Key Takeaways

• Medicare in 2025 does not cover everything—and the exclusions might affect your care and budget more than you realize.

• Understanding the limits of what Medicare pays for can help you prepare with additional coverage or savings options.

What Medicare Covers in 2025—And What It Doesn’t

If you’re enrolled in Medicare or planning to enroll soon, it’s easy to assume your healthcare needs are fully taken care of. But even in 2025, traditional Medicare leaves out a surprising number of services. Original Medicare (Part A and Part B) gives you broad coverage for hospital and medical care, yet there are notable gaps.

Here’s what you typically get:

• Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care.

• Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and durable medical equipment.

Yet even with both parts working together, you’re still responsible for a number of expenses and services that fall outside Medicare’s scope.

1. Long-Term Custodial Care Is Still Excluded

Medicare does not cover long-term custodial care—and that includes help with daily activities like bathing, dressing, and eating if it’s the only care you need. This type of care is common among people with chronic illnesses or disabilities, and it’s typically provided in nursing homes or through in-home assistance.

Medicare might pay for a short stay in a skilled nursing facility if it’s directly following a qualifying hospital stay, but only up to 100 days. After that, you pay the full cost. In 2025, this continues to be a major out-of-pocket expense for many.

2. Most Dental Services Are Still Out of Pocket

Routine dental care remains one of the most glaring gaps in Medicare coverage. Services such as:

• Cleanings

• Exams

• Fillings

• Crowns

• Root canals

• Dentures

are not covered by Medicare. Only in specific cases—usually when dental issues are tied to another covered medical procedure—might Medicare offer limited support.

This can leave you managing hundreds or even thousands of dollars a year in dental expenses if you don’t have alternative coverage.

3. Vision Care Isn’t Fully Included

Routine eye exams for eyeglasses or contact lenses aren’t covered under Medicare. While it does cover diagnosis and treatment of eye diseases such as glaucoma and cataracts, you’ll generally have to pay out of pocket for:

• Routine eye exams

• Eyeglass lenses and frames

• Contact lenses

• Vision correction procedures

People with chronic eye conditions may see some coverage under Part B, but general vision care still requires additional support.

4. Hearing Exams and Hearing Aids Still Aren’t Covered

In 2025, Original Medicare still doesn’t cover hearing aids or exams for fitting them. You’ll pay 100% for the devices and exams unless you have additional insurance.

This can be a major burden, as hearing aids can be costly, and hearing loss is increasingly common among older adults. While some legislative proposals have aimed to include hearing benefits in Medicare, they haven’t taken effect yet.

5. Prescription Drug Costs Need Extra Coverage

Medicare Part A and Part B do not cover most outpatient prescription drugs. To get that coverage, you need to enroll in a separate Part D plan.

In 2025, Part D includes the newly implemented $2,000 annual out-of-pocket cap for prescription drugs, which provides some financial relief. However, you still need to:

• Pay a monthly premium for Part D coverage

• Cover the full cost of drugs until you meet the deductible (up to $590 in 2025)

• Share costs during the initial coverage period

If you don’t have Part D or other creditable coverage, you’re responsible for the full cost of your prescriptions.

6. Medical Care Received Abroad Isn’t Covered

Traveling outside the U.S.? Medicare typically won’t cover medical care you receive in a foreign country. There are rare exceptions, such as emergencies near the U.S. border or if you are on a cruise ship within territorial waters.

Otherwise, you will need to pay out of pocket or obtain travel insurance with health coverage. For retirees who travel frequently, this is an important gap to be aware of.

7. Routine Foot Care Is Still Limited

Routine foot care like cutting toenails, removing corns, or treating calluses isn’t covered by Medicare unless it’s deemed medically necessary. If you have diabetes or a condition that puts your feet at risk, you might qualify for limited coverage.

In general, you can expect to pay for most podiatry services unless they are tied to a serious health condition.

8. Alternative Therapies Are Largely Excluded

Therapies such as acupuncture, massage therapy, or naturopathy are usually not covered unless they meet strict medical necessity requirements. As of 2025, Medicare covers acupuncture only for chronic low back pain, and even then, under specific circumstances.

Other holistic or integrative treatments often used to manage chronic pain or stress remain outside of Medicare’s reach.

9. Home Modifications Aren’t Covered

If you need to make changes to your home for safety or accessibility—like installing ramps, stair lifts, or bathroom grab bars—Medicare won’t help with the cost. These improvements are not considered medical expenses, even if they directly affect your ability to age in place.

That means you’ll need to plan for home safety expenses separately if staying at home long-term is part of your retirement plan.

10. Cosmetic Procedures and Non-Medically Necessary Services

Medicare excludes services that are cosmetic in nature or not medically necessary. This includes:

• Cosmetic surgery

• Botox for wrinkle treatment

• Teeth whitening

• Laser eye surgery for vision correction (if not due to an illness or injury)

While medically necessary surgeries like breast reconstruction after a mastectomy may be covered, general cosmetic enhancements are not.

11. Out-of-Pocket Costs Are Still Significant

Even for covered services, Medicare doesn’t mean free. In 2025, here’s what you can expect in terms of general costs:

• Part A deductible: $1,676 per benefit period

• Part B premium: $185 per month (standard)

• Part B deductible: $257 annually

• Coinsurance: Generally 20% for most Part B services

These amounts can add up quickly, especially if you have frequent medical needs. Planning for coinsurance, copayments, and deductibles is just as important as understanding what’s covered.

Planning Ahead for Medicare Gaps

Knowing what Medicare leaves out in 2025 gives you a head start on managing future healthcare costs. Here are a few steps you can take:

• Consider supplemental insurance to cover things Medicare doesn’t.

• Enroll in a Part D plan to protect yourself from high prescription drug costs.

• Set aside savings for services like dental care or hearing aids.

• Research travel medical insurance if you plan to spend time abroad.

• Talk with a licensed agent to get a complete understanding of your options.

Being Informed Helps You Stay Prepared

Medicare in 2025 continues to offer vital healthcare coverage, but it’s not complete. Gaps in services such as dental, vision, hearing, long-term care, and even drug coverage require thoughtful preparation. Being aware of what you’ll need to pay for—or plan for separately—is one of the best ways to avoid financial surprises and make the most of your healthcare benefits.

If you want personalized help understanding your Medicare options, speak with a licensed agent listed on this website for expert advice tailored to your situation.