What Medicare Doesn’t Cover
— and What It Costs You

Last week I had a conversation with an audiologist.

It was not a business conversation. He was describing his own work — research into the relationship between hearing loss and cognitive decline, and why he believes a hearing assessment belongs earlier in an adult's medical timeline than it usually sits.

Then he said something almost in passing, the way people do when they are describing an everyday frustration rather than making a point:

The hearing aids insurance actually covers are usually not the ones that work well enough. The ones that do, people pay for themselves.

I have spent years explaining to accomplished professionals why the retirement number they were handed is not the number they will live on. And in one sentence, a clinician who has never read a word of my work described the mechanism more cleanly than most of my own material does.

Because this is how the number actually gets built. Not in a catastrophe. In a category.

What Medicare Actually Says

Start with the primary source rather than the folklore. Medicare's own coverage documentation is unambiguous:

There are two exclusions in that one sentence, and the second is the one people miss.

Medicare Part B will pay for a diagnostic hearing exam when a provider orders one to determine whether you need medical treatment. So the visit that tells you that you have hearing loss is covered. The appointment that fits the device is not. And the device is not.

You are covered to learn about the problem. You are on your own to solve it.

This is not an oversight or a gap someone forgot to close. It is a statutory exclusion that has been in place since the program was written, and legislation to remove it has been introduced in Congress more than once without passing. Hearing sits alongside dental, vision, and long-term care in a category of care that Original Medicare was simply never built to pay for.

Why He Thinks It Matters

He was not talking to me about money. He was explaining why he believes a hearing assessment belongs earlier in an adult's medical timeline than it usually sits, based on where the research connecting hearing and cognition has been heading.

I am not going to summarize that research for you. I am a retirement income strategist, not a clinician, and the honest position is that the people who actually do this work describe it as an open question rather than a settled one. What I can tell you, as a layperson reading the same published material anyone can read, is that hearing turns up consistently among the factors that specialists think are worth addressing early — seriously enough that a practicing audiologist has built part of his professional argument around it.

That is as far as my competence goes, and further than this article needs to go.

Because the part that sits squarely in my lane does not depend on how the medical question resolves:

Whatever the research concludes in ten years, the financial structure is already fixed. Medicare does not pay for the device today, and it will not start paying for it while the question is being settled. The bill lands on the household either way.

The Arithmetic on One Excluded Category

Let us do the thing almost nobody does with a retirement healthcare statistic, which is take a single line item and follow it all the way through a retirement.

A 2026 survey of more than eleven hundred purchasers puts the average price of a pair of hearing aids at roughly $2,694. Mid-tier prescription devices — which is closer to what my audiologist meant by the ones that work well enough — run about $4,018. Purchased through a traditional clinic without insurance support, the average is $4,727. Consumer Reports puts prescription devices at upward of $4,000 a pair, which is independent corroboration of the same range.

Devices are typically replaced every five to six years.

Now apply a retirement. For a 65-year-old couple, there is a 50% probability that one partner is still alive past 96. Call the horizon twenty-six years, conservatively. At a five-to-six-year replacement cycle, that is roughly five pairs per person across a retirement.

Roughly $27,000 to $47,000 per couple, across a retirement, for ears. One category. One organ system.

That is a model, not a quotation, and I will state its assumptions plainly: flat nominal device pricing, a five-pair replacement schedule, and a twenty-six-year horizon. The flat-pricing assumption is deliberately conservative — average device prices have fallen substantially since 2018 as over-the-counter competition entered the market. I am not inflating the number to make the argument land harder. The argument does not need it.

The $371,000 Is Not the Total. It Is the Subtotal.

Here is where most people's mental model breaks, and it is worth slowing down for.

You have very likely encountered the figure. Fidelity publishes an annual estimate of what healthcare costs a retiree after Medicare. The 2026 estimate, released in July, puts it at $185,500 per person — a 7.5% increase over the prior year. Fidelity publishes the figure per person; for a couple that is $371,000.

It is a serious, well-constructed figure. It accounts for Part B premiums, Part A and B cost-sharing, and Part D premiums and out-of-pocket drug costs.

And when you read what it excludes, the number changes character entirely.

The $27,000 to $47,000 you just watched me calculate is not a slice of the $371,000.

It is on top of it.

So is every dental crown, implant and bridge. So is every pair of glasses and every cataract procedure beyond what Part B allows. And so is long-term care, which is the largest excluded category of all and the one most likely to arrive when the household has the least capacity to absorb it.

$371,000 is not the bill. It is the bill before your ears, your teeth, your eyes, and the years when someone needs help getting through the day.

Which means the figure you have been anchoring on — the one in every retirement article you have read — is a floor. It was never a ceiling. It was never presented as one. Almost nobody reads the footnote.

The Surcharge That Prices Your Best Years

There is a second mechanism that lands specifically on households in the $150,000 to $400,000 income range, and it is structurally strange enough that most people assume they have misread it.

Medicare premiums are income-related. Above a Modified Adjusted Gross Income threshold — $218,000 for a couple filing jointly in 2026 — you pay an income-related surcharge on top of standard Part B and Part D premiums. At the top tier, that surcharge approaches roughly $1,156 a month for a couple.

Now the part that catches people. The surcharge is assessed on your income from two years prior.

So the first years of your retirement are priced off your final years of full earnings. You stop working, your income drops, and your Medicare premium is calculated as though you are still at peak compensation — because two years ago, you were.

You are surcharged for having succeeded, at the precise moment the success stopped producing income.

There is an appeals process for a life-changing event, and retirement can qualify. But it is a form you have to know exists, file correctly, and sometimes refile. The default is that you pay.

This Is Not a Healthcare Problem. It Is a Liquidity Problem.

Everything above is usually filed under health. That is a category error, and it is the reason most plans have nothing to say about it.

None of these costs arrive on a schedule. Nobody's hearing fails on a date they selected. The crown cracks the same quarter the market is down eleven percent. Your mother needs care in the same eighteen months your daughter is finishing graduate school.

What those events have in common is not that they are medical. It is that they all ask the same question at the worst possible time: can you access capital right now, without selling something at a loss and without triggering a tax event you did not plan for?

For most accomplished professionals the honest answer is no. Not because they lack assets — they usually have substantial ones — but because of where those assets sit. A balance that is entirely inside a tax-deferred account is not liquidity. It is a gross number with a deduction attached. Every dollar pulled out arrives as ordinary income, at whatever rate applies in the year you need it, potentially pushing you into the next IRMAA tier and raising the Medicare premium that helped create the expense in the first place.

That is Liquidity Risk. It is one of the six forces we stress-test in every 360° LIFE DESIGN™ Strategy Session, and among professionals in their fifties it is consistently the one that has been thought about least — usually because it is the one their current advisor has no product to sell against.

What Has to Be True Instead

The structural requirement is not complicated to state, though it is precise to build.

Some portion of what you have accumulated has to be positioned so that reaching it does not require a market to cooperate, does not generate ordinary income in the year you touch it, and does not raise the cost of your Medicare coverage as a side effect.

That is the job Pillar One — the Tax-Advantaged Income Strategy — is built to do inside the 360° LIFE DESIGN™ architecture. It addresses Liquidity Risk not by predicting which category of cost arrives first, but by ensuring that whichever one does, there is capital available that is not hostage to the market's timing or to a tax bill set by a future Congress.

Tax treatment here operates under current federal law, is conditional on how the structure is built and maintained, and is not a guarantee. I would rather tell you that plainly than let the word guaranteed do work it has not earned.

What I can tell you with confidence is the shape of the problem. A couple retiring today faces $371,000 in healthcare costs after Medicare, and that figure leaves out four categories they are overwhelmingly likely to need. One of those categories — the smallest one, the one nobody plans for, the one my audiologist mentioned as an afterthought — adds $27,000 to $47,000 on its own.

Nobody budgets for their ears. That is exactly why the number gets to $371,000 and keeps going.

You can find out what your own version of this looks like before it starts arriving, or you can find out while it is arriving. Those are the two options. Only one of them leaves room to build anything.

Continue reading: The Income Floor: What It Is, Why It Matters, and How It Is Built · Longevity Risk: You May Live 30 Years in Retirement. Does Your Plan?