Start with the gap nobody advertises
The dental and hearing commercials run constantly in the fall, and they are aimed at the gaps that are easy to picture. The gap that actually ruins people is duller and gets no airtime.
Original Medicare has no out-of-pocket maximum. Part B pays 80% of approved charges and leaves you the other 20%, and there is no ceiling on that 20%. For someone with an ordinary year of checkups and a couple of specialist visits, this is a manageable number. For someone who gets a cancer diagnosis, or has a cardiac event followed by months of follow-up, 20% of a very large number is also a very large number, and it keeps going.
Everything else on this page is a spending problem. This one is a solvency problem. It is the reason Medicare Supplement policies exist and the reason every Medicare Advantage plan is required to cap your annual exposure. If you are weighing which gaps to close first, close this one and then argue about dental.
Dental
Original Medicare pays for no routine dental work at all. Not cleanings, not fillings, not extractions, not root canals, not dentures, not implants. The only dental Medicare pays for is dental work that is part of a covered medical procedure, such as jaw reconstruction after an accident or an oral exam required before an organ transplant.
Most Medicare Advantage plans include some dental benefit, and this is where the marketing gets ahead of the product. Read the annual maximum. Embedded dental benefits frequently cap out at a level that one crown will consume, and a full set of dentures is well past it. That does not make the benefit worthless. It makes it a cleanings-and-checkups benefit rather than a major-work benefit, and it should be evaluated as such.
A standalone dental plan is sold outside Medicare entirely, which means no enrollment window and no waiting for October. Price it against the embedded version rather than assuming the bundled one wins.
Vision
The line here is medical versus routine, and it is drawn more sensibly than people expect.
Medicare does not pay for an eye exam to get a glasses prescription, and does not pay for the glasses or contacts. It does pay for medical eye care: annual glaucoma screening if you are at high risk, which includes anyone with diabetes or a family history, and treatment for macular degeneration and diabetic retinopathy. Cataract surgery is covered, and it comes with the one vision exception in the program, which is a single pair of glasses or contacts afterwards.
Given how common diabetes is in Arkansas, the diabetic retinopathy screening is worth knowing about. It is covered annually, a lot of people entitled to it never use it, and it catches something that is far cheaper to treat early.
Hearing
Medicare covers a diagnostic hearing exam when a doctor orders it to investigate a medical problem. It does not cover routine hearing tests, and it does not cover hearing aids.
Hearing aids are one of the largest items retirees pay for entirely themselves, and the gap has real consequences beyond the money. People delay for years because of the price, and untreated hearing loss carries documented associations with social isolation and cognitive decline. Over-the-counter hearing aids are now available without a prescription for mild to moderate loss, which has changed the arithmetic considerably. Several Medicare Advantage plans include a hearing allowance, and it is one of the embedded benefits more likely to be worth something than the dental one.
Long-term care
This is the gap with the widest distance between what people believe and what is true, and it is the most expensive belief in retirement planning.
Medicare does not pay for long-term custodial care. What it covers is skilled nursing care, up to 100 days per benefit period, and only if three conditions all hold: you had a qualifying inpatient hospital stay first, you need daily skilled care rather than help with daily living, and you are actively improving. When you stop improving, coverage ends, whether or not you still need the care.
So the stroke patient in rehab is covered, right up until the point rehabilitation stops producing gains. The person with advancing dementia who needs help bathing and eating was never covered, because that is custodial care and not skilled care. Families discover this a few weeks into a nursing home stay, usually during the worst month of their lives.
What actually pays for long-term care is your own savings, a long-term care policy or a hybrid life policy with a long-term care rider bought years earlier, or Medicaid after you have spent down your assets to qualify. There is no fourth option, and Medicare is not one of the three. If you are in your fifties or early sixties, this is worth addressing while you are still insurable.
Smaller things that still catch people
- Care outside the United States. Almost never covered. Several Medigap plans include foreign travel emergency coverage up to a lifetime limit, which is the practical fix if you travel.
- Most podiatry. Routine foot care is excluded, though it is covered for people with diabetes, which is a meaningful exception in this state.
- Cosmetic surgery, except reconstruction after an accident or a mastectomy.
- Acupuncture, except for chronic low back pain, which is covered with visit limits.
- Most prescriptions you take at home, which need Part D. Part B covers only drugs administered in a clinical setting.
What to actually do about it
Rank these by what would genuinely damage you rather than by what annoys you. The missing out-of-pocket maximum is a financial risk and belongs first. Long-term care is a financial risk and belongs second, and it is solved years in advance or not at all. Dental, vision, and hearing are budget items, and while they are worth planning for, buying a plan primarily for its dental benefit is how people end up in a network that does not include their cardiologist.
Lancaster Cook is an independent agent in Little Rock, AHIP certified, Arkansas license #8021079, and will tell you plainly which of these are worth insuring in your situation and which are not.