When looking ahead to retirement, it’s important to know that Original Medicare, while valuable, doesn’t cover every health-related expense you might encounter. As someone who helps people navigate Medicare every day, I see how easy it is to overlook these gaps—especially when it comes to long-term custodial care. Medicare will provide limited skilled nursing or some home health services in certain situations, but ongoing assistance in your home, assisted living, or a nursing facility isn’t typically included.

Routine dental and vision care, glasses, contacts, and hearing aids are also generally outside of standard benefits, unless there’s a specific medical need. Many folks are surprised to learn that care received abroad, elective cosmetic procedures, over-the-counter supplies, routine foot care, and even some out-of-pocket comfort expenses during treatment aren’t covered either, except in very narrow cases.

That’s why I encourage anyone approaching retirement to review their options for supplemental coverage and budget thoughtfully for these likely out-of-pocket costs. Understanding where Original Medicare leaves off—especially in areas like long-term care, dental, vision, and hearing—can help you feel more prepared and confident as you plan for your future health and well-being.

Medicare surcharges can sneak up on more people than you might think—about 8% of beneficiaries now pay these extra premiums. For single retirees, staying at $109,000 in income keeps you at the standard premium. But just one extra dollar—$109,001—triggers the full annual surcharge, which can add up to $1,100. Couples face a similar challenge: if your combined income crosses $218,000 by even $1, both spouses see these surcharges. It’s not just high earners anymore; with thresholds frozen for years while costs rise, roughly 1 in 12 Medicare recipients are now affected. Regular income sources like RMDs, pensions, retirement benefits, and even tax-exempt interest can push you into higher premium territory.

Lawmakers have discussed raising the surcharge tiers and shielding home sale gains, but because these surcharges bring billions to Medicare, changes haven’t been easy to pass. That’s why careful planning matters. Precision Roth conversions before age 73, direct charitable transfers up to $111,000, and timely appeals after big life changes are all key strategies to manage your costs.

As someone who works one-on-one with clients to clarify Medicare and supplemental options, I know how overwhelming these numbers can be. My goal is always to help you understand your choices and feel confident about your coverage, so you’re protected from surprises like these surcharges.

When it comes to preparing for retirement, many people are surprised by the real cost of health care—even with Medicare in place. A recent planning estimate found that a 65-year-old retiring in 2026 could face an average of $185,500 in retirement health care expenses. That’s because medical costs often go well beyond what Medicare covers. In my work as a licensed independent insurance agent, I’ve seen how easy it is to assume Medicare will take care of everything, but research shows more than half of pre-retirees overestimate those benefits—especially as premiums continue to rise faster than retirement benefit increases.

It’s important to remember that Original Medicare doesn’t cover routine dental or vision exams for glasses, hearing aids, or long-term custodial care. These are major needs that require careful planning. Even with covered services, there are still out-of-pocket costs: in 2026, Part B alone is projected at about $203 a month, plus a deductible, 20% coinsurance, and possible surcharges if your income is above certain thresholds.

My approach is always to help you get ahead of these surprises. Reviewing Medicare’s gaps early, considering Medigap options during your one-time enrollment window, and using health savings accounts to build up reserves before you’re eligible can make all the difference in feeling secure about your choices. I believe that understanding your options—not just for Medicare, but also for dental, vision, and supplemental coverage—puts you in control of your retirement health and peace of mind.

It’s easy to assume Medicare will take care of all your health costs in retirement, but the reality is more complex. For someone retiring at 65 in 2026, average health care expenses are estimated at $185,500—far beyond what Medicare alone covers. I often hear from people who are surprised to learn that Original Medicare doesn’t include routine dental, vision exams for glasses, hearing aids, or long-term custodial care. Even with covered services, there are still out-of-pocket costs: for example, in 2026, the Part B premium is projected to be about $203 a month, plus a deductible and around 20% coinsurance. Higher incomes may also mean added surcharges.

If you’re approaching retirement, it’s important to review these gaps early. Take time to compare Medigap options during your one-time enrollment window, and consider using a health savings account to build up extra reserves before you become eligible. My approach is always to make these choices clear and manageable, so you can feel confident your coverage fits your real needs, not just what’s expected.