It’s 2025, and Medicare Still Doesn’t Cover What Most People Expect It To

Key Takeaways

• In 2025, Medicare still leaves major gaps in coverage, especially for services like dental, vision, hearing, and long-term care.

• You may face significant out-of-pocket expenses unless you understand what’s excluded and take steps to manage these costs.

Medicare Covers a Lot—But Not Everything You Might Assume

Medicare remains a lifeline for millions of older adults and individuals with disabilities, but it does not offer blanket coverage. Many people are surprised to learn, often too late, that their needs fall outside of Medicare’s standard scope. While you may rely on Medicare for hospital stays, doctor visits, and certain prescriptions, other common services—some of them essential—require careful planning or separate coverage.

To make sound decisions, you need a clear understanding of what’s included and, more importantly, what isn’t in 2025.

What Medicare Part A and Part B Do Cover

Let’s start with the foundation: Original Medicare includes Part A and Part B.

Part A (Hospital Insurance)

Part A generally covers:

• Inpatient hospital stays

• Skilled nursing facility care (with strict limits)

• Hospice care

• Some home health care services

Part A is premium-free if you or your spouse worked and paid Medicare taxes for at least 10 years. Still, it comes with a deductible and coinsurance responsibilities. For example, the hospital deductible in 2025 is $1,676 per benefit period.

Part B (Medical Insurance)

Part B covers:

• Outpatient care

• Doctor’s services

• Preventive services (e.g., screenings, vaccinations)

• Durable medical equipment (DME)

• Mental health services (in limited contexts)

You pay a monthly premium for Part B—$185 in 2025—and there’s an annual deductible of $257. After meeting the deductible, you typically pay 20% coinsurance for most services.

While these parts form a solid base, they stop short of addressing many routine and high-cost health needs.

Major Gaps That Still Exist in 2025

Despite recent improvements, particularly the new $2,000 out-of-pocket cap for Part D drugs, many gaps remain.

1. Dental Care

Medicare does not cover routine dental exams, cleanings, fillings, crowns, dentures, or implants. Even in 2025, coverage is only provided in very limited circumstances, such as a dental exam required before a major surgery.

That means you’re expected to pay the full cost out-of-pocket or find separate coverage.

2. Vision Services

Routine eye exams, eyeglasses, and contact lenses are not covered. Part B may cover eye-related services only if they’re tied to a medical condition, like glaucoma or diabetic retinopathy.

In general, though, if you simply need a new pair of glasses in 2025, you’re on your own.

3. Hearing Aids

Medicare still does not cover hearing aids or exams for fitting them. This exclusion can be especially frustrating for older adults, as untreated hearing loss affects quality of life and cognitive health.

Unless you’re enrolled in a supplemental plan that includes these benefits, the full cost falls to you.

4. Long-Term Custodial Care

One of the most widely misunderstood exclusions is long-term custodial care—help with bathing, dressing, eating, and other daily activities.

Medicare covers short-term skilled nursing care following a qualifying hospital stay, but it does not pay for ongoing assistance in nursing homes, assisted living, or in-home caregiving.

This gap can result in thousands of dollars per month in out-of-pocket costs.

5. Prescription Drugs Without Part D

While Medicare Part D now offers improved protection through its $2,000 cap, you must still enroll in a Part D plan to access that benefit. Original Medicare (Parts A and B) does not include most prescription drugs.

Even in 2025, if you haven’t enrolled in Part D or don’t have drug coverage through another source, you’ll have to pay for your medications yourself—and you may face penalties for late enrollment.

You Might Still Pay More Than You Expect

Even when a service is covered by Medicare, it’s not necessarily free.

In 2025, the cost-sharing structure still includes:

• Part A deductible: $1,676 per benefit period

• Part B premium: $185 per month (higher if your income exceeds certain thresholds)

• Part B deductible: $257 annually

• Coinsurance: Typically 20% for most Part B services

Some services, like ambulance transport or outpatient surgeries, can result in bills of hundreds or even thousands of dollars depending on the provider and your geographic location.

Supplemental Coverage Options—But With Limits

To help manage these gaps, many beneficiaries turn to supplemental insurance. While private plans are not discussed here by name, you should know your broad options.

Medigap Policies

Also known as Medicare Supplement Insurance, Medigap can help pay for your share of costs like deductibles and coinsurance under Original Medicare. However, Medigap policies do not cover dental, vision, hearing aids, or long-term care.

In 2025, Medigap plans are still standardized by letter (Plan G, Plan N, etc.), and you pay a monthly premium in addition to your Part B premium.

Medicare Advantage Plans

These plans (also called Part C) often include additional benefits not available through Original Medicare. However, they may involve different rules, provider networks, and cost-sharing structures.

Enrollment is only allowed during certain windows, such as the Annual Enrollment Period from October 15 to December 7.

Enrollment Windows Still Matter—Even in 2025

If you’re approaching age 65 or are newly eligible, it’s important to act within the right timeframes to avoid penalties.

• Initial Enrollment Period (IEP): 3 months before to 3 months after your 65th birthday month

• General Enrollment Period (GEP): January 1 to March 31 annually, with coverage starting July 1

• Open Enrollment: October 15 to December 7 each year (for switching or joining Medicare Advantage or Part D)

Missing these windows may result in lifetime late enrollment penalties or gaps in coverage.

How to Plan Around What Medicare Doesn’t Cover

Knowing what’s excluded allows you to make informed decisions.

Here’s what you can do:

• Consider separate dental, vision, and hearing coverage if these services matter to you.

• Plan for long-term care expenses with savings, long-term care insurance, or state-based programs if eligible.

• Enroll in Part D on time to avoid penalties and benefit from the 2025 drug cost cap.

• Review your coverage each year during Open Enrollment to make sure your plan still fits your needs.

• Work with a licensed agent listed on this website for help tailoring your coverage.

Medicare in 2025 Still Requires Active Management

While Medicare continues to evolve and improve, it’s still not a hands-off benefit. The gaps in dental, vision, hearing, long-term care, and some out-of-pocket costs mean you need to be actively involved in planning your coverage.

If you want to protect your health and your finances, take time now to understand your options—and adjust your strategy when your health needs change.

For personalized help, reach out to a licensed agent listed on this website. They can walk you through your choices and ensure you’re not caught off guard by Medicare’s hidden exclusions.