Key Takeaways
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Medicare covers more than you might expect, including preventive care, home health services, and even some international travel emergencies.
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Despite its coverage, Medicare has gaps that can leave you with out-of-pocket costs, so understanding where it falls short is essential.
Preventive Services You Might Not Expect
Medicare does more than just help with hospital and doctor visits. It actually covers a wide range of preventive care services, which can help you stay healthier and catch potential issues early.
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Annual Wellness Visits – You get a yearly wellness check-up, which is separate from a standard physical exam. This helps track your health and prevent future issues.
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Screenings and Vaccines – Medicare covers many preventive screenings, including mammograms, colonoscopies, and cardiovascular tests. Vaccines, such as flu, pneumonia, and shingles shots, are also covered.
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Mental Health Screenings – Depression and other mental health conditions are taken seriously. Medicare provides coverage for screenings, therapy, and counseling services.
Home Health Care That Keeps You Independent
Many people assume Medicare only helps when you’re in a hospital or nursing home, but it can also provide home health services under certain conditions.
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Skilled Nursing and Therapy – If you need part-time skilled nursing care or physical, speech, or occupational therapy, Medicare can cover it.
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Home Health Aides – While it won’t cover 24/7 custodial care, Medicare does provide some help with home health aides if you’re recovering from an illness or injury.
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Medical Equipment and Supplies – Things like wheelchairs, walkers, and oxygen equipment can be covered under Medicare Part B.
Prescription Drug Coverage and the Big 2025 Change
Prescription drugs can be one of the biggest medical expenses, but Medicare helps cover a significant portion of the cost.
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Medicare Part D – This helps cover the cost of prescription medications, but you’ll still have deductibles and copays.
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2025 Out-of-Pocket Cap – A big relief for beneficiaries is that as of 2025, Medicare Part D has a $2,000 annual out-of-pocket cap. Once you hit that, you won’t have to pay anything more for covered prescriptions.
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Medicare Prescription Payment Plan – Also new in 2025, this allows you to spread the cost of your medications over time instead of paying all at once.
Emergency Coverage Outside the U.S.
You might think Medicare only works within the U.S., but in some situations, it actually helps cover you abroad.
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Limited International Coverage – If you’re traveling outside the U.S., Medicare might cover emergency care if you’re in a border region or if you’re on a cruise ship within six hours of a U.S. port.
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Medicare Supplement Plans – While Original Medicare has limited coverage abroad, some additional insurance options may help fill in these gaps.
Skilled Nursing Facility Coverage With Limits
If you need rehabilitation or recovery time after a hospital stay, Medicare can help cover a skilled nursing facility (SNF), but only under specific conditions.
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Hospital Stay Requirement – To qualify, you must have a hospital stay of at least three consecutive days before admission to a Medicare-approved SNF.
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100-Day Coverage Limit – Medicare covers up to 100 days in an SNF per benefit period, but after 20 days, copayments apply.
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Not for Long-Term Care – Medicare does not cover long-term custodial care, so if you need extended assistance, you’ll need to explore other options.
Vision, Hearing, and Dental: What’s Covered and What’s Not
While Medicare provides excellent coverage for medical services, it has notable gaps in vision, hearing, and dental care.
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Vision Coverage – Medicare covers medically necessary eye care, such as cataract surgery and glaucoma screenings, but it does not cover routine eye exams or glasses.
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Hearing Services – While hearing tests for medical conditions are covered, hearing aids and routine exams are not.
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Dental Care – Medicare only covers dental services if they’re part of a hospital procedure, such as jaw surgery. Routine cleanings, fillings, and dentures are not covered.
Understanding Where Medicare Leaves Gaps
Medicare is a strong foundation for healthcare, but it doesn’t cover everything. Some of the biggest gaps include:
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Long-Term Care – Medicare does not cover long-term custodial care in nursing homes or assisted living facilities.
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Routine Dental, Vision, and Hearing – These common healthcare needs are not included under Original Medicare.
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Out-of-Pocket Costs – You’ll still have deductibles, copays, and coinsurance for many services.
Making the Most of Your Medicare Coverage
Understanding what Medicare covers and where it falls short can help you avoid unexpected expenses. If you need additional coverage, speaking with a licensed agent listed on this website can help you explore your options and ensure you get the care you need.
