Medicare Part B covers a wide range of outpatient medical services, but it leaves out several categories of care that catch many enrollees off guard. The biggest gaps include routine dental work, vision exams for eyeglasses, hearing aids, long-term custodial care, most prescription drugs you take at home, and cosmetic procedures. Understanding these exclusions helps you plan for out-of-pocket costs or decide whether supplemental coverage makes sense.
Dental, Vision, and Hearing Services
These three categories are the most well-known Part B exclusions, and they affect nearly every enrollee at some point. Original Medicare does not cover routine dental cleanings, fillings, tooth extractions, or dentures. It does not cover eye exams for prescription eyeglasses. And it does not cover hearing aids or the exams needed to fit them.
There are narrow exceptions. Part B will cover certain dental procedures if they’re tied to a covered medical treatment, such as jaw reconstruction after an accident or dental exams before specific surgeries. It also covers one pair of eyeglasses or contact lenses after cataract surgery with an intraocular lens implant, and it covers diagnostic hearing and balance exams ordered by a doctor to investigate a medical problem. But the routine versions of all three, the kind most people need year after year, are excluded entirely.
Prescription Drugs You Take at Home
Part B only covers a limited set of outpatient drugs. The general rule: if a medication is something you typically administer yourself, Part B won’t pay for it. That includes oral pills, inhalers, suppositories, topical creams, and most subcutaneous injections. These all fall under Part D (prescription drug plans) instead.
Part B does cover drugs that are administered by a healthcare provider in a clinical setting, particularly intravenous and intramuscular injections. The dividing line comes down to whether more than 50 percent of Medicare beneficiaries who use that drug self-administer it. If they do, the drug is excluded from Part B. There’s also a timing factor: drugs used for short-term acute conditions (less than two weeks) are more likely to qualify for Part B coverage, while medications for longer-term use are generally considered self-administered and pushed to Part D.
If you don’t have a Part D plan, you’re paying full price for most prescriptions filled at a pharmacy.
Custodial and Long-Term Care
This is one of the most financially significant exclusions. Medicare does not pay for custodial care when it’s the only type of care you need. Custodial care means non-skilled personal assistance with everyday activities: bathing, dressing, eating, getting in and out of bed, moving around, and using the bathroom. It also includes simple health tasks most people can do themselves, like applying eye drops.
Most nursing home care is custodial care. That means if you or a family member needs to move into a long-term care facility for help with daily living rather than skilled medical treatment, Medicare won’t cover the cost. Nursing home stays can run $8,000 to $10,000 per month or more depending on location, making this gap one of the largest financial risks in retirement. Long-term care insurance, Medicaid (for those who qualify), or personal savings are the primary ways people cover these costs.
Part A does cover short-term skilled nursing facility stays after a qualifying hospital admission, but that’s limited to 100 days and requires ongoing skilled care needs, not just help with daily activities.
Cosmetic Surgery
Part B does not cover procedures aimed at changing your appearance rather than treating a medical condition. Facelifts, procedures to reduce facial lines, and treatments for age-related changes in skin collagen or fat are all excluded.
There are two exceptions. Medicare will cover cosmetic-type procedures if they’re needed because of an accidental injury, or if they improve the function of a malformed body part. It also specifically covers breast reconstruction following a mastectomy for breast cancer.
Routine Foot Care
Part B draws a clear line between medically necessary foot treatment and routine maintenance. It covers podiatrist visits for foot injuries and diseases like hammer toe, bunion deformities, and heel spurs. But it does not cover routine foot care, which includes cutting or removing corns and calluses, trimming or clipping toenails, and hygienic maintenance like cleaning and soaking your feet.
The exception here involves people with certain systemic conditions, particularly diabetes, that create medical risks from routine foot problems. In those cases, some foot care that would otherwise be excluded may qualify for coverage.
Medical Care Outside the United States
Medicare generally does not cover healthcare you receive while traveling abroad. This applies to doctor visits, hospital stays, and prescription drugs purchased in another country. For Medicare purposes, “the U.S.” includes the 50 states, D.C., Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. Anywhere else is considered foreign.
Three rare emergency situations qualify for exceptions. First, if you’re in the U.S. when a medical emergency occurs and the nearest hospital capable of treating you happens to be across the border in another country. Second, if you’re driving through Canada on the most direct route between Alaska and another U.S. state and an emergency happens. Third, if you live in the U.S. but a foreign hospital is simply closer to your home than any U.S. hospital that can treat your condition. In these cases, Medicare may cover inpatient hospital care under Part A, and Part B may cover doctor and ambulance services immediately before and during that hospital stay.
Part B can also pay for services received on a ship within U.S. territorial waters, but not on the open ocean or in foreign ports. If you travel internationally with any regularity, a separate travel medical insurance policy is worth considering.
Therapy Services Above Certain Thresholds
Part B does cover physical therapy, occupational therapy, and speech-language pathology services, but there are spending thresholds that trigger additional scrutiny. For 2026, claims exceeding $2,480 for combined physical therapy and speech therapy (or $2,480 separately for occupational therapy) require your provider to add a special modifier confirming the services are medically necessary. Without it, claims are denied.
At $3,000 in spending, an even higher level of review kicks in, called targeted medical review, where Medicare may audit the medical necessity of continued treatment. These aren’t hard caps on coverage, meaning you can still receive therapy beyond these amounts. But your provider needs to document why ongoing treatment is warranted, and there’s a greater chance of claim denials above these levels.
How Supplemental Plans Fill the Gaps
If you have Original Medicare (Parts A and B), you can purchase a Medigap supplemental insurance policy. However, Medigap only helps cover cost-sharing for services that Medicare already covers, like copayments, coinsurance, and deductibles. It does not add new categories of benefits. A Medigap plan won’t pay for dental cleanings, hearing aids, or long-term custodial care because those services aren’t covered by Medicare in the first place.
Medicare Advantage plans (Part C) are a different story. These private insurance alternatives to Original Medicare often include extra benefits like routine dental exams, vision coverage, and hearing aid allowances. The specifics vary widely by plan, so if filling Part B’s gaps is a priority, compare what each Medicare Advantage plan in your area actually offers, including any additional premiums, provider network restrictions, or coverage limits that apply to those supplemental benefits.