Key Takeaways
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Medicare in 2025 covers a wide range of services, but there are several gaps that can leave you with unexpected out-of-pocket costs.
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Understanding what isn’t covered by Medicare helps you plan better, avoid surprise bills, and consider whether additional coverage may be needed.
What Medicare Generally Covers
Medicare is designed to provide essential healthcare services to those aged 65 and older, as well as certain younger individuals with disabilities. In 2025, the program includes four main parts:
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Part A (Hospital Insurance): Covers inpatient hospital care, skilled nursing facility care, hospice, and limited home health services.
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Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and some home health services.
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Part C (Medicare Advantage): An alternative way to receive Parts A and B coverage through private insurers.
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Part D (Prescription Drug Coverage): Offers drug coverage through approved plans, now featuring a $2,000 annual out-of-pocket cap.
While these parts seem to offer broad coverage, several important healthcare needs still fall outside their scope.
1. Long-Term Custodial Care Isn’t Included
A major gap in Medicare is its lack of coverage for long-term custodial care. This includes assistance with everyday tasks like bathing, eating, and dressing.
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Medicare only covers short-term skilled nursing care if it follows a hospital stay of at least three days and if it’s medically necessary.
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Long-term care, whether at home or in a facility, is not included if it is not skilled care.
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You may face substantial expenses if you need prolonged assistance with daily living activities.
2. Most Dental Care Is Excluded
In 2025, routine dental services are still not covered by Original Medicare. This includes:
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Regular cleanings
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Fillings and extractions
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Dentures and bridges
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Periodontal treatment
While some Medicare Advantage plans may offer dental benefits, these are not part of the core Medicare benefit. If you rely on Original Medicare, you’ll need to cover these costs out-of-pocket or seek standalone dental coverage.
3. Routine Vision Services Are Limited
Original Medicare does not cover routine vision exams, glasses, or contact lenses. What is covered:
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Eye exams related to specific medical conditions such as glaucoma or macular degeneration.
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Cataract surgery is covered, and in most cases, a basic pair of corrective lenses following surgery is included.
If you need regular eye exams or updated prescriptions for glasses, you’ll likely have to pay on your own.
4. Hearing Exams and Hearing Aids Are Not Covered
Medicare does not include coverage for hearing aids or routine hearing exams in 2025. This can be a significant gap, especially since hearing loss is common among older adults.
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Diagnostic hearing exams are only covered if ordered by a doctor to diagnose a medical condition.
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You are responsible for the full cost of hearing aids, fittings, and routine hearing tests.
5. International Travel Emergencies Are Excluded
If you plan to travel outside the U.S., don’t assume you’re covered by Medicare. Original Medicare typically does not cover healthcare services outside the country.
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Emergency medical care abroad is generally not included.
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A few Medigap policies may provide limited emergency coverage abroad, but Original Medicare alone does not.
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Medicare Advantage plans may have some provisions, but it depends on the plan.
6. Prescription Drugs During Inpatient Stays
Medicare Part A covers medications administered during a hospital stay, but if you’re in a skilled nursing facility or long-term care setting, coverage isn’t always straightforward.
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You may be billed for medications not covered under Part A.
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Medicare Part D may cover some prescription drugs in these settings, but only if the drugs meet plan requirements.
Understanding how different parts of Medicare work together is important for managing these medication costs.
7. Routine Foot Care Is Not Covered
Routine foot care is another common exclusion under Medicare.
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Services like nail trimming, callus removal, and foot massages are not included.
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Exceptions apply only if foot care is medically necessary, such as for individuals with diabetes or certain circulation problems.
If you require routine podiatry visits, you’ll need to plan for these costs yourself unless a medical condition justifies coverage.
8. Personal Comfort Items in the Hospital
During hospital stays, certain personal comfort items are not covered by Medicare. These include:
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Private rooms (unless medically necessary)
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Televisions or phone rentals
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Toiletries and personal grooming items
You’ll need to cover these extras out-of-pocket or decline them during your stay.
9. Alternative or Complementary Treatments
Although alternative medicine has grown in popularity, Medicare still limits coverage for such treatments.
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Acupuncture is only covered for chronic low back pain under specific conditions.
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Services like massage therapy, naturopathy, homeopathy, and chiropractic care beyond spinal manipulation are generally excluded.
If you rely on these therapies, you’ll need to pay separately or consider alternative funding options.
10. Excess Charges from Non-Participating Providers
Some healthcare providers don’t accept Medicare assignment, meaning they can charge more than the Medicare-approved amount.
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These excess charges can be up to 15% above the standard rate.
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You’re responsible for paying the difference.
To avoid surprise billing, always confirm whether your provider accepts Medicare assignment before receiving care.
11. Mental Health Services Can Have Limitations
Medicare covers mental health care, but there are coverage nuances:
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Inpatient psychiatric care is capped at 190 days over your lifetime in a freestanding psychiatric hospital.
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Outpatient mental health visits are covered under Part B, but cost-sharing applies.
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Coverage for certain services like intensive outpatient programs may vary.
Knowing these details helps you make informed decisions about accessing mental health care under Medicare.
12. Homemaker Services Are Not Included
Help with household tasks is another exclusion under Medicare.
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Services like cleaning, laundry, shopping, or meal preparation are not covered unless part of a broader home health plan.
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These are considered non-medical support and require separate planning.
If you rely on help around the house due to aging or illness, this is a gap you’ll need to address outside of Medicare.
13. Cosmetic Surgery Is Excluded
Cosmetic procedures are not covered unless deemed medically necessary.
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Reconstructive surgery following an injury or disease (like breast reconstruction after mastectomy) may be covered.
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Elective cosmetic surgeries, such as facelifts or liposuction, are not.
Always check with a provider to determine whether a procedure meets Medicare’s medical necessity requirements.
Getting Ahead of the Gaps in Medicare Coverage
Now that you’ve seen what Medicare doesn’t cover in 2025, you’re in a better position to prepare. These gaps can result in significant expenses if you’re not careful. From long-term care to hearing aids and dental work, planning ahead ensures you won’t be caught off guard. Speak with a licensed agent listed on this website to review your needs and get personalized advice on your next steps.
