Most of the surprises that show up in someone's first year of Medicare aren't about what Medicare pays. They're about what it doesn't. Routine dental cleanings, eyeglasses, hearing aids, custodial nursing care — folks expect Medicare to cover these and find out it doesn't. Then they're scrambling.
Here's the honest list of the big gaps, what your options are for each one, and where to look for help in St. Louis if you need it.
The 60-second summary
Original Medicare does not cover routine dental, vision (eyeglasses), or hearing care (hearing aids), and it does not cover long-term custodial care like assisted living. Many Medicare Advantage plans add dental, vision, and hearing benefits; stand-alone policies are available too. Long-term care needs its own plan — insurance, savings, or Medicaid spend-down.
Now the detail.
Routine dental care
Original Medicare doesn't pay for cleanings, fillings, crowns, dentures, or root canals.
There are narrow exceptions where Medicare will pay for medically necessary dental work tied to another covered procedure — for example, a dental exam required before heart surgery or organ transplant. That exception is narrow and gets denied a lot.
Two practical paths for dental coverage:
- Medicare Advantage plans with dental benefits. Most Advantage plans now include a dental allowance — sometimes basic preventive only, sometimes a comprehensive allowance up to a yearly cap. The dollar amounts and rules vary by plan. We check the actual dental benefit on every plan we recommend.
- Stand-alone dental insurance. Separate policies from carriers that offer Medicare-supplemental dental. Useful if you're on Original Medicare + a Supplement, or if your Advantage plan's dental benefit isn't enough for your needs.
Routine vision and hearing
Original Medicare does not cover routine eye exams for prescription glasses, the glasses themselves, or hearing aids. It does cover medical eye conditions (cataract surgery, glaucoma screening for high-risk patients, diabetic retinopathy exams) and medical hearing concerns (a diagnostic exam from an audiologist for balance issues, for example).
For routine care:
- Most Medicare Advantage plans include a vision benefit (annual exam plus an allowance for glasses or contacts) and a hearing benefit (annual exam plus a hearing-aid allowance or copay structure).
- Stand-alone vision and hearing plans are available, often as add-ons to Supplement coverage.
What we often find is that hearing aids are the most common gap people don't plan for. A pair runs into the thousands. The Advantage plans' hearing benefit can change the picture meaningfully — check the actual allowance, not just whether the plan "includes" hearing.
Long-term care — the biggest gap
This is the one folks misunderstand most, and it's the one with the biggest financial exposure if you get it wrong.
Medicare pays for short-term skilled nursing rehab. If you've been admitted to a hospital for three days and are discharged to a skilled nursing facility for rehab, Medicare can cover up to 100 days of skilled care. Days 1–20 are usually fully covered. Days 21–100 have a daily coinsurance ($217.00/day in 2026) unless a Supplement covers it. After day 100, Medicare stops paying. The qualifying rules are strict — the care has to be skilled, not custodial.
Medicare does not pay for long-term custodial care. That's the day-to-day help with bathing, dressing, eating, medication management — whether at home, in assisted living, or in a nursing home as a long-term resident. Most long-term care is custodial.
Three ways people typically cover long-term care
Long-term care insurance
A separate policy you buy in your 50s or 60s. Premiums are real, but the policy can cover home care, assisted living, and nursing facility care for a defined benefit period. Underwriting gets harder with age — this is a "decide while you're healthy" conversation.
Personal savings and assets
Self-funding. Works if assets are large enough. The right path for some families; the wrong one if it forces a spouse to spend down the household nest egg to pay for one person's care.
Medicaid (MO HealthNet)
Medicaid covers nursing-home care after assets are spent down to the program's limits. Missouri's spend-down rules, the home-protection rules for a community spouse, and the 60-month look-back period are detailed — an elder-law attorney is the right help here.
Glasses, hearing aids, routine foot care — the specifics
A few specific gaps that come up a lot:
- Prescription eyeglasses: not covered by Original Medicare unless they're for cataract surgery aftercare. Advantage plans often include an eyewear allowance.
- Hearing aids: see above. Advantage plan allowances or stand-alone hearing coverage are the practical paths.
- Routine foot care: Original Medicare covers medically necessary foot care (diabetic ulcers, peripheral neuropathy treatment, etc.). It doesn't cover routine nail-cutting and corn-removal for otherwise healthy feet. A common misconception.
- Acupuncture for chronic back pain: covered up to a limit under Original Medicare since 2020 — surprises folks who assume it's not.
- Cosmetic dental and cosmetic surgery: not covered.
Care outside the United States
Original Medicare generally does not cover care outside the U.S. There are very limited exceptions (rare emergencies near a U.S. border, for example).
If international travel is part of your retirement, two options to know:
- Some Medicare Supplement plans (Plan G, Plan N, others) include a foreign-travel emergency benefit — typically 80% coverage up to a lifetime limit (often around $50,000) after a small deductible, for emergencies during the first 60 days of any trip outside the U.S.
- Travel medical insurance is sold by stand-alone insurers and is often a better fit for long international trips.
Most Medicare Advantage plans cover only emergency care outside the U.S. — and many do not cover any international care at all. Check the plan documents before a trip.
The St. Louis resource map
For folks already on Medicare who need help with something Medicare doesn't cover, a few St. Louis-area resources we point people to often:
- St. Louis Area Agency on Aging — local advocacy and benefits help, including LIS/Extra Help applications and Medicaid screening.
- MO Rx Plan — Missouri's state pharmacy assistance program for certain Medicare beneficiaries.
- BJC and Mercy financial-assistance programs — both major health systems have charity-care and financial-assistance applications for uninsured costs.
- Missouri SHIP (CLAIM) — the state's federally-funded Medicare counseling program, free and unbiased.
- Elder-law attorneys in the St. Louis area for Medicaid planning and asset-protection questions.
We have a working relationship with several of these. If a client needs a warm handoff, we make it.
Plan around the gaps, not just the coverage
The first-year-on-Medicare surprises are mostly avoidable. They happen because folks plan around what Medicare covers without sitting down with what it doesn't.
Before you finalize a plan, run a quick mental audit:
- Will you need routine dental, vision, or hearing care this year?
- Do you wear hearing aids, or expect to?
- Does anyone in your family have a long-term-care exposure (Alzheimer's, Parkinson's, MS) that should be addressed with separate coverage?
- Do you travel internationally, even occasionally?
Most of these are conversations we have in the plan-fit meeting. I've been helping people with Medicare in St. Louis since 2013 — I've seen most of these surprises play out, and I can help you plan around the gaps as carefully as you plan around the coverage.
No fee, no pressure, no sales pitch — that's the rule of the house. We answer every call.
