While Medicare generally provides health insurance coverage for those 65 and older, few people are aware of what is not covered by Medicare or how these costs can be quite high. Medical costs such as dental, vision, hearing, long term care services and other out of pocket expenses are not covered by Medicare. According to The Commonwealth Fund, Medicare beneficiaries spend on average over $3000 per year on out of pocket costs. Such amounts are particularly burdensome to those seniors with low income – a group that makes up about one-half of all Medicare beneficiaries. As the baby boom population becomes eligible for Medicare – further increasing the overall financial burden on the program – any potential reform will need to address those most at risk – the poor.