Medicare (Parts A and B) covers most essential medical services you'll need. Understanding what's included helps you spot the gaps and plan for them. Medicare benefits and costs can change annually and vary by location.
What Does Medicare Cover and Not Cover? (2025 Guide)
Updated: October 7, 2025
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Key Takeaways
Medicare covers your hospital stays and doctor visits, but you'll still pay deductibles and coinsurance for most services.
You won't get coverage for dental cleanings, hearing aids or long-term nursing care, which Medicare doesn't cover.
If Medicare denies coverage, you have 120 days to appeal or you can switch to Medicare Advantage for additional benefits.
What Does Medicare Cover
What Does Medicare Part A Cover
Knowing about your Medicare Part A benefits helps you prepare for health care costs in retirement. Part A doesn't charge monthly premiums if you've worked and paid Medicare taxes for at least 10 years.
Inpatient hospital stays cover your semi-private room, meals, general nursing care and medical supplies. The 2025 deductible is $1,676 per benefit period, then daily coinsurance applies after 60 days. Private rooms will cost extra unless your doctor states them as medically necessary.
Skilled nursing facility care provides up to 100 days of skilled medical services or rehabilitation after a qualifying 3-day hospital stay. The first 20 days cost nothing to you, but you have to pay a daily coinsurance of $209.50 from the 21st day in 2025. But this only covers skilled medical care and therapy, not custodial or long-term care.
Hospice care provides full support when you're facing a terminal diagnosis with six months or less to live. Pain management, medical equipment, medications and family counseling are usually covered completely, allowing you to focus on comfort and quality time with loved ones.
Home health services deliver care to your home when you're unable to leave and your doctor confirms you need skilled medical attention. Part-time skilled nursing, physical therapy and medical social services cost nothing when you meet Medicare's homebound requirements.
Inpatient mental health care covers psychiatric hospital treatment, though freestanding psychiatric facilities have a 190-day lifetime limit. If you have received psychiatric care at general hospitals, that’s not counted toward this limit, providing you with more treatment options when you need mental health support.
What Does Medicare Part B Cover
While Medicare Part B requires monthly premiums, it provides essential outpatient services. In 2025, it will cost $185 monthly for most people (higher earners pay more). Once you have met your annual $257 deductible, Medicare covers 80% of approved costs for outpatient services.
Doctor visits and specialist care cover your routine checkups, specialist consultations and emergency room visits. After meeting your annual deductible, you'll pay 20% coinsurance for most services.
Preventive services provide excellent coverage with cancer screenings, flu shots, mammograms, colonoscopies and annual wellness visits at no cost when your provider accepts Medicare assignment.
Ambulance services cover emergency transportation when your medical condition requires it. Non-emergency ambulance rides aren't covered unless using other transportation would risk your health.
Durable medical equipment covers wheelchairs, walkers, hospital beds and oxygen equipment your doctor prescribes. Medicare covers equipment rental rather than outright purchase, which helps keep your out-of-pocket costs manageable.
Mental health services, including outpatient therapy, counseling sessions and psychiatric evaluations, are covered under the same policy as other medical visits. After meeting your deductible, you'll pay 20% coinsurance.
Diagnostic tests, including X-rays, MRIs, CT scans, lab work and EKGs are covered when your doctor orders them as medically necessary for diagnosis or treatment.
Insulin pump users pay $35 monthly for their insulin supply with no deductible required when Medicare covers the pump as durable medical equipment. This can really cut your costs.
What Does Medicare Not Cover
Medicare covers many essential health services, but it doesn't pay for everything. You'll handle costs for dental cleanings, hearing aids, long-term nursing home care and most prescription drugs through other coverage options or out-of-pocket payments. Medicare coverage can vary by location and individual circumstances.
Medically Unnecessary Services | Hospital stays exceeding Medicare's time limits, services in expensive settings when cheaper options exist, excessive therapy sessions, unnecessary screenings unrelated to symptoms | Medicare usually covers approved preventive screenings, care coordination after hospital discharge, Chronic Care Management for ongoing conditions |
Long-Term Care | Nursing home care, assisted living, daily personal care (bathing, dressing, eating) | Days 1-20: Skilled nursing fully covered after 3-day hospital stay. Days 21-100: You pay daily coinsurance (amount varies by year) |
Dental Services | Routine cleanings, fillings, crowns, dentures, tooth extractions | Emergency dental for jaw fractures, pre-surgery dental exams for heart/kidney procedures, hospitalized dental treatment for medical conditions |
Vision Care | Eye exams for glasses, eyeglasses, contact lenses, routine eye care | Post-cataract surgery glasses, diabetic retinopathy exams, glaucoma screenings for high-risk patients, cataract surgery with artificial lens implant |
Hearing Services | Hearing aids, routine hearing tests, hearing aid fittings | Medical treatment for ear infections, hearing-related surgeries, diagnostic hearing tests for medical conditions |
Prescription Drugs | Medications you take at home under Original Medicare | Part B generally covers drugs given in a doctor's office, hospital, or clinic. |
Chiropractic Care | Most chiropractic services, X-rays, massage therapy, acupuncture | Manual spinal manipulation for spinal misalignment(with doctor referral) - this is the only covered chiropractic service |
International Care | Health services outside the United States | Emergency care when foreign hospital is closer than nearest U.S. facility, emergency care during direct travel between U.S. states via Canada |
Cosmetic Surgery | Face lifts, tummy tucks, liposuction, purely aesthetic procedures | Reconstructive surgery after mastectomy, accident-related repairs, surgery to improve function of malformed body parts |
Personal Comfort Items | Hospital TVs, private rooms (unless medically necessary), telephone, barber services | Basic hygiene services in skilled nursing facilities and psychiatric hospitals when you can't perform them yourself |
Alternative Medicine | Massage therapy, most acupuncture, naturopathic treatments, transcendental meditation | Acupuncture for chronic lower back pain (limited coverage) |
Routine Foot Care | Nail trimming, corn removal, callus care, most orthopedic shoes, flat feet treatment | Therapeutic shoes for diabetes patients, orthopedic shoes as part of leg braces, foot care for specific medical conditions |
Family/Household Care | Services provided by immediate family members or household members | None - Medicare usually does not cover care from relatives living in your home |
Investigational Services | Experimental devices and procedures under development | Category B investigational devices deemed medically necessary and reasonable |
Bundled Services | Standby physician services during procedures, administrative services, fragmented services considered part of initial treatment | None - these services are included in the main procedure payment |
What to Do When Medicare Doesn't Cover Services You Need
If Medicare doesn't cover an item or a service you need, you might feel frustrated, especially when you're already dealing with health concerns. Understanding your options for supplemental coverage and appeals can help you get the financial protection you need.
Here's how you can take action to secure coverage and reduce your out-of-pocket costs.
- 1
Review Medicare Summary Notices
Check your Medicare Summary Notice (MSN) to understand why Medicare denied your claim. Your MSN details what providers billed Medicare and what was paid or rejected.
You might find Medicare denied coverage because other government programs already cover the services (like Veterans Administration benefits), providers donated medical equipment for free or warranties replaced defective medical devices.
- 2
File an Appeal
If you think Medicare made an error in its coverage decision, appeal within 120 days. Call your doctor and ask them to back you up with medical records to prove that the service was medically necessary.
- 3
Check Alternative Insurance Options
Consider these types of health insurance plans as they often offer additional coverage not provided by Original Medicare.
- Medicare Advantage Plans (Part C): Private plans offered by Medicare-approved private insurance companies that cover everything Original Medicare does. They often include extra benefits like dental, vision and hearing aids.
- Medigap (Medicare Supplement Insurance) Plans: These plans supplement your Original Medicare coverage by helping pay some of the health care costs that Original Medicare doesn't cover, like copayments, co-insurance and deductibles. Note that Medigap plans don't usually cover services that Medicare doesn't cover at all.
- Employer Insurance: If you're still working, your employer plan may cover services that Medicare doesn't.
- 4
Access Community Resources
Community health centers base their fees on what you can afford to pay. Even without insurance, you can get dental, vision and preventive care at Federally Qualified Health Centers (FQHCs). These serve patients across all ages, including newborns and Medicare beneficiaries.
Use findahealthcenter.hrsa.gov to locate centers in your area.
- 5
Apply for Financial Assistance Programs
Many programs can help you lower your medical costs:
- Medicare Extra Help: This program helps you to pay prescription drug costs if you have limited income or resources.
- Medicaid and Children’s Health Insurance Program (CHIP): If you have low income, you can get comprehensive health coverage through these federal programs.
- State Pharmaceutical Assistance Programs: Twenty-four states offer these discount programs for prescription medications.
- Manufacturer Patient Assistance Programs: Drug companies provide free medications directly to qualifying patients through these programs.
- 6
Negotiate Payment Plans
If you're facing high out-of-pocket costs for services not covered by Medicare, talk to your health care provider about payment plans. Many providers also offer discounts for upfront payment.
Bottom Line
Medicare provides solid financial protection for hospital stays and doctor visits, though you'll still face deductibles and coinsurance costs. The program won't cover dental care, hearing aids or long-term nursing services.
If you're dealing with these coverage gaps, you can appeal denied claims within 120 days, look into Medigap plans or apply for assistance programs.
What Is and Isn't Covered by Medicare: FAQ
We answered the most frequently asked questions on what Medicare covers and does not cover:
What does Medicare cover and not cover?
Medicare covers hospital stays, doctor visits, preventive services and diagnostic tests through Parts A and B. It doesn't cover dental cleanings, hearing aids, most prescription drugs, vision care or long-term nursing home care. You'll pay deductibles and coinsurance for covered services.
Does Medicare cover prescription drugs?
Original Medicare only covers prescription drugs given in medical settings, like chemotherapy or injections during doctor visits. It doesn't cover medications you take at home. You'll need Medicare Part D or Medicare Advantage for regular pharmacy prescriptions.
Does Medicare cover eye exams?
Medicare doesn't cover routine eye exams for glasses or contact lenses. It covers eye exams for medical conditions like diabetic retinopathy, glaucoma screenings for high-risk patients, and post-cataract surgery follow-ups when medically necessary.
Does Medicare cover emergency room visits?
Medicare Part B covers emergency room visits. After meeting your annual $257 deductible in 2025, you'll pay 20% coinsurance for the visit. Medicare generally covers emergency care at any Medicare-certified hospital. Note that 'network' concepts apply differently to Original Medicare versus Medicare Advantage plans.
About Mark Fitzpatrick
Mark Fitzpatrick, a Licensed Property and Casualty Insurance Producer, is MoneyGeek's resident Personal Finance Expert. With over five years of experience analyzing the insurance market, he conducts original research and creates tailored content for all types of buyers. His insights have been featured in publications like CNBC, NBC News and Mashable.
Fitzpatrick holds a master’s degree in economics and international relations from Johns Hopkins University and a bachelor’s degree from Boston College. He's also a five-time Jeopardy champion!
Passionate about economics and insurance, he aims to promote transparency in financial topics and empower others to make confident money decisions.
sources
- Centers for Medicare & Medicaid Services. "Items and Services Not Covered by Medicare." Accessed September 26, 2025.
- Centers for Medicare & Medicaid Services. "Medicare Deductible, Coinsurance, & Premium Rates: CY 2025 Update." Accessed September 26, 2025.
- Centers for Medicare & Medicaid Services. "2025 Medicare Parts A & B Premiums and Deductibles." Accessed September 26, 2025.
- Medicare.gov. "Medicare’s Extra Help Program." Accessed September 26, 2025.