What Medicare Doesn't Cover: Gaps Every Washington Beneficiary Should Know

The four biggest coverage gaps

Medicare Advantage plans may offer extra benefits that Original Medicare doesn't cover, such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.

Dental: the most-asked-about gap

Original Medicare doesn't cover routine dental care such as cleanings, fillings, tooth extractions, dentures or implants. It does cover some dental services that are tied to other covered treatment, for example:

• An oral exam and needed dental treatment before a heart valve replacement or an organ transplant
• Treating a mouth infection (such as an extraction) before cancer treatment, and treating dental complications of head and neck cancer treatment
• Dental exams and treatment of oral infections before and during dialysis for end-stage renal disease
• Some dental services when you're a hospital inpatient because of your condition or the severity of the procedure

Your options for dental coverage in Washington:

• Medicare Advantage plans with dental coverage. Read the plan's Evidence of Coverage to see which services are covered and any yearly limits.
• Separate dental insurance. Sold by private insurance companies, with its own premium, waiting periods and yearly maximums.
• Apple Health (Medicaid). If you qualify for Apple Health, it covers dental care for adults. See Apple Health in Washington.
• Dental school clinics. The University of Washington School of Dentistry in Seattle offers care from supervised students; ask the clinic about fees and wait times.
• Community health centers. Many Washington community health centers offer dental care on a sliding fee scale based on income.

Vision: medical care yes, routine care no

Medicare covers medical eye care: cataract surgery (including a standard intraocular lens), a yearly glaucoma test for people at high risk, a yearly eye exam for diabetic retinopathy if you have diabetes, and treatment of eye diseases. After each cataract surgery that implants an intraocular lens, Part B covers one pair of eyeglasses with standard frames or one set of contact lenses.

Medicare doesn't cover routine eye exams for glasses or contact lenses, or eyeglasses and contact lenses in other cases.

Options:

• Medicare Advantage plans with vision coverage. Check the plan's Evidence of Coverage for exams and eyewear.
• Separate vision insurance, with its own premium.
• Apple Health. If you qualify, check with Apple Health which eye exams and eyewear it covers for adults.

Hearing aids: long the most expensive gap

Medicare doesn't cover hearing aids or exams for fitting them. Part B does cover diagnostic hearing and balance exams when your doctor or other provider orders them to see whether you need medical treatment, and in some cases you can see an audiologist once every 12 months without an order.

Ways people get hearing aids:

• Over-the-counter (OTC) hearing aids. Since an FDA rule in 2022, adults 18 and older with perceived mild to moderate hearing loss can buy hearing aids in stores and online without a prescription or exam.
• Medicare Advantage plans with hearing coverage. Check the plan's Evidence of Coverage for any limits.
• VA benefits. Veterans enrolled in VA health care may get hearing aids through the VA. See Veterans and the VA in Washington.
• Apple Health. If you qualify, ask Apple Health about its hearing aid coverage for adults.

Long-term care: the biggest financial risk

This is the gap that catches people off guard. Medicare pays for short-term skilled care, such as rehabilitation in a skilled nursing facility after a hospital stay of at least 3 days as an inpatient: up to 100 days per benefit period, with coinsurance ($217 a day in 2026) for days 21 to 100. Medicare doesn't pay for long-term custodial care, the help with bathing, dressing, eating and using the bathroom that most people who need long-term care need.

Your options:

• WA Cares Fund. Washington's state long-term care benefit for people who have contributed through payroll. Benefits became available July 1, 2026, to people who meet the contribution and care-need requirements, up to a benefit amount set by law and adjusted for inflation. Check wacaresfund.wa.gov to see whether you qualify.
• Apple Health long-term care. Washington's Medicaid program covers nursing home care and many in-home and community services for people who qualify by income, resources and care needs.
• Private long-term care insurance. Premiums are generally higher the older you are when you buy, and companies can turn you down for health reasons.
• Life insurance with long-term care benefits. Some policies combine a death benefit with long-term care coverage.
• Personal savings. Many people pay for some care themselves.

Community Living Connections (1-855-567-0252) is Washington's statewide line for finding long-term services and supports, at no cost to you.

Other things Medicare doesn't cover

• Cosmetic surgery, unless it's needed because of an accidental injury or to improve the function of a malformed body part
• Acupuncture, except for chronic low back pain, with limits
• Routine foot care, except for certain medical conditions such as diabetes-related nerve damage
• Care outside the United States, with rare exceptions (below)
• Most weight-loss programs; Medicare covers obesity screening and counseling, and bariatric surgery for some people with morbid obesity who meet requirements
• Gym and fitness memberships; some Medicare Advantage plans include fitness benefits

Care outside the U.S., and the Canadian border

Original Medicare generally doesn't cover care outside the U.S. The exceptions that matter most in Washington: Medicare may pay for care in a Canadian hospital if you have an emergency while in the U.S. and the Canadian hospital is closer than the nearest U.S. hospital that can treat you, if the Canadian hospital is nearer your home than any U.S. hospital that can treat your condition, or if you have an emergency while driving through Canada by the most direct route between Alaska and another state.

For trips to Canada or farther, Medigap Plans C, D, F, G, M and N pay 80% of emergency care during the first 60 days of a trip, after a $250 yearly deductible, up to a $50,000 lifetime limit. Some Medicare Advantage plans cover emergency care abroad. See Snowbirds and Medicare.

Help understanding the gaps

• 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) and Medicare.gov, for what Medicare covers
• Community Living Connections (1-855-567-0252), for long-term care planning
• A licensed insurance agent with Benefits Life, at (206) SENIORS (206-736-4677), TTY 711, at no cost to you, to compare Medicare Advantage and Medigap plans from the companies they work with, or an independent licensed insurance agent near you. You can also see plans in your ZIP code.

Sources

• Medicare.gov — Dental services
• Medicare.gov — Eyeglasses and contact lenses
• Medicare.gov — Eye exams (routine)
• Medicare.gov — Hearing aids
• Medicare.gov — Hearing and balance exams
• Medicare.gov — Long-term care
• Medicare.gov — Skilled nursing facility care
• Medicare.gov — Acupuncture
• Medicare.gov — Travel outside the U.S.
• FDA — OTC hearing aids: what you should know
• Washington Health Care Authority — Apple Health dental services
• WA Cares Fund — Benefits now available
• University of Washington School of Dentistry

Frequently asked questions

Does Medicare cover dental in Washington?

Original Medicare doesn't cover routine dental care such as cleanings, fillings, extractions or dentures. It covers some dental care tied to other covered treatment, such as an exam before a heart valve replacement. Some Medicare Advantage plans include dental coverage, Apple Health covers dental care for adults who qualify, and separate dental insurance is available.

Does Medicare pay for hearing aids?

No. Original Medicare doesn't cover hearing aids or exams for fitting them, though Part B covers diagnostic hearing and balance exams in some cases. Some Medicare Advantage plans include hearing coverage, veterans may get hearing aids through the VA, and over-the-counter hearing aids are sold without a prescription to adults with perceived mild to moderate hearing loss.

What about long-term care in a nursing home?

Medicare doesn't cover long-term custodial care, the help with bathing, dressing and eating that most long-term care involves. It covers up to 100 days of skilled nursing facility care per benefit period after a qualifying hospital stay, with daily coinsurance after day 20. In Washington, options include Apple Health long-term care, the WA Cares Fund (benefits available since July 1, 2026), and private long-term care insurance.

Does Medicare cover care outside the United States?

Generally no. Original Medicare covers care abroad only in rare cases, such as when a Canadian hospital is closer than the nearest U.S. hospital that can treat your emergency, which can matter near Washington's border. Medigap Plans C, D, F, G, M and N pay 80% of emergency care abroad after a deductible, up to a lifetime limit.

Are eyeglasses covered by Medicare?

Original Medicare doesn't cover routine eye exams for glasses or most eyeglasses and contact lenses. It does cover one pair of eyeglasses with standard frames, or one set of contact lenses, after each cataract surgery that implants an intraocular lens. Some Medicare Advantage plans include vision coverage, and separate vision insurance is available.

Medicare in your Washington county

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