For many retirees, Medicare feels like a safety net. After decades of paying into the system, you expect some peace of mind when you finally qualify. And while Medicare Part A, often called “hospital insurance,” does cover major services like inpatient stays, skilled nursing, and hospice, it’s far from a complete package.
In fact, one of the biggest retirement planning mistakes is assuming that Medicare will protect you from large medical bills. The truth is, there are plenty of gaps. And if you don’t know what Part A doesn’t cover, those gaps can quickly turn into deep financial holes. Here are seven surprising (and expensive) things Medicare Part A doesn’t cover and what you can do to protect yourself.
1. Long-Term Custodial Care
One of the biggest misconceptions about Medicare is that it covers long-term care in a nursing home. It doesn’t—at least, not in the way people expect.
Medicare Part A covers skilled nursing facility care only under specific conditions: you must first have a qualifying hospital stay of at least three days, and even then, coverage is limited to a maximum of 100 days. After that, you’re on your own.
But what if you or a loved one needs help with basic daily tasks, like dressing, bathing, or eating, on a long-term basis? That’s called custodial care, and Medicare won’t pay for it. Unfortunately, it’s one of the most common needs for seniors, and it can easily cost $5,000 to $10,000 per month, depending on where you live.
2. Routine Eye, Dental, and Hearing Care
Part A is designed for hospitalization, not prevention or routine maintenance. That means basic dental checkups, eye exams, and hearing aids aren’t covered. This can come as a nasty surprise for older adults whose health depends on these services. Poor dental health can affect nutrition. Untreated hearing loss has been linked to dementia. And not being able to afford an updated eyeglass prescription can increase fall risk.
Unless you have supplemental insurance, you’ll be paying out of pocket for these essentials. The costs add up fast: dental cleanings, fillings, dentures, hearing aids, and new glasses can total thousands per year.
3. Prescription Medications (Outside the Hospital)
Many retirees are stunned to learn that Medicare Part A doesn’t cover their prescriptions unless the drugs are administered during a hospital stay. Need blood pressure meds, insulin, or cholesterol pills after discharge? You’re out of luck unless you have Medicare Part D or another plan.
It’s not just an inconvenience. It’s a financial liability. The average senior takes 4–5 prescription drugs regularly. Without a drug plan, those monthly refills can take a serious chunk out of a fixed income. Worse, the cost confusion can lead people to skip doses or abandon necessary treatments, potentially resulting in hospital readmission, another hidden cost of Part A’s limits.
4. Outpatient Care and Diagnostic Tests
Let’s say your doctor wants you to get an MRI or some bloodwork done. Or maybe you need physical therapy or a visit to a specialist, but you’re not being admitted to a hospital. That’s outpatient care, and Medicare Part A won’t touch it.
Outpatient services fall under Medicare Part B. If you don’t sign up for Part B (or delay it), you could be facing huge bills for even routine diagnostics and checkups. This includes X-rays, lab work, and outpatient surgeries—common needs for aging adults. People are often blindsided by this because they assume “medical coverage” includes any interaction with the healthcare system. It doesn’t.
5. Deductibles and Coinsurance
Medicare Part A isn’t actually free healthcare. It just feels that way because you paid into it during your working years. But when you use it, there are out-of-pocket costs you need to prepare for.
In 2025, the Part A hospital deductible is more than $1,600 per benefit period. That’s not annual. That’s per benefit period, which restarts every time you’re out of the hospital for 60 consecutive days. If you’re hospitalized multiple times in a year, you’ll pay that deductible more than once.
And after 60 days in the hospital, daily coinsurance kicks in—more than $400 per day starting on day 61. These hidden costs can devastate someone who assumes their “free” Medicare plan will handle everything.
6. Private Rooms and Personal Comfort Items
When you’re hospitalized under Medicare Part A, you don’t get to customize your stay. A private room? Not unless it’s medically necessary. Otherwise, expect to share with another patient. Need a TV, phone service, or a few creature comforts? Those may also come with additional charges. Medicare pays only for medically necessary services, not amenities.
In long hospital stays, especially for seniors recovering from surgery or illness, these small details can impact mental well-being. But unless you’re prepared to pay, they’re not covered.
7. Medical Care Outside the U.S.
Planning to retire abroad or take a few big trips in your golden years? You might want to rethink that Medicare card as your passport to health. Because if you need medical care outside the U.S., Medicare Part A won’t cover it.
The only rare exceptions are some emergencies near the U.S. border or on cruise ships within 6 hours of a U.S. port, but generally, Medicare doesn’t extend beyond U.S. soil. If you’re a snowbird, a travel enthusiast, or have family overseas, you’ll need travel insurance or an international health plan. Otherwise, a fall in Italy or a stroke in Thailand could become a six-figure nightmare.
How to Fill the Gaps in Medicare Part A
If you’re feeling shocked or discouraged, you’re not alone. Many Americans find out too late that Medicare leaves some of the most common and costly health services uncovered.
But there are ways to protect yourself:
Consider Medicare Part B for outpatient services
Enroll in Medicare Part D for prescription drug coverage
Look into Medigap policies to cover deductibles and coinsurance
Explore Medicare Advantage plans that bundle multiple coverages
Set aside savings for long-term care or consider long-term care insurance
Knowledge is power—and in this case, it’s the power to avoid financial disaster in your later years.
Medicare Isn’t One-Size-Fits-All
Medicare Part A can be a vital foundation for your healthcare in retirement, but it is not a complete solution. Without understanding its limits, you could end up blindsided by costs that eat away at your savings and sense of security.
Healthcare should never be based on guesswork. Yet many Americans find out too late that their assumptions about coverage were wrong. Don’t let that be you. Learn the rules. Know the gaps. And plan accordingly.
Which of these Medicare Part A gaps surprised you most? Have you or someone you know been caught off guard by one of these costs?
Read More:
10 Legal Ways to Get Medicare to Cover More Than They Say
10 Medicare Plans That Look Helpful—Until You Read the Fine Print
Riley is an Arizona native with over nine years of writing experience. From personal finance to travel to digital marketing to pop culture, she’s written about everything under the sun. When she’s not writing, she’s spending her time outside, reading, or cuddling with her two corgis.
