Medical Costs Medicare Won't Cover For Seniors

Between the 2025 Social Security adjustment affecting Medicare and the essential healthcare that Boomers won't be able to afford in 10 years, it's a good idea to know ahead of time what Medicare can and can't do for you. While Medicare is mostly known as a Federal health insurance program for Americans 65 years old and up, it can also be accessed by younger Americans with disabilities and certain chronic health issues.

According to the Centers for Medicare & Medicaid Services, 68 million people were insured by Medicare as of September 2024, with this total broken up among different types of coverage. Part A covers hospital insurance, Part B covers medical insurance, Part C provides alternative coverage plans (known as Medicare Advantage), and Part D covers prescriptions. An important thing to keep in mind is that seniors can qualify for both traditional Medicare and Medicare Advantage. In fact, as many as 54% of eligible beneficiaries, or 34 million Americans, have coverage under Medicare Advantage, with seven million Americans claiming eligibility for both in 2022. With that said, there are still things that aren't covered by Medicare that you should be aware of sooner rather than later. Although these Medicare gaps primarily affect seniors, it's important not to wait until your golden years to learn know what they are and how they could affect you.

When you consider that a majority of American seniors are worried their retirement savings will run out, any unexpected expense can have significant consequences. This is why it is so particularly important to know exactly what Medicare doesn't cover before you might end up needing it. For starters, expect to pay during a visit to an ear, eye, nose, or throat specialist. Dental work, eye exams, new glasses, and even hearing aids are not covered by Medicare. For seniors typically experiencing some level of hearing and/or sight loss as they age, this Medicare gap can be a healthcare cost they weren't prepared for.

If you find yourself leaning more into the personal care and wellness space as you age, it's important to realize that things like massage therapy and specialized foot care aren't covered either. Long-term care, which is a possibility for many seniors, is also not covered through Medicare — although we did catalogue the five U.S. states that offer the cheapest assisted living options. Another thing to consider is that, as more seniors retire overseas, Medicare doesn't cover medical care outside of the U.S., meaning any medical costs you might accumulate elsewhere will be your problem.

Beyond the things Medicare absolutely won't cover, there are also certain things they only partially cover that could be relevant to you. For starters, while you do receive a free check up within one year of becoming a beneficiary – which covers basic vitals checks, health history, and even shots – any additional tests or required care will require you to pay a deductible. Since seniors are generally more prone to having additional health needs, chances are good that you will need more than what is covered under this basic check up. Similarly, beneficiaries can take advantage of annual wellness visits. However, unlike the free check up in a beneficiary's first year, these annual wellness visits aren't comprehensive physical exams. Also, while Medicare offers beneficiaries an annual mammogram, should your care provider find a reason for additional tests — an ultrasound or diagnostic mammogram for instance — you may be on the hook for that.  

Another thing to keep in mind is that Part B Medicare only covers one annual psychological evaluation for depression per year. This means that, should your primary care provider not recommend further treatment, you could be financially on the hook for any additional psychological care. If your doctor does recommend additional care, it's important to know that Medicare only covers 80% of the Medicare-approved amount for things like therapy, meaning you would need to pay the other 20% in addition to your deductible and any potential coinsurance costs.