Key Takeaways
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In 2025, Medicare continues to cover essential hospital, medical, and prescription services, but some benefits have shifted or come with new requirements.
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Understanding what Medicare still covers—and what it no longer does—can help you avoid unexpected out-of-pocket costs and coverage gaps.
What You Can Still Count On in Medicare Coverage
Medicare in 2025 still provides broad coverage for many essential health services. Whether you are newly eligible or already enrolled, you can rely on the following components:
Hospital Services Under Part A
Medicare Part A continues to cover inpatient care in hospitals and skilled nursing facilities, as long as specific conditions are met.
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Inpatient hospital care includes semi-private rooms, meals, and general nursing.
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Skilled nursing facility care is covered following a qualifying hospital stay of at least three days.
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Home health services are provided under certain conditions for homebound individuals.
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Hospice care is covered for those diagnosed with a terminal illness and a life expectancy of six months or less.
2025 Cost Considerations for Part A:
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Inpatient hospital deductible: $1,676 per benefit period
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Coinsurance for days 61–90: $419/day
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Lifetime reserve day coinsurance: $838/day
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Skilled nursing facility coinsurance (days 21–100): $209.50/day
Outpatient and Medical Services Under Part B
Part B remains essential for routine and specialized outpatient care. It covers services like:
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Doctor visits (both primary and specialist)
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Outpatient surgeries and diagnostic tests
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Preventive screenings (e.g., mammograms, colonoscopies, flu shots)
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Mental health services
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Durable medical equipment like walkers and oxygen
2025 Part B Updates:
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Monthly premium: $185
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Annual deductible: $257
After meeting your deductible, Medicare generally pays 80% of the approved cost, and you are responsible for the remaining 20%.
Prescription Drug Coverage Remains But With Major Changes
Medicare Part D still provides prescription drug coverage through stand-alone plans or plans integrated with other coverage. As of 2025, there are two major changes:
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A $2,000 annual cap on out-of-pocket prescription drug costs. Once you reach this cap, you pay nothing more for covered drugs for the rest of the year.
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Medicare Prescription Payment Plan (MPPP) lets you spread out-of-pocket costs over the year in monthly payments instead of paying large sums all at once at the pharmacy.
These changes eliminate the old coverage gap known as the “donut hole” and significantly reduce financial stress for those with high medication costs.
What Medicare No Longer Covers or Now Limits in 2025
While many benefits remain, others have been reduced, phased out, or made subject to more specific eligibility rules in 2025.
Fewer Supplemental Benefits in Medicare Advantage Plans
Although Medicare Advantage plans still offer extra perks beyond Original Medicare, fewer plans are offering these in 2025:
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Over-the-counter benefits are now included in about 73% of plans, down from 85% in 2024.
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Transportation benefits for non-emergency medical appointments are now available in only 30% of plans, compared to 36% in 2024.
If you rely on these extras, it’s crucial to check whether they are still part of your current coverage.
Restrictions on Non-Medically Necessary Services
Medicare continues to tighten its definition of what counts as medically necessary. In 2025, you may notice that:
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Certain tests or repeat screenings might require more documentation.
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Some outpatient therapies like physical or occupational therapy may be subject to more stringent review.
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Cosmetic or alternative treatments remain uncovered unless there’s a valid medical reason supported by documentation.
Limited Coverage for Long-Term Care
Medicare still does not cover most long-term custodial care. In 2025, this includes:
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Assisted living facilities
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Ongoing help with activities of daily living (like bathing or dressing) when not linked to recovery
Skilled nursing care is only covered when it’s part of a recovery plan following a qualifying hospital stay.
Dental, Vision, and Hearing Services Still Not Fully Included
Medicare does not cover most routine dental, vision, or hearing services. In 2025, unless you’re in a Medicare Advantage plan that includes these benefits:
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Dental cleanings and dentures are not covered
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Eye exams for glasses and hearing aids are excluded
You would need to pay out of pocket or find separate coverage for these needs.
Preventive Care: What’s Covered Now
Medicare still strongly supports preventive services to help you catch issues early. In 2025, you continue to get coverage for many screenings and tests, often without any cost to you.
Covered preventive services include:
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Annual wellness visit
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Cardiovascular disease screenings
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Diabetes screenings and self-management training
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Flu, pneumonia, COVID-19, and hepatitis B vaccines
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Cancer screenings such as mammograms, Pap smears, and colorectal tests
Make sure you schedule these appointments annually to take full advantage of your benefits.
Mental Health and Telehealth Services Are Still Available
The growing demand for mental health care and remote services continues in 2025. Medicare covers:
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Individual and group psychotherapy
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Psychiatric evaluations
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Substance use disorder treatment
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Virtual visits with mental health professionals
Telehealth coverage remains a standard part of Medicare in 2025, especially for mental health and rural beneficiaries. However, the list of approved services and eligible providers may be narrower than during the public health emergency.
What’s New or Evolving in 2025 Medicare Coverage
Several updates have gone into effect in 2025 that reshape how Medicare delivers care.
Part D Redesign Brings Simplified Drug Spending
With the $2,000 cap and the option for monthly payments, your experience at the pharmacy is likely to be easier and less stressful. There is no longer a gap in coverage, and catastrophic costs are significantly reduced.
Mid-Year Notifications Help Track Unused Benefits
Between June 30 and July 31, Medicare sends you a personalized summary of any unused supplemental benefits you may have under your Medicare Advantage plan. This feature helps you make the most of what you’re already paying for.
Higher Income Thresholds for IRMAA
The Income-Related Monthly Adjustment Amount (IRMAA) applies to higher-income beneficiaries. In 2025, the thresholds are now:
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$106,000 for individuals
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$212,000 for couples filing jointly
If your income exceeds these amounts, you will pay more for Parts B and D. These thresholds are adjusted annually based on inflation.
Important Timelines to Keep in Mind
Here are the critical periods for Medicare in 2025:
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General Enrollment Period: January 1 to March 31
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Open Enrollment Period: October 15 to December 7
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Special Enrollment Periods: Based on specific life events like losing employer coverage or moving
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Mid-Year Notification Period: June 30 to July 31
Missing these windows can lead to delays in coverage or financial penalties, so mark your calendar accordingly.
Be Proactive With Your Medicare Choices in 2025
Understanding what Medicare covers in 2025—and what it doesn’t—is essential to making informed choices about your healthcare. While the core structure remains stable, specific benefits, costs, and eligibility rules continue to evolve. Whether it’s checking if your prescription drugs are still on your plan’s formulary or reviewing if supplemental benefits have changed, staying alert to these changes is key.
If you’re unsure how these updates affect you, reach out to a licensed agent listed on this website for professional advice tailored to your situation.
