Key Takeaways

• Medicare gives you broad foundational coverage but leaves out some essential services you might assume are included.

• Understanding what’s optional—and what it will cost you in the long run—is just as important as knowing what’s covered.

What Medicare Covers in 2025

Medicare is designed to offer a safety net for your healthcare in retirement, but it’s not a blanket solution. To start, here’s what the core of Medicare includes:

Medicare Part A: Hospital Insurance

You automatically qualify for Part A if you or your spouse paid Medicare taxes for at least 10 years. Part A includes:

• Inpatient hospital care (after you pay the deductible)

• Skilled nursing facility care (limited to 100 days per benefit period after a qualifying hospital stay)

• Hospice care

• Some home health services

You pay no premium for Part A if you meet the work history requirement, but there is a deductible—$1,676 per benefit period in 2025.

Medicare Part B: Medical Insurance

Part B covers your outpatient services, including:

• Doctor visits

• Preventive services like screenings and vaccines

• Lab tests and diagnostic imaging

• Durable medical equipment (like walkers or oxygen tanks)

• Mental health services (outpatient only)

In 2025, the standard monthly premium for Part B is $185, and the annual deductible is $257. After meeting the deductible, you typically pay 20% of the Medicare-approved amount for most services.

Medicare Part D: Prescription Drug Coverage

Part D is optional and helps cover the cost of prescription medications. Plans are offered through private insurers approved by Medicare. In 2025, the deductible is capped at $590. After reaching the $2,000 out-of-pocket maximum, your plan covers all covered drug costs for the rest of the year.

What Medicare Does Not Cover

This is where surprises happen. Many people assume Medicare covers everything they might need in retirement. It doesn’t.

1. Long-Term Custodial Care

Medicare only covers short-term skilled nursing care under specific conditions. It does not cover ongoing custodial care, such as help with bathing, dressing, or eating, if that’s the only care you need.

2. Routine Dental, Vision, and Hearing

Original Medicare doesn’t cover:

• Dental cleanings, fillings, or dentures

• Eye exams, glasses, or contacts (unless related to a specific medical issue)

• Hearing exams or hearing aids

You’d need to pay out of pocket or explore supplemental insurance for these services.

3. International Health Coverage

Medicare doesn’t provide coverage outside the U.S. with few exceptions. If you plan to travel or retire abroad, this is a major gap you’ll need to address separately.

4. Cosmetic Surgery and Most Alternative Therapies

Procedures for cosmetic purposes are not covered. Similarly, acupuncture, naturopathy, or massage therapy are not reimbursed unless very specific conditions are met.

Optional Coverage Choices—and Why They Matter

Because Original Medicare doesn’t cover everything, you have the option to add coverage to protect yourself from large out-of-pocket expenses.

Medigap (Medicare Supplement Insurance)

Medigap policies help cover the costs that Medicare Part A and B don’t, such as:

• Deductibles

• Copayments

• Coinsurance

You must be enrolled in both Part A and Part B to buy a Medigap policy. The best time to apply is during your six-month Medigap Open Enrollment Period, which starts the month you turn 65 and are enrolled in Part B. During this time, you can’t be denied or charged more due to health conditions.

Medicare Advantage (Part C)

Medicare Advantage plans bundle Part A, Part B, and usually Part D into one plan. These plans often include extra benefits like dental, vision, and hearing coverage. But remember:

• You must still pay the Part B premium.

• Plans can have different provider networks and rules.

• Costs and benefits vary widely.

These plans are offered by private insurers, so it’s crucial to review the details closely.

Standalone Part D Plans

If you stay with Original Medicare and want drug coverage, you need to enroll in a separate Part D plan. Not having drug coverage could mean:

• Higher out-of-pocket drug costs

• A permanent late enrollment penalty if you go too long without creditable coverage

The Costs That Sneak Up On You

Even with Medicare, you can still face significant costs if you’re not prepared. These include:

• Deductibles: Each part has its own deductible.

• Coinsurance: You may owe 20% or more for services after the deductible.

• Out-of-pocket maximums: Original Medicare doesn’t cap your out-of-pocket spending. Only Medicare Advantage plans do.

• Non-covered services: As mentioned, dental, vision, hearing, and long-term care costs are entirely on you unless you add coverage.

Important Medicare Deadlines You Need to Know

Medicare comes with critical windows for enrollment. Missing them can result in penalties or gaps in coverage.

Initial Enrollment Period (IEP)

You have a 7-month window:

• Begins 3 months before your 65th birthday month

• Includes your birthday month

• Ends 3 months after

This is the time to enroll in Parts A and B, and optionally, a Part D plan or Medicare Advantage.

General Enrollment Period (GEP)

If you miss your IEP, you can sign up from January 1 to March 31. But:

• Coverage begins July 1

• You may face late penalties

Annual Enrollment Period (AEP)

From October 15 to December 7, you can:

• Switch between Medicare Advantage and Original Medicare

• Change your Part D plan

• Join or drop a Medicare Advantage plan

Changes take effect January 1.

Medicare Advantage Open Enrollment Period

From January 1 to March 31, if you’re already in a Medicare Advantage plan, you can:

• Switch to a different Medicare Advantage plan

• Return to Original Medicare and join a Part D plan

Who Pays What: Government vs. You

Medicare is a shared-cost system. The government covers a significant portion, but you’re still responsible for premiums, deductibles, and co-pays.

• For Part A, the government pays the majority, but you face costs if hospitalized for extended periods.

• For Part B, you pay a monthly premium plus coinsurance.

• For Part D, plan costs vary, but the government subsidizes a portion of premiums and drug expenses.

If your income is higher, you may pay an Income-Related Monthly Adjustment Amount (IRMAA) for Parts B and D.

What You Can Do Now

Understanding what Medicare does—and does not—cover is essential to planning your healthcare in retirement. Here’s how you can take charge:

• Review your coverage annually: Medicare plans and your health needs change.

• Compare options during Open Enrollment: Even small plan changes can impact your coverage or costs.

• Budget for uncovered services: Dental, vision, and long-term care can cost thousands if unplanned.

• Ask about extra help programs: If your income is limited, you may qualify for help with premiums and drug costs.

Why Clarity Now Saves Stress Later

Choosing Medicare options without knowing the limits can lead to serious financial stress down the line. Gaps in coverage can hit when you least expect them—especially during emergencies or prolonged illnesses.

Your health is your most valuable asset. If you’re unsure what your current Medicare plan includes or whether you’re missing out on critical protections, get professional help. It’s not just about getting more coverage—it’s about making sure you have the right kind for your life.

To make sense of all the options available to you and understand how they align with your healthcare goals, speak with a licensed agent listed on this website.