Medicare does not cover long-term custodial care, most dental, vision, and hearing services, or prescriptions under Original Medicare Parts A and B. These are among the most significant gaps people encounter.
Medicare is genuinely comprehensive for medical care, but there are real gaps that catch people off guard if they're not expecting them.The biggest one is long-term custodial care. If you need help with daily activities like bathing, dressing, or eating because of age or disability, Medicare doesn't pay for that, whether it's in a nursing home or at home. That kind of ongoing personal care is typically covered by Medicaid for people who qualify financially, or by long-term care insurance.Dental care is mostly excluded. Medicare doesn't cover routine cleanings, fillings, dentures, or most extractions. There are narrow exceptions for dental work that's directly tied to a covered medical procedure, but that's not the norm. Some Medicare Advantage plans include limited dental benefits, so this is worth asking about.Vision coverage is limited. Medicare covers treatment for diseases of the eye, like glaucoma or cataracts, but not routine eye exams or eyeglasses. Again, some Advantage plans add this.Hearing is similar. Medicare doesn't cover routine hearing exams or hearing aids, though some Advantage plans offer an allowance toward them.Prescription drugs filled at a pharmacy aren't covered under Parts A and B. You need Part D or a drug-inclusive Advantage plan for that.Care received outside the United States generally isn't covered, with very limited exceptions for emergencies near the Canadian or Mexican border.Knowing these gaps upfront helps you plan for them rather than discover them at the worst possible moment.
Utah has a Medicare Savings Program that can help qualifying low-income residents with Part B premiums and some cost-sharing, but it doesn't fill coverage gaps like dental or long-term care. Utah's ADRC offices can help assess whether someone qualifies for additional assistance programs.
For you, this means planning ahead for dental, vision, hearing, and long-term care costs is part of a realistic Medicare strategy, not an afterthought.
Our Commitment to Reliable Medicare Information
At Resting Sycamore Advisors, we work to provide accurate, current, and trustworthy information about Medicare Advantage, Medicare Part D, and Special Needs Plans.
To do that, we use data published by the Centers for Medicare & Medicaid Services (CMS), which is the official source for Medicare plan and enrollment information.
Our Medicare plan pages and comparison tools are powered by CMS datasets, including:
When possible, we link to the original CMS resources so you can review the source material directly.
We follow the CMS release schedule and update our website as new data becomes available.
We load new plan year Landscape and PBP files before the Medicare Annual Enrollment Period (October 15 through December 7). We also monitor CMS.gov for updates or revisions and refresh our content when needed.
We update enrollment and performance data as CMS publishes revised files, which are typically released monthly or quarterly.
We routinely monitor CMS announcements for corrections, reissued files, or other changes and update our pages accordingly.
Each plan page includes a Last Accessed date so visitors can see when the source information was most recently reviewed.
CMS data can be difficult to read in raw form. To make it easier to use, we format and organize the data for clarity.
This includes:
All data values come from CMS. We do not change the underlying values beyond formatting, organization, and presentation.
We keep internal records of the CMS dataset versions used on our site.
If CMS issues corrected or revised files, we update our website to reflect the latest available version.
Please keep the following in mind:
For personalized Medicare assistance, please use these official resources: