Key Takeaways

• Medicare in 2025 continues to offer broad healthcare coverage, but significant gaps remain that can expose you to unexpected costs.

• Understanding what Medicare doesn’t cover and exploring supplemental options can help protect your health and your finances.

Medicare Is Foundational—But Not Fully Comprehensive

Medicare provides critical healthcare coverage for millions of Americans, and in 2025, it remains a cornerstone of retirement planning. But many beneficiaries mistakenly believe that Medicare takes care of all their healthcare needs. It doesn’t.

The standard Medicare program—Parts A and B—has substantial coverage limitations that can leave you vulnerable. And if you’re relying on Medicare alone, you may face sizable out-of-pocket expenses or go without care you assumed was included.

Let’s walk through what’s missing and how to plan around it.

Hospital Costs Aren’t Fully Covered

Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. But it’s not unlimited.

• In 2025, there is a $1,676 deductible per benefit period for inpatient hospital care.

• After 60 days in the hospital, daily coinsurance applies ($419 per day for days 61–90 and $838 per day for lifetime reserve days).

• Skilled nursing facility care requires a daily coinsurance of $209.50 starting on day 21.

These figures add up quickly if you experience a serious illness or extended hospital stay. Relying on Medicare alone means you’re exposed to these costs without a cap.

Medical Services Come With Ongoing Expenses

Part B covers doctor visits, outpatient care, durable medical equipment, and preventive services. But again, you shoulder part of the cost.

Here’s what you pay in 2025:

• A standard monthly premium of $185

• An annual deductible of $257

• 20% coinsurance on most services after you meet the deductible

While preventive services may be covered without cost-sharing, anything diagnostic or treatment-related typically triggers the 20% coinsurance. There’s no out-of-pocket maximum under Original Medicare—meaning costs can keep rising.

Prescription Drugs Aren’t Covered by Part A or B

If you’re only enrolled in Parts A and B, your prescription drugs are not covered. To get drug coverage, you need to enroll in a Part D plan or other drug plan.

Medicare Part D is designed to reduce the cost of medications, but in 2025, it still has limits:

• A maximum deductible of $590

• After meeting the deductible, you pay a share of drug costs during the initial coverage period

• You hit a $2,000 annual out-of-pocket cap, after which your plan pays 100% of covered drugs

If you skipped drug coverage thinking you didn’t need it, even one new prescription could create a financial burden. And without any coverage at all, you’d pay full retail prices.

Long-Term Care Isn’t Covered at All

This surprises many people: Medicare does not cover long-term custodial care. That includes services such as help with dressing, bathing, or eating at home or in a nursing home when it’s not part of recovery from an illness.

While Medicare covers short-term stays in a skilled nursing facility under strict criteria, it does not cover the ongoing personal care many people need as they age. Long-term care is one of the largest uninsured risks facing Medicare beneficiaries.

Dental, Vision, and Hearing Are Largely Excluded

Original Medicare does not cover routine dental, vision, or hearing care. That means:

• No cleanings, fillings, dentures, or root canals

• No routine eye exams, glasses, or contacts

• No hearing exams or hearing aids

In 2025, the only exceptions are when these services are medically necessary for another covered treatment—for example, a dental exam before a heart valve replacement. But routine, preventive, and maintenance care remains your responsibility.

Emergency Coverage Outside the U.S. Is Missing

If you travel abroad, Original Medicare generally does not pay for your healthcare outside the United States. There are a few limited exceptions, such as emergencies near the U.S. border or on cruise ships under certain conditions. But broadly speaking, foreign healthcare is not covered.

If you rely only on Medicare and get sick overseas, you could face thousands of dollars in unexpected costs.

There’s No Out-of-Pocket Maximum

One of the most critical things missing from Original Medicare is an annual cap on your expenses.

In most employer health plans or other insurance, there’s a limit to how much you pay out of pocket each year. But with Medicare Parts A and B alone, no such limit exists.

This means you could face:

• Unlimited 20% coinsurance on expensive Part B treatments

• Repeated deductibles for hospital stays

• No financial protection in a worst-case scenario

This lack of a safety net makes supplemental coverage crucial.

Late Enrollment Penalties Are Real and Lasting

Another hidden cost of relying on Medicare without understanding its rules is penalties.

If you don’t enroll in Part B or Part D when you’re first eligible—and you don’t qualify for a Special Enrollment Period—you may face permanent monthly penalties:

• Part B: Your premium increases 10% for each full 12-month period you delay enrollment.

• Part D: Your premium increases by 1% for each month you go without creditable drug coverage.

These penalties are cumulative and last as long as you have Medicare. If you thought you were saving money by delaying coverage, it can cost you far more later.

Supplemental Coverage Isn’t Automatic

Many people assume Medicare includes everything they need—or that they’ll be automatically covered for additional services. But unless you take steps to enroll in a supplemental policy, you’re left with the gaps.

Here’s what supplemental coverage can help with:

• Covering your Part A and B deductibles, coinsurance, and copayments

• Limiting your out-of-pocket spending

• Providing additional benefits like foreign travel emergency care, dental, vision, or hearing coverage

Without these additions, your coverage is incomplete.

Even Routine Services May Require Strategic Planning

In 2025, more healthcare providers are moving toward requiring prior authorization—even for Medicare-covered services. If you rely solely on Original Medicare, you may experience delays in care or confusion around eligibility and coverage for procedures.

And if you’re hospitalized, you may not be considered an inpatient even if you stay overnight. Observation status rules can shift the burden of costs onto you unexpectedly.

Understanding how Medicare works in real situations is essential to avoiding gaps in care.

Don’t Forget About Coordination With Other Benefits

If you have retiree benefits, TRICARE, VA coverage, or are still working and covered by employer insurance, your Medicare benefits might interact in complex ways. Relying on Medicare alone, without checking how it coordinates with other plans, could lead to denied claims or excess costs.

In 2025, proper coordination is more important than ever:

• Some retiree plans require you to enroll in Medicare Parts A and B to remain eligible

• Others may automatically become secondary once you’re Medicare-eligible

• TRICARE for Life works only if you have Medicare Parts A and B

Failing to review these interactions can leave you with coverage gaps you didn’t expect.

It’s Easy to Miss Deadlines That Affect Coverage

Medicare has strict enrollment periods. If you miss them, you may have to wait until the next cycle, potentially going months without coverage. These include:

• Initial Enrollment Period (IEP): A 7-month window around your 65th birthday

• General Enrollment Period (GEP): From January 1 to March 31 if you missed IEP

• Annual Enrollment Period (AEP): October 15 to December 7 to make changes for the next year

• Special Enrollment Periods (SEPs): Triggered by qualifying events like loss of employer coverage

Relying solely on Medicare without understanding these windows could lead to delays in access, missed opportunities for better coverage, or penalties.

Thinking Ahead Can Spare You Financial Stress

Planning beyond the basics of Medicare allows you to:

• Estimate your potential out-of-pocket exposure

• Evaluate whether supplemental coverage makes sense for you

• Make timely decisions about drug plans and enrollment periods

• Understand how Medicare coordinates with other benefits you may have

Even if Medicare covers a large share of your healthcare costs, the missing pieces can add up fast if you’re not prepared.

Strengthen Your Coverage for 2025 and Beyond

Medicare forms the core of your health insurance in retirement, but by itself, it leaves too many needs unmet. In 2025, with rising costs and evolving rules, relying on Medicare alone is more risky than ever.

You don’t have to solve this alone. Speak with a licensed agent listed on this website to explore your full range of options. You’ll get help reviewing your current Medicare plan, understanding what’s missing, and considering ways to fill those gaps so you’re protected for the long term.