Does Medicare Cover All My Medical Bills?
Key Points
- Part B typically covers 80% of approved costs — you owe the other 20% with no cap.
- Medicare does not cover long-term custodial care in nursing homes or assisted living.
- Routine dental, vision, and hearing services are generally not covered under Original Medicare.
Medicare provides solid health coverage — but it was never designed to pay for everything. Understanding what it leaves uncovered is just as important as knowing what it does pay for.
The 80/20 Split — and Why It Matters
Under Original Medicare Part B, Medicare pays 80% of the approved amount for covered services once you've met your annual deductible. You are responsible for the remaining 20%. This sounds manageable until you consider that there is no annual out-of-pocket maximum under Original Medicare alone.
If you're diagnosed with cancer, have a heart attack, or face a major surgery, your 20% share can quickly reach tens of thousands of dollars. This is the exposure that Medicare Supplement (Medigap) plans are designed to protect against — by covering that coinsurance so your costs are predictable.
What Medicare Does Not Cover
Long-term custodial care is one of the most significant gaps in Medicare coverage. If you need help with daily activities — bathing, dressing, eating — in a nursing home or assisted living facility over an extended period, Medicare will not pay for it. Medicare only covers short-term skilled nursing care following a qualifying hospital stay, and only up to 100 days.
Routine dental care — cleanings, fillings, extractions, crowns — is not covered under Original Medicare. Neither are routine eye exams or eyeglasses, most hearing aids, or cosmetic procedures. These are services many people use regularly, and the cost adds up significantly over retirement.
Other Common Gaps
Medicare does not cover care received outside the United States in most circumstances. If you travel internationally or spend part of the year abroad, you would typically be responsible for any medical costs incurred overseas.
Prescription drugs are not covered under Original Medicare Parts A and B. You need a separate Part D plan for most outpatient medications. Some drugs administered in a clinical setting are covered under Part B, but the majority of drugs you pick up at a pharmacy require Part D coverage.
How to Close the Gaps
The two primary ways to address Medicare's gaps are Medicare Supplement (Medigap) plans and Medicare Advantage plans. Medigap plans cover the cost-sharing that Original Medicare leaves behind — particularly the 20% coinsurance and deductibles. Medicare Advantage plans add an annual out-of-pocket maximum and often include extra benefits.
For long-term care exposure, separate long-term care insurance or hybrid life/LTC products exist to protect your assets if you ever need extended custodial care. Addressing these gaps before you need them is the foundation of a sound retirement health strategy.
Still Have Questions?
Our licensed Medicare brokers are here to help — at no cost to you.