Key Takeaways
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Understanding what each part of Medicare covers in 2025 can help you avoid unnecessary costs and confusion. Each part (A, B, C, and D) serves a distinct purpose with unique rules and enrollment timelines.
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Knowing what isn’t covered under Original Medicare (Parts A and B) is just as important as knowing what is, especially when considering additional coverage options.
Why Medicare Is Split Into Parts in the First Place
Medicare isn’t just one program—it’s a collection of different parts designed to handle different aspects of healthcare. Think of it like sections of a playbook: each part plays a specific role, but the full picture comes together only when you understand how they interact.
In 2025, the program still breaks down into four main parts: A, B, C, and D. Here’s what each part means—and what it doesn’t cover.
Medicare Part A: Hospital Insurance
Part A is often called hospital insurance. It generally covers:
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Inpatient hospital stays
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Skilled nursing facility care (after a qualifying hospital stay)
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Hospice care
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Some home health care
What You Should Know in 2025:
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If you worked and paid Medicare taxes for at least 40 quarters (10 years), you typically don’t pay a monthly premium for Part A.
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The inpatient hospital deductible in 2025 is $1,676 per benefit period.
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After day 60 in the hospital, daily coinsurance kicks in—$419 per day from days 61–90, and $838 per day for lifetime reserve days.
What’s Not Covered:
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Long-term care
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Personal care in nursing homes
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Private duty nursing
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Most non-hospital home care
Medicare Part B: Medical Insurance
Part B covers the outpatient side of healthcare. It includes:
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Doctor visits
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Preventive services
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Lab tests and X-rays
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Outpatient surgeries
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Durable medical equipment (like walkers or oxygen equipment)
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Some home health services
What You Should Know in 2025:
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The standard Part B premium is $185 per month.
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The annual deductible is $257.
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After you meet your deductible, Medicare usually pays 80% of approved services, leaving you responsible for the remaining 20%.
What’s Not Covered:
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Prescription drugs
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Routine vision and dental care
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Hearing aids and exams for fitting them
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Long-term custodial care
Medicare Part C: Medicare Advantage
Part C is an alternative way to receive your Medicare benefits. Medicare Advantage plans are offered through private insurance companies approved by Medicare. In 2025, they are still required to offer the same benefits as Parts A and B, but they often include additional benefits.
What Part C May Include:
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Coverage for vision, dental, and hearing services
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Wellness programs
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Prescription drug coverage (most plans include it)
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A cap on out-of-pocket expenses for in-network services (the limit for 2025 is $9,350 in-network, $14,000 combined in- and out-of-network)
What to Keep in Mind:
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You must still pay your Part B premium.
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Costs, networks, and covered benefits vary by plan.
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Prior authorization is often required for certain services.
Not a Replacement for Medicare: Part C is still Medicare. You remain in the Medicare program, but your benefits are managed by a private plan rather than Original Medicare.
Medicare Part D: Prescription Drug Coverage
Part D helps pay for prescription drugs. Plans are offered through private companies approved by Medicare. You can add a Part D plan to Original Medicare or get it included in a Medicare Advantage plan.
What You Should Know in 2025:
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The maximum deductible allowed is $590.
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Once you reach the $2,000 out-of-pocket cap (new in 2025), you pay nothing more for covered drugs for the rest of the year.
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The coverage gap or “donut hole” no longer exists in 2025. Beneficiaries transition straight into full coverage once the cap is reached.
What’s Not Covered:
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Drugs not on your plan’s formulary
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Over-the-counter medications
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Drugs for weight loss or cosmetic purposes
Timelines and Enrollment Windows
Understanding when and how you can enroll in these parts is just as important as knowing what they cover.
Initial Enrollment Period (IEP)
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Starts three months before the month you turn 65
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Ends three months after that month
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If you miss it, you may have to wait for the General Enrollment Period and face late penalties
General Enrollment Period (GEP)
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Runs from January 1 to March 31 annually
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Coverage begins July 1
Medicare Advantage Open Enrollment Period
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January 1 to March 31
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You can switch between Advantage plans or return to Original Medicare
Annual Enrollment Period (AEP)
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October 15 to December 7
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You can make changes to your Part D or Advantage plans
Special Enrollment Periods (SEPs)
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Triggered by specific life events (moving, losing employer coverage, etc.)
What Original Medicare Doesn’t Cover
Original Medicare (Parts A and B) has significant coverage gaps. Many people are surprised to learn they need additional insurance for:
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Prescription drugs
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Routine dental, vision, and hearing care
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Care outside the U.S.
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Extended long-term care
Supplemental coverage—like a Medigap policy or a Medicare Advantage plan—can help fill these gaps.
Out-of-Pocket Costs: How They Add Up
Even with Medicare, you’ll face out-of-pocket costs:
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premiums: Part B (and possibly Part A) premiums
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Deductibles: For hospital stays and outpatient services
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Coinsurance/Co-pays: 20% for most Part B services
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Drug Costs: If you have a Part D plan, you’re responsible for monthly premiums, deductibles, and a portion of drug costs until you hit the $2,000 cap
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Non-Covered Services: Vision, dental, hearing, and long-term care are usually fully out-of-pocket unless you have extra coverage
These expenses can add up quickly, especially if you face health issues later in the year.
How the Parts Work Together
Think of Medicare as a layered system:
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Part A and B: The foundation—hospital and medical coverage
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Part D: Add-on prescription drug help
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Part C: A bundled alternative that can include everything above
It’s up to you to decide how you want to structure your coverage. But understanding the roles and limits of each part gives you the tools to make informed choices.
Understanding the Whole Picture
No one expects you to become a Medicare expert overnight. But you do need to know what each part is, what it’s not, and how it fits into your life.
Take time to:
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Review your current and expected healthcare needs
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Evaluate what each part of Medicare offers
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Think about gaps that could leave you with high out-of-pocket costs
And when you’re ready to compare options or want help figuring out the best route for you, reach out to a licensed insurance agent listed on this website. They can help you personalize your Medicare choices so that nothing essential slips through the cracks.
