Workers often assume that once they reach 65 and enroll in Medicare, their retirement health costs are largely handled. They are not. Original Medicare — Part A, which covers hospital stays, and Part B, which covers doctor visits and outpatient care — leaves several large gaps that retirees pay for themselves.

Three stand out, and one of them can run well into six figures.

1. Long-term care

The biggest gap is long-term care, sometimes called custodial care: help with daily activities like bathing, dressing and eating, the kind of support many people need late in life. Medicare does not pay for custodial care when that is the only care a person needs. It covers only short, limited skilled-nursing stays tied to a qualifying hospital admission.

The costs are steep. According to the CareScout 2025 Cost of Care Survey — the successor to the long-running Genworth survey — the national median cost of a private room in a nursing home rose to about $355 a day, roughly $129,575 a year. A semi-private room runs about $114,975 annually, while assisted living and home health aide services cost in the range of $70,000 to $78,000 a year. Most of this falls on families or, for those who qualify, on Medicaid — the separate, income- and asset-tested program — after savings are largely spent down.

2. Dental, vision and hearing

Original Medicare also generally does not cover routine dental, vision and hearing care. Cleanings, fillings, dentures, root canals, routine eye exams, eyeglasses, hearing tests and hearing aids are largely out of pocket. Individual costs are modest next to nursing-home bills but add up: dentures can range from a few hundred dollars to well over $10,000, and hearing aids commonly run into the thousands.

3. Care outside the United States

The third gap is geographic. Medicare does not cover most care delivered outside the U.S., with narrow exceptions. Retirees who travel often or spend part of the year abroad need separate travel or expatriate coverage.

How big is the overall bill?

Even setting long-term care aside, retirement health spending is substantial. Fidelity's 2025 estimate puts the average lifetime health-care cost for a 65-year-old retiring in 2025 at about $172,500 — and that figure explicitly excludes long-term care.

The planning tools people use

Financial planners point to a handful of common approaches. None is a recommendation; each carries trade-offs.

  • Medigap and Medicare Advantage. Most beneficiaries supplement Original Medicare. Medigap policies help with deductibles and coinsurance, while many Medicare Advantage plans add dental, vision and hearing benefits — though those extras are often capped and vary by plan. Neither covers long-term custodial care.
  • Health Savings Accounts (HSAs). Funded before retirement through a high-deductible health plan, HSA money grows tax-free and can be withdrawn tax-free for qualified medical costs. After 65, non-medical withdrawals are taxed as ordinary income without the usual penalty.
  • Long-term care insurance. Standalone or hybrid policies are designed specifically to address the custodial-care gap that Medicare leaves open. Premiums and terms vary widely.

The practical takeaway, as these sources frame it, is that Medicare is a foundation, not a full roof. The largest single risk — long-term care — sits almost entirely outside it. This article is for education and is not financial advice; cost figures reflect national medians and vary widely by location and care setting.