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What’s Actually Covered by Medicare and What’s Definitely Not
- Aromedy Insights (AI)
- Sep 13
- 3 min read
A clear guide to what Original Medicare includes, what you need add-ons for, and what you’ll have to pay out-of-pocket.
You’re about to turn 65, and you’ve signed up for Medicare. Great! But here’s the catch: Medicare doesn’t cover everything—and finding that out too late can be both stressful and expensive.
This guide explains what’s included in Original Medicare (Parts A and B), what you only get if you add Part D or Medicare Advantage, and what’s off-limits unless you buy extra coverage. Spoiler: dental, vision, hearing aids, and long-term custodial care aren’t included.
Medicare Basics in Plain English
Medicare isn’t one giant blanket—it’s more like a quilt with squares that cover some things but leave gaps. Part A helps pay for hospital stays, skilled nursing facility care, hospice, and limited home health services. Part B handles outpatient care, doctor visits, preventive services, and durable medical equipment.
According to the Kaiser Family Foundation, Part A is premium-free for most people who worked at least 40 quarters, while Part B comes with a standard monthly premium—currently $174.70 in 2025.
What’s Included for Free (and What Isn’t)
Original Medicare offers some fully covered preventive services, including:
Annual wellness visits
Screenings for cancer, diabetes, and heart disease
Vaccines like flu and COVID-19 shots
But most other services have deductibles, coinsurance, or copays. In 2025, the Part A deductible is $1,632 per benefit period, while Part B has a $240 annual deductible and 20% coinsurance for most outpatient care (Centers for Medicare & Medicaid Services).
CMS data shows that 22% of beneficiaries spend over $2,000 annually in out-of-pocket costs for services not fully covered by Parts A and B.
What Medicare Won’t Pay For
Here’s where people get caught off guard. Original Medicare does not cover:
Routine dental care (cleanings, crowns, implants)
Eye exams and eyeglasses
Hearing aids and exams
Most long-term custodial care, such as assisted living or nursing home stays beyond 100 days
The National Institute on Aging notes that these exclusions often push retirees to buy separate policies or pay cash.
Filling the Gaps with Extra Coverage
To avoid surprise bills, many choose one of two options:
Medigap (Supplement) Plans – Private policies that help with deductibles, coinsurance, and other cost-sharing.
Medicare Advantage (Part C) – All-in-one plans that often include dental, vision, and hearing coverage, plus prescription drugs.
Comparing these choices on the Medicare Plan Finder can save hundreds of dollars a year.
Typical Out-of-Pocket Costs by Coverage Type
(Original Medicare vs. Medigap vs. Advantage)
Medicare is a sturdy base, but it’s not a one-stop shop. Understanding its limits—and planning for them with Medigap or Medicare Advantage—can spare you thousands and give you peace of mind as you age into coverage.
Medical Disclaimer
The information provided in this article is for educational and informational purposes only and is not intended as medical advice. It should not be used to diagnose, treat, cure, or prevent any medical or mental health condition. Always seek the guidance of a qualified healthcare professional or licensed mental health provider with any questions you may have regarding a medical condition, diagnosis, or treatment. Never disregard professional medical advice or delay seeking it because of something you have read here.
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