Key Takeaways

• Medicare covers a wide range of medical services, but it doesn’t pay for everything. Knowing what’s included—and what’s not—is essential for managing your health expenses.

• Even with Medicare, you’re likely to face out-of-pocket costs such as deductibles, copayments, and services that aren’t covered at all, like dental and vision care.

What You Get with Original Medicare

Original Medicare consists of two main parts: Part A (Hospital Insurance) and Part B (Medical Insurance).

Medicare Part A: Hospital Insurance

Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.

• Inpatient hospital care: Covers semi-private rooms, meals, nursing, and other hospital services.

• Skilled nursing facility care: Covered after a qualifying hospital stay of at least three days.

• Hospice care: Includes pain relief, symptom management, and support services for terminally ill patients.

• Home health care: Limited to part-time skilled nursing care and therapy, prescribed by a doctor.

You don’t pay a premium for Part A if you worked and paid Medicare taxes for at least 40 quarters (10 years). But you still pay deductibles and coinsurance.

In 2025:

• The Part A deductible is $1,676 per benefit period.

• Hospital stays longer than 60 days incur daily coinsurance: $419/day for days 61–90, and $838/day for lifetime reserve days.

• Skilled nursing facility care is covered up to 100 days per benefit period, but days 21–100 require a coinsurance of $209.50/day.

Medicare Part B: Medical Insurance

Part B helps cover outpatient care, doctor visits, preventive services, durable medical equipment, and some home health services.

In 2025:

• The monthly premium is $185 for most people.

• The annual deductible is $257.

• After meeting the deductible, you typically pay 20% coinsurance for most services.

Preventive services like flu shots, screenings, and wellness visits are fully covered if you meet eligibility requirements.

What Medicare Leaves Out

Medicare has important gaps you’ll need to plan for, especially if you want a more complete health coverage picture.

Routine Dental, Vision, and Hearing Care

• Original Medicare does not cover routine dental cleanings, fillings, dentures, or extractions.

• It doesn’t pay for routine vision exams, glasses, or contact lenses (exceptions apply for specific medical needs).

• Hearing exams for hearing aids and the devices themselves are also not covered.

You may need to look at supplemental dental and vision plans or consider additional insurance to address these services.

Prescription Drug Coverage (Part D)

Prescription drugs are not covered under Part A or B. To get this coverage, you need to enroll in a stand-alone Part D plan or a Medicare Advantage plan that includes drug benefits.

In 2025:

• The maximum deductible for a Part D plan is $590.

• Once your total out-of-pocket spending on prescriptions reaches $2,000, your plan covers 100% of covered medications for the rest of the year.

You’re responsible for copayments and coinsurance until you hit this cap.

Long-Term Custodial Care

Medicare does not pay for long-term care services such as help with bathing, dressing, or eating if these are the only types of care you need. These are considered custodial services and typically require separate planning, such as long-term care insurance or private payment.

Foreign Travel Medical Emergencies

Care received outside the U.S. is generally not covered by Original Medicare. Some Medigap policies or supplemental plans offer limited emergency coverage abroad, but you’ll need to verify details separately.

The Role of Supplemental Coverage

Because Medicare doesn’t cover everything, many people choose to add supplemental coverage.

Medigap (Medicare Supplement Insurance)

Medigap plans are offered by private insurers to help pay for:

• Part A and Part B deductibles

• Coinsurance and copayments

• Excess charges

• Limited emergency medical coverage abroad

You must have both Part A and Part B to purchase a Medigap plan. These plans do not include drug coverage, so a separate Part D plan is still needed.

Medicare Advantage (Part C)

These are all-in-one plans that typically bundle Parts A, B, and D and often include extra benefits like dental, vision, or wellness perks. Costs and coverage vary significantly.

Just remember: you cannot have both a Medicare Advantage plan and a Medigap plan.

Understanding Your Out-of-Pocket Costs

Even with coverage in place, here are common costs you may still face each year.

1. Premiums

Most people pay monthly premiums for Part B and any optional plans they select (like Part D or Medicare Advantage).

2. Deductibles

Each part of Medicare has its own deductible that you must meet before coverage kicks in.

3. Coinsurance and Copayments

After your deductible, you’ll usually pay a percentage of the service cost (coinsurance) or a fixed fee (copayment).

4. Services Medicare Doesn’t Cover

Out-of-pocket spending is also driven by services Medicare doesn’t touch—like dental or long-term care.

5. Income-Related Monthly Adjustment Amount (IRMAA)

If your income exceeds certain thresholds, you’ll pay an added premium for Part B and Part D. In 2025, IRMAA applies if your income is above $106,000 (individuals) or $212,000 (joint filers).

How to Get Ahead of the Hidden Costs

Planning ahead can reduce surprises. Here’s what you can do:

• Review coverage annually: During Medicare Open Enrollment (October 15–December 7), check if your current plan still fits your needs.

• Compare plan options: Costs and coverage change, so shop around.

• Understand billing: Know how your providers bill services—some may charge more than Medicare approves.

• Ask questions: Speak to a licensed insurance agent listed on this website for plan comparisons and out-of-pocket projections.

Where This Leaves You: Covered, But With Limits

Medicare gives you access to essential health services, but it’s not complete coverage. The reality in 2025 is that you’ll still pay out of pocket for some services, and the costs can add up quickly if you’re not prepared.

Think of Medicare as a strong base. You may need to build on it to get the full protection you want—whether that’s through supplemental insurance, long-term care planning, or simply budgeting for routine costs.

If you’re unsure which combination is best for you, get in touch with a licensed insurance agent listed on this website to explore your options.