigap pairs with Original Medicare and pays after Medicare pays.

Here is what Medigap typically covers:

What every Medigap plan helps with

• Part A hospital coinsurance plus 365 extra days of inpatient coverage after Medicare's benefits run out
• Part B 20% coinsurance on covered services (Plans K and L pay 50% and 75% respectively; Plan N has small office and ER copays)
• First three pints of blood each year
• Part A hospice coinsurance and copayments

What only certain plans cover

• Part A hospital deductible: Plans B, C, D, F, G, M, and N pay it in full. Plans K and L pay a percentage.
• Skilled nursing facility coinsurance: Most plans except A and B cover the $217/day charge for days 21-100.
• Part B excess charges: Only Plans F and G pay these. If you live in one of the eight states that prohibit excess charges, this benefit matters less.
• Foreign travel emergency care: Plans C, D, F, G, M, and N pay 80% of approved emergency care abroad, subject to a deductible and a $50,000 lifetime cap.

Gaps Medigap Does NOT Fill

Medigap is supplemental medical insurance for the gaps in Original Medicare. It does not add new categories of benefits, so you still need separate coverage for several big-ticket items.

Prescription drugs

Medigap policies sold today do not include outpatient prescription drug coverage. If you take any regular medications, you need a standalone Part D plan. In 2026, Part D has a hard $2,100 annual out-of-pocket cap on covered drugs, after which the plan pays 100% for the rest of the year.

Long-term custodial care

This is the largest uncovered risk in retirement. In 2026, national median costs run roughly:

Medigap and Medicare both stop paying once skilled care is no longer needed. If you want protection from these costs, you need long-term care insurance, a hybrid life/LTC policy, personal savings, or eventual Medicaid eligibility after spending down assets.

Routine dental, vision, and hearing

Medigap does not cover routine cleanings, glasses, or hearing aids. Most enrollees buy a standalone dental and vision plan, a dental discount program, or a hearing benefits package separately. Annual premiums for a basic dental/vision plan typically run a few hundred dollars.

Other gaps Medigap will not touch

• Private-duty nursing
• Cosmetic procedures
• Most over-the-counter items
• Care from providers who have opted out of Medicare entirely

The general rule: if Original Medicare does not consider it covered, Medigap will not pay either, except for foreign travel emergencies on certain plan letters.

How to Match Coverage to Your Personal Risk

The right combination depends on your health, your budget, your travel habits, and how much financial uncertainty you can stomach. Use this framework to think it through.

Step 1: Cover the catastrophic gap first

If you do nothing else, address the unlimited 20% Part B coinsurance and the recurring Part A deductible. A Medigap Plan G or Plan N from a financially strong carrier handles this for a predictable monthly premium.

Step 2: Add a Part D drug plan

Even if you take no medications today, enrolling in a low-cost Part D plan when you first become eligible avoids the late enrollment penalty and protects you from sudden new prescriptions.

Step 3: Decide on dental, vision, and hearing

If you have healthy teeth and only need cleanings, a basic dental plan or discount card may be plenty. If you expect crowns, implants, or dentures, look for a plan with higher annual maximums and a shorter waiting period.

Step 4: Plan for long-term care separately

If you have meaningful assets to protect, talk with an independent insurance agent or financial planner about long-term care insurance, a hybrid life/LTC policy, or an annuity with LTC riders. The younger and healthier you are when you apply, the cheaper the coverage.

Step 5: Re-check coverage every fall

Annual Open Enrollment runs October 15 through December 7. Part D and Medicare Advantage plans change every year, and your prescriptions may change too. Medigap rates can also be shopped at any time, though you may face medical underwriting outside your initial enrollment window.

Frequently Asked Questions

Does Medicare cover dental work if it is medically necessary?

In limited cases, yes. Medicare Part A may pay for dental services performed as part of a covered hospital procedure, such as a tooth extraction needed before heart surgery or organ transplant. Routine cleanings, fillings, crowns, and dentures are still excluded. For everything else, you need a standalone dental plan, a dental discount program, or a Medicare Advantage plan with a dental benefit.

What is the difference between skilled nursing care and long-term custodial care?

Skilled care is short-term, medically necessary treatment like IV therapy, wound care, or rehab after a hospital stay, and Medicare can cover up to 100 days per benefit period in a skilled nursing facility. Custodial care is long-term help with activities of daily living such as bathing, dressing, and eating. Medicare does not pay for custodial care at any setting, which is why long-term care insurance or Medicaid usually steps in for those costs.

Can a Medigap plan eliminate my Medicare out-of-pocket costs entirely?

Plan G comes close. It covers everything except the small Part B annual deductible ($283 in 2026). After that, your covered medical costs are essentially zero. Plan F goes one step further by covering the Part B deductible too, but it is only available to people who were eligible for Medicare before January 1, 2020.

Do I really need a Part D plan if I take no prescriptions?

Yes, in most cases. If you delay enrolling in Part D when you are first eligible and do not have other creditable drug coverage, you will owe a permanent late enrollment penalty that grows the longer you wait. Picking the lowest-premium Part D plan in your area is a cheap way to avoid that penalty and have coverage ready if your needs change.

Will a Medigap plan cover me when I travel abroad?

Plans C, D, F, G, M, and N include foreign travel emergency coverage. After a $250 annual deductible, they pay 80% of approved emergency medical care during the first 60 days of a trip outside the United States, up to a $50,000 lifetime maximum. If you travel frequently or for long stretches, supplement that benefit with a separate travel medical policy for fuller protection.