Key Takeaways

• Medicare offers broad coverage, but it doesn’t pay for every medical service or expense. Understanding what isn’t covered helps prevent costly surprises.

• Gaps in Medicare coverage in 2025 still include dental, vision, hearing, long-term care, and certain international medical costs.

What Medicare Covers Well

Medicare in 2025 remains a vital source of healthcare coverage for millions of older adults and people with disabilities. If you’re enrolled in Original Medicare (Part A and Part B), you receive strong coverage for hospital stays, doctor visits, lab tests, outpatient care, and preventive services.

• Part A covers inpatient hospital care, skilled nursing facility care, some home health services, and hospice care.

• Part B handles outpatient services, such as doctor appointments, preventive screenings, lab work, durable medical equipment, and some mental health care.

However, while these parts form the foundation of Medicare, they leave some critical areas of care either partially covered or excluded altogether.

Where Medicare Stops: The Big Gaps in 2025

Even with its solid base, Medicare has limits. These exclusions matter when planning your healthcare and budgeting for your future.

1. Long-Term Custodial Care

Medicare does not pay for long-term custodial care, which includes help with daily tasks like bathing, eating, or dressing. This kind of care is needed in nursing homes, assisted living facilities, or even in your own home if you have chronic conditions.

• What’s covered: Medicare may cover short-term skilled nursing care after a qualifying hospital stay.

• What’s not covered: Extended stays in a nursing home or ongoing help with non-medical needs.

2. Dental Services

Routine dental care is not part of Medicare’s benefits.

• What’s excluded: Cleanings, fillings, crowns, extractions, dentures, and most other dental work.

• Why it matters: Poor dental health is linked to heart disease, diabetes complications, and other chronic conditions.

Unless you have additional dental coverage or pay out of pocket, these services are your responsibility.

3. Vision Care

While Medicare does cover certain eye-related services under Part B, it doesn’t cover routine vision needs.

• Not covered: Eye exams for glasses or contact lenses, eyeglasses, and most vision correction surgeries.

• Covered only when medically necessary: Cataract surgery and related corrective lenses.

If you rely on glasses or contacts to see clearly, you’ll need to plan for those expenses.

4. Hearing Aids

Hearing loss becomes more common with age, but Medicare still doesn’t cover hearing aids or routine hearing exams.

• Excluded: Hearing aids and exams for fitting them.

• Included only in limited cases: Diagnostic tests if your doctor suspects a balance or medical issue.

This gap leaves many people paying entirely out of pocket for devices that can cost thousands.

5. Prescription Drugs (Without Part D)

Original Medicare does not include prescription drug coverage unless you enroll in a separate Part D plan.

• Uncovered: Most outpatient medications.

• Solution: You can add a standalone Part D plan for this purpose, or enroll in a plan that includes drug coverage.

As of 2025, a major change is the $2,000 annual out-of-pocket cap on Part D drug costs, but this only applies if you have a Part D plan in place.

Cost Sharing That Can Surprise You

Even for services Medicare does cover, you still pay your share. Medicare includes deductibles, coinsurance, and copayments.

Deductibles and Coinsurance in 2025

• Part A Deductible: $1,676 per benefit period.

• Part B Deductible: $257 annually.

• Coinsurance: Typically 20% of the Medicare-approved amount for Part B services, with no annual cap.

These costs can add up quickly, especially if you need frequent medical care.

Overseas Medical Emergencies

Medicare coverage is extremely limited outside the United States and its territories.

• Uncovered: Most emergency or non-emergency medical treatment abroad.

• Limited exceptions: Only under specific circumstances, such as if a foreign hospital is closer than a U.S. one for treatment of a medical emergency.

You may need separate travel or international medical insurance if you’re planning to go abroad.

Mental Health Coverage Limitations

While Medicare has improved its mental health offerings over the years, access is still limited.

• Part B covers: Outpatient therapy, some screenings, and psychiatric evaluations.

• Still limited: Number of sessions, availability of providers who accept Medicare, and lack of coverage for certain services like marriage or family counseling.

If mental health is a priority, you may need to supplement with additional coverage or private services.

Home Health Services: Limited Scope

Home health care under Medicare is only available under strict conditions.

• Covered: Skilled nursing, physical therapy, and other specific medical services ordered by a doctor.

• Not covered: 24-hour care, meal delivery, or help with activities of daily living unless medically necessary.

Many assume home health means full in-home support, but Medicare’s definition is narrower.

Routine Physical Exams

Medicare doesn’t cover a traditional annual physical exam. Instead, it offers:

• “Welcome to Medicare” visit (within 12 months of enrollment)

• Annual wellness visit (a preventive planning session, not a full exam)

While these visits are valuable, they may not include comprehensive testing or screenings unless specifically recommended.

Emergency Room and Ambulance Costs

Emergency services are covered, but not fully.

• Ambulance services: Typically 20% coinsurance after the Part B deductible.

• ER visits: Subject to copayments and coinsurance, with no out-of-pocket maximum under Original Medicare.

Unexpected emergencies can become expensive quickly without additional coverage.

Durable Medical Equipment (DME)

Medicare covers equipment like wheelchairs and oxygen tanks when medically necessary.

• Your share: 20% coinsurance after meeting your Part B deductible.

• Not included: Most convenience items (like bathroom safety equipment) or anything not considered medically essential.

Always check if your equipment is both doctor-prescribed and from a Medicare-approved supplier.

Coverage for Spouses or Dependents

Medicare is not family coverage. It covers only you as the enrolled beneficiary.

No dependent coverage: Your spouse or children must qualify individually.

This is a key distinction from employer health insurance and often overlooked during retirement planning.

Why This Matters in 2025

Medicare remains the backbone of senior healthcare in the United States, but in 2025, it’s still not comprehensive. As medical costs continue to rise and life expectancy increases, planning for these coverage gaps becomes critical.

If you assume Medicare covers every need, you could end up with unexpected bills or skipped care due to cost. That’s why understanding these boundaries isn’t just helpful—it’s essential.

Get the Clarity You Need About Medicare Coverage

Understanding what Medicare doesn’t cover helps you take smart steps now. Whether it’s reviewing supplemental coverage, evaluating your need for Part D, or considering your long-term care strategy, it starts with knowing where Medicare stops.

If you’re unsure how these gaps affect your situation, speak with a licensed agent listed on this website. They can walk you through your options and help you build a coverage plan that suits your needs.