Medicare is comprehensive, but it is not all-inclusive. Many seniors enter retirement assuming that “medical + hospital = covered.” In 2026, they are discovering the hard way that Medicare has specific, statutory exclusions that leave gaping holes in their safety net.
These aren’t “errors”—they are features of the system. But they result in bills that can reach thousands of dollars. From the dentist’s chair to the ambulance ride, here are six charges seniors are shocked to find they have to pay themselves.
1. The “Observation Status” Rehab Bill
We’ve mentioned this before, but it remains the #1 shock for families. If a hospital keeps you under “Observation” (Outpatient) rather than admitting you as an “Inpatient” for at least three midnights, Medicare will not pay for your subsequent stay in a Skilled Nursing Facility (SNF).
Seniors often think “I was in the hospital for 4 days, so rehab is covered.” If those 4 days were “Observation,” the $15,000 rehab bill is 100% your responsibility. You must ask every day: “Am I inpatient or observation?” If you are observation, you can appeal, but you are fighting an uphill battle against hospital coding rules.
2. Routine Dental & “The Bone” Rule
Medicare pays for nothing involving the teeth—no cleanings, no fillings, no dentures. The confusion arises because they do pay for jaw surgery or oral cancer treatment.
Seniors often assume that if a dental infection is “medically necessary” to treat (e.g., before heart surgery), Medicare will pay to pull the tooth. Wrong. They will pay for the heart surgery, but they will carve out the cost of the extraction and bill you for it. This statutory exclusion is strict and often leaves patients with a surprise bill from the oral surgeon.
3. Hearing Aids and Exams
Hearing loss is a medical issue, but Medicare treats hearing aids as “routine.” They cover zero percent of the cost of the devices or the fitting exams.
In 2026, with Over-the-Counter (OTC) hearing aids available, some seniors are finding relief. But for prescription-grade devices needed for severe loss, the $4,000 to $6,000 bill is entirely out-of-pocket unless you have a specific Medicare Advantage plan with a hearing benefit.
4. Ambulance “Taxi” Denials
Medicare only pays for an ambulance if it is “medically necessary,” meaning that traveling by any other means (like a car or taxi) would endanger your life.
If you call 911 because you fell and broke your wrist, but you were alert and stable, Medicare may decide you could have taken a car. They will deny the $1,200 ambulance claim months later. Lack of a ride does not justify an ambulance in Medicare’s eyes; only your medical condition does.
5. “Self-Administered” Drugs in the Hospital
If you are in the hospital (Outpatient/Observation) and the nurse gives you your daily insulin or blood pressure pill, Medicare Part B does not cover it. These are considered “Self-Administered Drugs.”
The hospital will bill you for them, often at massive markups (e.g., $20 for a single aspirin). It is one of the most frustrating small bills seniors receive. Savvy patients know to bring their own meds from home, provided the hospital policy allows it.
6. Routine Vision & The “Refraction” Fee
Medicare covers cataract surgery, but it does not cover the “refraction” test (the “better 1 or better 2” test) that determines your prescription for glasses.
Even if you are at the ophthalmologist for a covered medical issue like glaucoma, if they do a refraction to check your vision, you will be handed a separate bill for $40 to $60 for that specific part of the exam. It is a “non-covered service” that almost everyone needs but no one expects to pay for during a medical visit.
Know the Gaps
The only way to protect yourself is to know what isn’t covered. Consider a “Hospital Indemnity” plan to cover observation stays, and set aside a dedicated savings bucket for dental and hearing needs. Medicare is a safety net, but it has holes.
Did you get stuck with a bill for a hearing exam? Leave a comment below—tell us if you found a cheaper option!
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