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 plans cover a lot—but not everything. And some of the things it doesn’t cover may surprise you. In fact, the biggest misunderstandings usually come from assuming Medicare is “free,” that it covers long-term care, or that it includes dental and vision automatically. It doesn’t.
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 in plain English.
What Medicare Covers
At its core, original Medicare is hospital coverage (Part A), medical coverage (Part B), optional prescription drug coverage (Part D), and the choice to get all-in-one coverage through a private Medicare Advantage plan (Part C). But each part works differently, and each has its own costs.
Here’s how it breaks down.
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.
A quick example: A hospital stay can trigger a per-benefit-period deductible, not an annual one. That means if you’re hospitalized twice with enough time in between, you could pay the deductible twice in the same year.
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.
Here’s the part people often miss: Original Medicare has no out-of-pocket maximum. If you have a major health year—multiple specialist visits, surgeries, or ongoing treatments—your costs can climb quickly.
Medicare Part C – Medicare Advantage Plans
These private Medicare Advantage plans 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.
Important notes:
- Most plans use networks, meaning your doctors must participate.
- Some services require prior authorization, which can delay or deny care.
- Medicare Advantage plans include an annual Maximum Out-of-Pocket (MOOP) limit—something Original Medicare does not have.
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, especially if you take brand-name or specialty drugs.
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
Original Medicare doesn’t cover:
- Dental cleanings, fillings, dentures
- Eye exams for glasses or contacts
- Hearing aids or routine 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
This is one of the biggest areas of confusion. Medicare covers skilled care, like rehab after a hospital stay. But it does not cover long-term custodial care such as:
- Assisted living
- Nursing homes (beyond short-term rehab)
- Help with daily living activities (bathing, dressing, etc.)
This is why long-term care planning is so important.
4. Medical Services Outside the U.S.
In most cases, Medicare doesn’t cover care outside the U.S. Some Medigap plans offer limited foreign travel emergency benefits, but you may still need travel medical insurance.
5. Cosmetic Procedures and Non-Essential Services
This includes elective surgeries, cosmetic procedures, and most alternative therapies.
6. Routine Chiropractic, Podiatry, and Alternative Care
Medicare only covers spinal manipulation for subluxation—not routine chiropractic visits. Podiatry isn’t covered unless medically necessary.
These limitations surprise people every year.
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.
Medigap is best for people who want:
- Predictable medical costs
- No networks
- Fewer prior authorizations
- Nationwide coverage
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.
Medicare Advantage is best for people who want:
- Low or $0 premiums
- Bundled extras
- One card and one plan to manage
A Few Things Medicare Sometimes Covers
To reduce confusion, here are services Medicare covers only under certain conditions:
- Ambulance transportation (not automatic)
- Home health care (very strict rules)
- Physical therapy and rehab (when medically necessary)
- Mental health outpatient care
- Some preventive screenings based on age or risk
This “sometimes” category causes tons of billing surprises.
FAQs
Does Medicare cover routine dental, vision, and hearing care?
No. Original Medicare doesn’t cover cleanings, glasses, or hearing aids. You’ll need a Medicare Advantage plan with these benefits or separate standalone coverage.
Does Medicare have an out-of-pocket maximum?
Original Medicare has no out-of-pocket maximum. Medicare Advantage plans do, which is one reason people choose them.
Does Medicare pay for long-term care?
No. Medicare only covers short-term skilled nursing after a qualifying hospital stay. It does not cover custodial or long-term care in assisted living or nursing homes.
Does Medicare cover care outside the U.S.?
Not usually. Some Medigap plans offer limited emergency coverage abroad, but most people need travel medical insurance for international trips.
Why do I need Part D if Medicare covers some medications?
Medicare Part B covers limited drugs (usually those given in a clinic or outpatient setting). Part D is needed for retail pharmacy prescriptions.
What’s the difference between Medigap and Medicare Advantage?
Medigap works with Original Medicare and reduces your out-of-pocket costs. Medicare Advantage replaces Original Medicare with an all-in-one plan including networks and extra benefits.
You Don’t Have to Figure This Out Alone
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 based on how you actually use care.
At Brickhouse, we help people like you understand what Medicare will (and won’t) do—and how to make smart decisions based on your doctors, your prescriptions, and your budget.
Schedule a free consultation with our team. There’s no cost and no obligation to enroll.
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.
