Key Takeaways

• Medicare covers a wide range of essential health services, but it does not pay for everything, and there are important coverage gaps that can lead to unexpected out-of-pocket costs.

• Understanding what is and isn’t included in Medicare coverage in 2025 can help you avoid costly surprises and make better decisions when managing your healthcare.

What You Can Expect From Medicare in 2025

Medicare is often seen as a safety net, and for good reason. It provides essential health coverage to millions of Americans aged 65 and older, as well as to some younger individuals with certain disabilities. However, while Medicare covers many important services, it doesn’t offer blanket protection. Knowing what to expect can help you prepare accordingly.

Let’s take a closer look at what is covered, what isn’t, and where you might need additional support.

The Core Services Medicare Covers

Hospital Care (Part A)

Medicare Part A focuses on inpatient care. It covers:

• Hospital stays (after you pay the deductible)

• Skilled nursing facility care (with conditions)

• Hospice care

• Some home health services

There are limits. For example, Medicare covers up to 90 days per benefit period for inpatient hospital care, with an additional 60 lifetime reserve days. Skilled nursing care is only covered up to 100 days per benefit period and only after a qualifying hospital stay of at least three days.

Medical Services (Part B)

Part B covers outpatient care, including:

• Doctor visits

• Preventive services (such as screenings and vaccines)

• Durable medical equipment (like walkers or wheelchairs)

• Mental health services

• Outpatient surgeries

Part B requires you to pay a monthly premium and a deductible ($257 in 2025), and you generally cover 20% of the Medicare-approved amount for services.

Prescription Drugs (Part D)

Part D provides coverage for prescription medications. It involves:

• A deductible phase (up to $590 in 2025)

• An initial coverage phase

• Catastrophic coverage after reaching the $2,000 out-of-pocket cap

This new cap helps limit your drug spending significantly, but you are still responsible for cost-sharing until that point is reached.

Preventive Services

Medicare places a strong emphasis on preventive care. Covered services include:

• Annual wellness visits

• Screenings for cancers, diabetes, and cardiovascular conditions

• Flu and pneumonia shots

• Tobacco cessation counseling

These services are typically covered in full, meaning you pay nothing out of pocket if the provider accepts Medicare.

The Surprising Gaps You Might Not Expect

Despite its comprehensive structure, Medicare leaves several essential services uncovered or partially covered. These gaps can lead to higher out-of-pocket costs if you are not prepared.

1. Long-Term Custodial Care

Medicare does not cover custodial care if it is the only type of care you need. This includes:

• Help with activities of daily living (bathing, dressing, eating)

• Long-term stays in nursing homes when no skilled care is needed

If you require assistance over an extended period, you may need to pay privately or seek other insurance options.

2. Dental, Vision, and Hearing Services

Original Medicare does not include routine care for:

• Dental checkups, fillings, or dentures

• Eye exams for prescription glasses or contact lenses

• Hearing exams and hearing aids

These services are only covered if they are directly related to a medical condition (e.g., eye surgery after an injury).

3. Overseas Medical Care

Generally, Medicare does not cover medical care received outside the U.S. Exceptions are limited and apply mostly to emergencies near the U.S. border or while on a cruise.

If you travel internationally, you may need separate travel insurance or consider additional coverage.

4. Routine Foot Care

Routine foot exams and care (such as callus removal or nail trimming) are not covered unless you have specific conditions like diabetes that justify medical necessity.

5. Cosmetic Surgery

Any procedures deemed cosmetic are excluded unless they are needed due to injury or to improve the function of a malformed body part.

6. Acupuncture and Alternative Therapies

As of 2025, Medicare only covers acupuncture for chronic low back pain. Other alternative treatments, including chiropractic services (except spinal manipulation), are generally not covered.

Financial Responsibilities You Still Have

Even when Medicare covers a service, you usually have to pay a portion of the cost.

Premiums

You must pay a monthly premium for Part B and possibly Part A (if you don’t have enough work credits).

Deductibles

Each part of Medicare has its own deductible:

• Part A: $1,676 per benefit period in 2025

• Part B: $257 annually in 2025

• Part D: Up to $590 annually in 2025

Coinsurance and Copayments

• Part B typically requires 20% coinsurance for approved services

• Part A hospital stays may involve daily coinsurance after a certain number of days

Out-of-pocket costs can escalate quickly, especially if you need ongoing care or multiple medications.

Out-of-Pocket Maximums

Original Medicare has no built-in annual out-of-pocket limit. This means your costs can continue to add up without a cap. Only some private plans include an annual limit.

What You Can Do to Prepare

Understanding what Medicare covers (and what it doesn’t) is the first step. Here are ways to manage your healthcare more effectively:

Review Your Needs Annually

Your health changes year to year. Review your Medicare coverage every fall during the Annual Enrollment Period (October 15 to December 7). Ask yourself:

• Are your medications still covered?

• Have your provider preferences changed?

• Do you anticipate new health conditions in the coming year?

Explore Additional Coverage

Many people look into supplemental options to fill the gaps, such as:

• Separate vision, dental, or hearing plans

• Travel insurance for overseas medical care

• Long-term care insurance to cover custodial services

Just be aware that these options often come with additional premiums and require careful consideration.

Know the Timeline for Enrollment

Missing an enrollment deadline can result in late penalties:

• Initial Enrollment Period: 3 months before, the month of, and 3 months after your 65th birthday

• General Enrollment Period: January 1 to March 31 (for those who missed initial signup)

• Annual Enrollment Period: October 15 to December 7 (to make plan changes)

Understanding these windows ensures you stay covered and avoid extra charges.

Keep Records and Ask Questions

Keep documentation of your medical visits, prescriptions, and correspondence with Medicare. If you’re unsure about a service, ask your provider or contact Medicare directly.

Final Thoughts on Medicare’s Coverage Limits

Medicare provides critical coverage for millions of Americans, but it isn’t all-inclusive. You are responsible for understanding the boundaries of your plan and being proactive about filling the gaps. From dental and vision to long-term care and international coverage, the things Medicare does not pay for can catch you off guard if you’re not prepared.

Taking the time to plan your coverage around these limitations can save you thousands and ensure you receive the care you need without surprises. If you need help making sense of your coverage or want advice tailored to your situation, speak with a licensed agent listed on this website for professional support.