Medicare pays for hospital stays, doctor visits, and many medical treatments. But there are still plenty of health expenses that patients have to pay themselves. Dental work, hearing aids, prescription glasses, and long-term care are among the services Original Medicare generally will not cover in 2027.
Some prescription medications are excluded as well. Even a prescription written by a doctor does not guarantee that Medicare will pay for the drug.
Most of these exclusions are not new. They have existed for years. However, prescription drug costs and coverage rules are changing in 2027, and there are some important exceptions that patients should know about.
The Full List of Common Medical Expenses Medicare Won’t Cover in 2027
Original Medicare includes Part A for hospital insurance and Part B for medical insurance. Part D provides prescription drug coverage through private insurance plans.
The following chart covers the main exclusions, including cases where Medicare may still help pay. The official Medicare exclusions apply to Original Medicare. Certain Medicare Advantage plans offer additional benefits.
Federal prescription drug coverage rules set separate restrictions for Part D. A drug missing from one insurance plan’s covered medication list is not necessarily excluded by federal law.
Dental Care and Hearing Aids Remain Major Coverage Gaps
Original Medicare generally leaves patients paying for dental cleanings, fillings, dentures, and implants. The costs can become much higher when someone needs several teeth replaced.
CDC figures showed that 19.7% of Americans aged 75 and older had lost all their natural teeth. Our report on complete tooth loss among seniors further explain why dental coverage is an important issue for older adults.
There are exceptions. Medicare covers certain dental services directly connected to other medical treatments, including specific procedures before organ transplants, heart valve surgery, or cancer treatment.
Hearing aids present a similar problem. Original Medicare covers certain diagnostic hearing tests, but patients generally pay the full cost of hearing aids and fitting appointments.
Some Medicare Advantage plans offer dental, hearing, and vision benefits. However, the additional coverage differs by plan, so patients need to check spending limits and participating providers.
Long-Term Care Can Cost More Than $100,000 a Year
Long-term care is among the most expensive services Medicare generally excludes.
Someone who needs daily help bathing, dressing, eating, or moving around may require assistance for months or years. Original Medicare does not pay for ongoing custodial care simply because a person needs that help.
The national median cost of a private nursing home room reached $129,575 per year in the CareScout survey covering 2025. A shared room cost $114,975 annually, and assisted living averaged $74,400.
Nonmedical care at home cost $80,080 annually when calculated using 44 hours of assistance per week.
The national care cost survey shows how expensive ongoing assistance has become. Individual costs depend on location, facility, and the amount of care required.
Medicare does cover qualifying skilled nursing services under specific conditions. Medicaid may help eligible patients with long-term care, although income, assets, and state rules affect eligibility.
Some Prescription Drugs Are Excluded Even With a Doctor’s Prescription
Getting a prescription does not automatically mean Medicare will pay for the medication.
Part D has restrictions on drugs used for fertility treatment, cosmetic purposes, ordinary cold symptoms, and several other uses listed in the chart.
A different problem occurs when a medication qualifies for Medicare coverage but does not appear on a particular plan’s formulary, which is its list of covered drugs.
Patients may be able to request a coverage exception or appeal in that situation. However, an insurance plan cannot simply ignore federal exclusions because a doctor prescribed the medication.
Some Weight-Loss Drugs Have an Exception
Medicare has traditionally excluded medications prescribed solely for weight loss under standard Part D rules.
However, eligible patients can now receive certain GLP-1 medications through the temporary Medicare GLP-1 Bridge program.
The program includes specified formulations of Wegovy, Zepbound, and Foundayo. Eligible beneficiaries pay $50 for a monthly supply, and the program is scheduled to continue through December 31, 2027.
The Medicare GLP-1 Bridge requirements include medical and eligibility restrictions. The program operates separately from standard Part D coverage.
The $50 copayment does not count toward the regular Part D deductible or annual out-of-pocket spending threshold.
Prices of Prescription Drugs Are Also Changing in 2027
Along with the coverage gaps, Medicare beneficiaries face two confirmed changes to Part D costs.
| Part D Cost | 2026 | 2027 |
|---|---|---|
| Maximum annual deductible | $615 | $700 |
| Annual out-of-pocket spending threshold | $2,100 | $2,400 |
The maximum deductible rises by $85, while the annual out-of-pocket threshold increases by $300. Both changes appear in the official Medicare cost information.
Not every plan charges the full $700 deductible. Some plans have lower deductibles, and eligible beneficiaries receiving financial assistance face different costs.
The $2,400 threshold applies to qualifying spending on covered Part D medications. It does not include every drug a patient purchases, and monthly premiums do not count toward the threshold.
Monthly costs also depend on the insurance plan. Changes to Medicare Part D premiums affect annual spending, especially for patients who already pay substantial amounts for prescriptions.
There is also some positive news. Negotiated Medicare prices for 15 additional medications take effect in 2027, including drugs used to treat diabetes, cancer, and lung disease.
The negotiated drug price list identifies the medications included in the program. Actual patient savings depend on the prescription and insurance plan.
What Medicare Beneficiaries Should Check Before 2027
Medicare open enrollment runs through December 7, 2026. Changes made during this period generally take effect January 1, 2027.
People reviewing their coverage should compare more than monthly premiums.
- Prescription coverage. Confirm that regularly used medications appear on the plan’s covered drug list.
- Dental, hearing, and vision benefits. Check covered services, spending allowances, and participating providers.
- Total costs. Compare premiums, deductibles, copayments, and coinsurance.
- Coverage restrictions. Check prior authorization requirements and other conditions for expensive medications.
- Expected medical procedures. Confirm coverage before scheduling treatment that could leave a large bill.
Some Medicare Advantage premiums in 2027 are expected to be lower, but the monthly premium alone does not show how much someone will spend on medical care.
Patients can compare available plans, covered drugs, and expected costs using the Medicare Plan Finder.
Final Thoughts
Medicare provides important protection against major medical bills, but I find it concerning how many everyday health needs remain outside Original Medicare coverage. Dental work, hearing aids, and help with basic daily activities are hardly unusual expenses for older Americans.
The long-term care figures are especially troubling. A single year of assistance can cost more than many households earn. Knowing what Medicare excludes before a medical problem arises is far less stressful than discovering the gap when the bill arrives.
