Key Takeaways

• Medicare in 2025 continues to offer strong foundational coverage, but it does not cover everything. Gaps in coverage can lead to significant out-of-pocket expenses if you aren’t prepared.

• Understanding what Medicare excludes — from long-term care to routine dental and vision services — can help you plan for supplemental options or alternative strategies.

What Medicare Covers in 2025

Before diving into what’s missing, let’s clarify what Medicare does include. In 2025, Original Medicare is composed of two main parts:

• Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Most people do not pay a premium if they have 40 quarters of work history.

• Part B (Medical Insurance): Covers outpatient care, preventive services, doctor visits, durable medical equipment, and some home health care. The monthly premium in 2025 is $185, with an annual deductible of $257.

While this provides a solid base, there are important areas where Medicare coverage stops short.

1. Long-Term Custodial Care Is Not Included

One of the most significant gaps in Medicare is the lack of long-term custodial care coverage. Medicare only covers short-term stays in skilled nursing facilities after a qualifying hospital stay of at least three days. Even then, coverage is limited:

• Full coverage for the first 20 days.

• Partial coverage from days 21 to 100.

• No coverage beyond day 100.

Custodial care, such as assistance with daily living activities (eating, bathing, dressing), is not covered at all. Given the high cost of assisted living or nursing home care, this can be financially devastating.

2. Routine Dental, Vision, and Hearing Services Are Largely Excluded

Original Medicare does not cover routine dental, vision, or hearing services, even though these are essential for maintaining overall health:

• Dental: No coverage for cleanings, fillings, tooth extractions, or dentures.

• Vision: No routine eye exams or glasses/contacts.

• Hearing: Hearing aids and related exams are not covered.

You may receive coverage for these services only if they are medically necessary and directly related to another covered service. For instance, an eye exam for diabetes complications would be covered under Part B.

3. Prescription Drug Coverage Requires a Separate Plan

Medicare Part A and Part B do not include prescription drug coverage. To get this, you need to enroll in a separate Part D plan. In 2025, the maximum deductible for Part D is $590, and the out-of-pocket cost cap is now set at $2,000 per year.

Without Part D or a creditable drug coverage alternative, you would be responsible for the full cost of your medications. This can add up quickly, especially for chronic conditions.

4. Overseas Medical Care Isn’t Covered

Traveling outside the United States? Medicare generally doesn’t cover healthcare services you receive abroad, with very few exceptions:

• If you’re in the U.S. when a medical emergency occurs and a foreign hospital is closer than a U.S. one.

• If you’re traveling through Canada without delay and an emergency happens.

Otherwise, you are responsible for 100% of the costs. If you travel frequently, you may need to consider supplemental insurance that includes foreign emergency coverage.

5. Home Modifications and Custodial Equipment Are Not Covered

If you need to modify your home due to mobility issues — such as installing ramps, stairlifts, or walk-in bathtubs — Medicare won’t cover those expenses. Likewise, items considered “custodial” rather than medically necessary are excluded, such as:

• Grab bars

• Raised toilet seats

• Meal delivery services

These can be essential for independent living but are not considered medically necessary under Medicare rules.

6. Alternative and Holistic Therapies Are Not Typically Covered

Many people turn to alternative treatments such as acupuncture, chiropractic care, or naturopathy for chronic pain or general well-being. Medicare is selective about which services it covers:

• Acupuncture: Covered for chronic low back pain only.

• Chiropractic: Covered for spinal manipulation if medically necessary.

• Naturopathy, massage therapy, and other alternative approaches are not covered.

If you rely on these services, you should be prepared to pay out of pocket or explore other options.

7. Excess Charges Can Apply Under Part B

In 2025, some providers who don’t accept Medicare assignment can bill you up to 15% more than the Medicare-approved amount. These are known as “excess charges.”

For example, if Medicare approves $100 for a service, and your provider doesn’t accept assignment, you could be charged $115. This doesn’t seem like much initially, but over time, those charges can add up if you frequently see non-participating providers.

8. Mental Health Services May Have Limits

Medicare covers mental health care, but with certain restrictions. Outpatient therapy, psychiatric evaluations, and medications are generally covered under Part B and Part D, but limitations may include:

• Limited number of therapy visits covered per year.

• Higher cost-sharing for some mental health drugs.

• Restrictions on inpatient psychiatric care, with a lifetime limit of 190 days in a psychiatric hospital.

This can create challenges for long-term mental health care planning.

9. Podiatry and Foot Care Are Mostly Excluded

Routine foot care is not covered under Medicare unless it is medically necessary due to conditions like diabetes. This includes:

• Regular nail trimming

• Removal of corns or calluses

• Orthotics for flat feet

For people with chronic foot conditions or mobility issues, these exclusions can lead to increased risk of falls or other complications.

10. Emergency Transportation Limitations

Medicare does cover emergency ambulance services when medically necessary, but there are limitations:

• Non-emergency transportation is typically not covered.

• Air ambulance services require strict qualification criteria.

In cases where transportation is needed for routine care or specialist visits, you may need to arrange and pay for alternative solutions.

Planning Around These Gaps in 2025

Being aware of these limitations is only the first step. You should consider ways to address these coverage gaps, such as:

• Supplemental coverage: Many people explore options to help cover what Medicare does not.

• Health savings: Planning ahead by budgeting for common out-of-pocket expenses.

• Provider selection: Always check if your provider accepts Medicare assignment to avoid excess charges.

• Preventive care: Staying healthy reduces the need for many uncovered services.

Why Understanding Gaps Matters Now More Than Ever

In 2025, healthcare costs continue to rise, and knowing where Medicare coverage stops can save you from surprise bills. People turning 65 this year or already enrolled in Medicare need to pay close attention to coverage limits.

Failing to plan around these gaps can lead to:

• Unexpected out-of-pocket expenses

• Delayed access to necessary care

• Missed opportunities to enroll in helpful supplemental plans

Reviewing your Medicare coverage annually and adjusting your plan as your needs change is essential.

What You Should Do Next

If you’re unsure how these gaps affect you or which steps to take, it’s smart to speak with someone who can guide you. Timing matters. Many people make decisions during Medicare’s Annual Enrollment Period (October 15 to December 7) or when first eligible. But don’t wait until the last minute to prepare.

Get in touch with a licensed agent listed on this website to review your options and make sure you’re not missing important benefits that can support your health and peace of mind.