Most people assume that once they hit 65 and enroll in Medicare, they’ll be fully covered for healthcare. But that’s not quite how it works.
Medicare covers a lot—but not everything. And some of the things it doesn’t cover may surprise you.
Whether you’re planning ahead or already enrolled, understanding what’s included—and what’s not—can help you avoid unexpected medical bills and make better coverage choices.
Let’s walk through it.
What Medicare Covers
Medicare Part A – Hospital Insurance
Part A generally covers:
- Inpatient hospital stays
- Skilled nursing facility care (after a qualifying hospital stay)
- Hospice care
- Some home health services
If you’ve worked and paid Medicare taxes for 10 years or more, Part A is typically premium-free. But it’s not cost-free. You’ll still be responsible for deductibles, daily hospital copays after 60 days, and limitations on long hospital stays (including a lifetime reserve of 60 hospital days, which you can run out of).
Medicare Part B – Medical Insurance
Part B covers:
- Doctor visits
- Outpatient care
- Preventive services
- Lab work, X-rays, and diagnostic tests
- Durable medical equipment
- Some home health care
Part B comes with a monthly premium (based on your income), an annual deductible, and 20% coinsurance on most services—with no out-of-pocket max.
Medicare Part C – Medicare Advantage Plans
These are private plans that replace Original Medicare. They must cover everything Parts A and B cover, and often include extra benefits like:
- Prescription drug coverage
- Dental, vision, and hearing
- Fitness benefits
- Over-the-counter allowances
Coverage, networks, and costs vary widely depending on the plan.
Medicare Part D – Prescription Drug Coverage
Part D plans cover outpatient prescription drugs. You buy this separately if you’re on Original Medicare or it may be bundled into a Medicare Advantage plan.
Coverage levels, copays, and formulary tiers vary by plan, and you’ll want to double-check how your medications are covered.
What Medicare Does NOT Cover
Here’s where things get tricky. Many people are shocked to learn that Medicare doesn’t cover:
1. Prescription Drugs (unless you enroll in Part D)
Original Medicare doesn’t cover your medications at the pharmacy. You must enroll in a standalone Part D plan or choose a Medicare Advantage plan that includes drug coverage.
2. Routine Dental, Vision, and Hearing Care
Medicare doesn’t cover:
- Dental cleanings, fillings, dentures
- Eye exams for glasses or contacts
- Hearing aids or hearing tests
You’ll need to add separate coverage, choose a Medicare Advantage plan with these benefits, or pay out of pocket.
3. Long-Term Care or Custodial Care
Medicare covers short-term skilled care, like rehab after a hospital stay. But it does not cover long-term care services like:
- Assisted living
- Nursing homes (beyond short-term rehab)
- Help with daily living activities (bathing, dressing, etc.)
4. Medical Services Outside the U.S.
In most cases, Medicare doesn’t cover medical care outside the U.S. You may need to purchase travel medical insurance or choose a Medigap plan with foreign travel emergency benefits.
5. Cosmetic Procedures and Non-Essential Services
Things like elective surgeries, cosmetic procedures, or alternative therapies typically aren’t covered.
How to Fill the Gaps
There are two main ways people cover what Medicare doesn’t:
1. Medicare Supplement (Medigap) Plans
These work alongside Original Medicare and help pay for deductibles, coinsurance, and copays. Some plans offer foreign travel emergency coverage. You’ll still need a separate Part D plan for prescriptions.
2. Medicare Advantage Plans (Part C)
These all-in-one plans often include dental, vision, hearing, and drug coverage. They also cap your out-of-pocket spending, unlike Original Medicare.
Final Thoughts
Medicare covers a lot—but not everything. And the last thing you want is to find out something isn’t covered after the bill arrives.
The good news? With the right guidance, you can build a plan that fills the gaps and protects your health and finances.
At Brickhouse, we help people like you understand what Medicare will (and won’t) do—and how to make smart decisions based on your actual needs.
Schedule a free consultation with Niki or a member of our team. There’s no cost and no obligation to enroll.
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Written by Niki Feret
Licensed Independent Medicare Insurance Agent
Founder, Brickhouse Agency & Chicagoland Medicare
As a female agency owner in a space that’s often dominated by call centers and cookie-cutter advice, I started Brickhouse to do things differently.
We’re a boutique Medicare agency—real people helping real people. No scripts, no pressure, and no one-size-fits-all recommendations. Just thoughtful, personalized guidance that helps you make confident Medicare decisions. If you’re ready to feel supported—not sold—
Schedule a free consultation here. There’s no cost and no obligation to enroll. Ever.