Key Takeaways
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Medicare pays for a wide range of health services in 2025, but it doesn’t cover everything. Understanding where your benefits begin and end helps you avoid costly surprises.
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Some of the biggest out-of-pocket costs come from services Medicare does not fully cover, such as long-term custodial care, dental work, and vision correction.
What You’re Really Getting With Medicare Coverage in 2025
When you enroll in Medicare, you may expect it to handle all your healthcare needs. But in 2025, Medicare coverage remains both broad and limited at the same time. It’s essential to know exactly what’s included in each part—A, B, C, and D—so you can plan for the costs Medicare won’t pick up.
Let’s start by examining what each part of Medicare covers.
Medicare Part A: Hospital Insurance
You typically don’t pay a premium for Part A if you or your spouse worked and paid Medicare taxes for at least 40 quarters. But that doesn’t mean it’s free.
What It Covers:
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Skilled nursing facility (SNF) care (after a qualifying hospital stay)
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Some home health services
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Hospice care
What It Doesn’t Cover:
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Long-term care (custodial care in a nursing home)
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Private rooms (unless medically necessary)
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Personal items like a television or phone
2025 Costs to Keep in Mind:
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Inpatient deductible: $1,676 per benefit period
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Coinsurance for hospital stays after 60 days and SNF stays after 20 days
Medicare Part B: Medical Insurance
You pay a monthly premium for Part B, which is $185 in 2025, along with an annual deductible of $257. After meeting your deductible, you usually pay 20% of the Medicare-approved amount for most services.
What It Covers:
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Doctor visits
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Outpatient care
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Preventive services
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Durable medical equipment (like walkers or wheelchairs)
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Diagnostic tests
What It Doesn’t Cover:
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Routine dental, vision, or hearing exams
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Eyeglasses and hearing aids
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Most prescription drugs (you’ll need Part D for those)
Medicare Part D: Prescription Drug Coverage
Part D plans are provided by private insurers approved by Medicare, and they cover prescription medications.
What It Covers:
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Brand-name and generic drugs on your plan’s formulary
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Vaccines (such as shingles, flu, pneumonia)
What It Doesn’t Cover:
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Drugs not on your plan’s formulary
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Drugs received during hospital or skilled nursing stays (these are covered under Part A or B)
Important 2025 Updates:
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Annual deductible: Up to $590
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Out-of-pocket cap: $2,000 (after which your medications are fully covered for the year)
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New option to spread drug costs over 12 months
Medicare Part C: Medicare Advantage
Medicare Advantage plans must cover everything Original Medicare does, but they often include extra benefits. However, they may also limit your network of doctors and facilities.
Common Extras Offered:
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Vision, dental, and hearing benefits
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Fitness memberships
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Transportation to appointments
Limitations:
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Prior authorization requirements
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Network restrictions
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Costs and benefits vary by region and plan
The Gaps in Medicare Coverage You Shouldn’t Ignore
Knowing what Medicare doesn’t cover is just as important as knowing what it does. In 2025, several critical healthcare needs remain outside standard Medicare coverage.
1. Long-Term Custodial Care
Medicare will cover short-term skilled nursing after a hospital stay, but it does not pay for non-medical custodial care—like help with bathing, dressing, or eating—if that’s all you need. This is one of the biggest gaps in Medicare coverage.
2. Routine Dental, Vision, and Hearing Care
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Dental: Cleanings, fillings, dentures, and root canals are not covered under Part A or B.
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Vision: Eye exams for glasses or contact lenses are excluded, though exams related to medical conditions (like glaucoma or macular degeneration) may be covered.
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Hearing: Routine exams and hearing aids are not covered.
3. Foreign Travel Emergencies
Generally, Medicare does not cover healthcare outside the U.S. There are rare exceptions for emergencies near the border or when a foreign hospital is closer than a U.S. one.
4. Acupuncture and Alternative Therapies
Medicare may cover acupuncture for chronic low back pain only. Other alternative treatments like chiropractic beyond spinal manipulation or naturopathy are excluded.
5. Cosmetic Procedures
Cosmetic surgery isn’t covered unless it’s needed for reconstruction after an accident or due to a disease. For example, eyelid surgery to improve vision may be approved, but one done purely for appearance is not.
6. Personal Comfort Items and Non-Medical Support
Items such as hospital televisions, private duty nursing, or meal delivery after discharge are not covered.
What You Can Do to Fill the Coverage Gaps
To manage these coverage limitations, many people choose to enroll in additional insurance or budget for certain out-of-pocket costs.
Medigap (Medicare Supplement Insurance)
Offered by private companies, Medigap policies help pay for things like copayments, coinsurance, and deductibles that Original Medicare doesn’t fully cover.
Standalone Dental, Vision, and Hearing Plans
Separate insurance policies may help reduce costs for routine exams, procedures, and devices like hearing aids.
Long-Term Care Planning
You may need to explore long-term care insurance or set aside savings to prepare for potential future needs in assisted living or nursing homes.
Emergency Travel Coverage
Consider purchasing travel insurance that includes medical evacuation and emergency healthcare abroad if you plan to travel.
The Role of Preventive Services in Medicare
Medicare continues to emphasize preventive care. In 2025, most preventive services are covered with no cost to you if delivered by a provider who accepts Medicare assignment.
Services Covered Without Cost Sharing:
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Annual wellness visit
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Screenings for breast, cervical, and colorectal cancers
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Flu and COVID-19 vaccines
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Cardiovascular disease screenings
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Diabetes prevention program (for eligible individuals)
Importance of Staying In-Network
If you are enrolled in a Medicare Advantage plan, be sure to check that your provider is in the plan’s network. Receiving services from an out-of-network provider may lead to unexpected charges.
Coverage Rules and Timeframes That Affect You
Several key timelines apply to your Medicare coverage and the ability to make changes.
Initial Enrollment Period
This 7-month window surrounds your 65th birthday: it begins three months before, includes your birth month, and ends three months after. Missing it can lead to late penalties.
Medicare Advantage & Part D Open Enrollment
From October 15 to December 7, you can:
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Switch between Original Medicare and Medicare Advantage
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Change or enroll in a Part D drug plan
Medicare Advantage Open Enrollment Period
From January 1 to March 31, if you’re enrolled in a Medicare Advantage plan, you can:
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Switch to a different Medicare Advantage plan
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Drop your Advantage plan and return to Original Medicare
Special Enrollment Periods (SEPs)
If you lose other health coverage, move to a new service area, or experience certain life events, you may qualify for an SEP.
Informed Choices Lead to Fewer Surprises
Being clear-eyed about what Medicare covers in 2025 and where the gaps exist is the first step in avoiding frustration and unexpected bills. Whether it’s a hospital stay, a preventive screening, or a prescription refill, your choices today impact what you pay tomorrow.
Stay informed, review your benefits every year, and consider supplemental coverage where needed.
Make Sure You’re Covered From All Angles
Understanding what Medicare pays for—and what it doesn’t—is essential for making smart healthcare decisions. If you’re unsure whether you need extra coverage, or if you’re looking to better understand your options, speak with a licensed agent listed on this website. They can walk you through what fits your situation best.
