10 Medicare Costs That Catch Retirees Off Guard (And Add Up Fast)

Nearly 25% of Americans are enrolled in Medicare, and many assume it will cover the bulk of their medical expenses in retirement. But the reality is that Medicare comes with significant gaps, and these hidden costs can derail your plans for a stress-free retirement if you're not prepared. From dental work to long-term care, these expenses can quickly add up and chip away at your savings.

Here's a breakdown of the most commonly overlooked Medicare costs, along with real dollar amounts and smart strategies to keep more money in your pocket.

Recent studies estimate that roughly 63% of adults over 70 years old in the United States have some level of hearing loss. Surprisingly, Medicare doesn't cover routine hearing exams or hearing aids.

Hearing aids can cost up to $7,000. Some Medicare Advantage plans provide hearing benefits, but you can also consider FDA-approved, over-the-counter hearing aids.

Original Medicare does not cover routine vision care, including eye exams, glasses, and contact lenses. While cataract surgery is an exception, annual routine care can cost a few hundred dollars, and other services can quickly turn expensive.

Consider a Medicare Advantage plan that includes vision coverage, or opt for low-cost retailers for eye exams and glasses like Costco.

Taking care of your teeth is a big part of staying healthy, but as you might have guessed, Medicare doesn't cover routine dental work. That means cleanings, fillings, crowns, and even dentures are all out-of-pocket. And those costs can add up fast. Just one dental crown might set you back $2,500.

To avoid a major financial hit, look into a Medicare Advantage plan that includes dental coverage, or consider getting a stand-alone dental insurance policy that fits your budget.

It's easy to assume Medicare will cover help around the house as you age, but that's not usually the case. Medicare only pays for in-home care when it's medically necessary and prescribed by a doctor, like after a surgery or hospital stay.

You'll have to pay out of pocket for custodial care like bathing, dressing, cooking, and cleaning. These services can cost up to $43 per hour on average, so be sure to pad your budget just in case.

Providers who do not accept Medicare as full payment are not bound by Medicare-approved amounts. They can charge up to 15% more than what your insurance will cover (also known as the "limiting charge"). Even one medical bill can have a significant financial impact. This is why it's best advised to stick with participating providers.

If you delay enrolling in Medicare Part B or Part D, you could face permanent late enrollment penalties. For Part B, the penalty is a 10% for every 12-month period you wait. For Part D, it's 1% of the national base premium for every month you delay enrollment. These penalties stick with you for life, so they can really add up over time.

If you're earning more in retirement than the average person, you could get hit with higher Medicare premiums. Medicare uses something called IRMAA (Income-Related Monthly Adjustment Amount) to add surcharges to your Part B and Part D premiums if your income is above certain thresholds. In 2025, high earners could end up paying as much as $628.90 per month for Part B alone.

Original Medicare leaves significant out-of-pocket exposure. Medigap can assist with many of these costs, but the average premium for this coverage is $217 per month.

To save money, make sure you shop for plans during your open enrollment period. Review plans annually and consider high-deductible options if you're healthy and want lower premiums.

Medicare doesn't cover custodial long-term care, such as assisted living or nursing homes. The national average for this care is $10,965 per month. Since this kind of care isn't typically covered, plan early by exploring long-term care insurance or hybrid life insurance policies. You could also earmark personal savings or work with a Medicare planning attorney.

While this will not be a concern for everyone, it's still vital for retirees to understand overseas health options. If you travel internationally, Medicare will not generally cover medical expenses abroad. This can be financially devastating if an emergency arises on vacation. Plan ahead by purchasing foreign travel insurance.

If you expect Medicare to cover your health care costs after retirement, you're not alone. But reality can be much more expensive. Hidden costs like supplemental insurance, drug coverage gaps, and long-term care can drain your retirement savings.

That's why planning for retirement isn't just about saving enough. It's also about understanding what Medicare does (and doesn't) cover. That's why knowledge is power. Regularly review your coverage and plan early for known expenses.