What Medicare Does (and Doesn’t) Cover for Seniors
What Medicare Does (and Doesn’t) Cover for Seniors
Medicare is one of the most valuable benefits available to older Americans — but it’s also one of the most misunderstood. Many people assume Medicare covers everything once they turn 65, only to be surprised by out-of-pocket costs or uncovered services later on.
This guide breaks down what Medicare does (and doesn’t) cover, so you can plan ahead, avoid unexpected bills, and make smart decisions about your healthcare.
1. What Medicare Does Cover
Medicare is divided into four main parts, each covering specific types of care.
Medicare Part A (Hospital Insurance)
Covers:
Inpatient hospital stays
Skilled nursing facility care (short-term)
Hospice care
Some home health care
You generally won’t pay a premium for Part A if you or your spouse paid Medicare taxes for at least 10 years.
Medicare Part B (Medical Insurance)
Covers:
Doctor visits (including specialists)
Outpatient care and lab tests
Durable medical equipment (like wheelchairs)
Preventive care (flu shots, cancer screenings, annual wellness visits)
You’ll pay a monthly premium for Part B, and typically 20% coinsurance for most services after meeting the annual deductible.
Medicare Part D (Prescription Drug Coverage)
Helps pay for:
Prescription medications
Some vaccines and insulin products
Part D plans are offered by private insurers and vary in cost and drug coverage, so it’s worth comparing your options every year.
Medicare Advantage (Part C)
Private insurance plans that combine Parts A, B, and usually D into one package. Many offer extra benefits like:
Vision, dental, and hearing care
Fitness memberships
Transportation or meal services
Telehealth coverage
2. What Medicare Doesn’t Cover
Here’s where many seniors are caught off guard — Medicare doesn’t cover everything.
Common exclusions include:
Long-term care (custodial care): Medicare covers rehab in a skilled nursing facility, but not ongoing help with daily activities like bathing or dressing.
Routine dental, vision, and hearing: Unless you have a Medicare Advantage plan that includes them, you’ll pay out-of-pocket for exams, glasses, hearing aids, and dental work.
Cosmetic surgery: Procedures for appearance rather than health are not covered.
Overseas medical care: Most care received outside the U.S. isn’t covered (some Medigap plans offer limited foreign travel benefits).
Routine foot care: Unless medically necessary, routine podiatry visits aren’t covered.
3. Filling the Gaps with Supplemental Coverage
Because of these limitations, many seniors add supplemental coverage:
Medigap (Medicare Supplement Insurance): Helps pay deductibles, copayments, and coinsurance not covered by Original Medicare.
Medicare Advantage: Combines all coverage in one plan, often with added perks.
Standalone Dental, Vision, or Hearing Plans: Useful if those needs are a priority.
A Medicare specialist can help compare your options to find the most cost-effective solution for your situation.
4. The Bottom Line
Medicare is a strong foundation for senior healthcare, but it’s not all-inclusive. Understanding what’s covered — and where the gaps are — helps you avoid surprises and make confident coverage decisions.
✅ Covered: Hospital stays, doctor visits, preventive care, and prescriptions (with a Part D plan).
❌ Not Covered: Long-term care, routine dental, vision, and hearing, and most care outside the U.S.
Need help reviewing your coverage?
Talk with a licensed Medicare expert who can walk you through your current plan, identify what’s missing, and help you find affordable options to fill the gaps.
https://sentinelretirementservices.com
