What Original Medicare Covers (and What It Doesn’t)

If you’re approaching Medicare eligibility or currently trying to figure out your coverage, you’re probably asking: What does Medicare really cover? At Overton Agency, we’re here to clear up the confusion and make sure you understand your options. Whether you’re choosing between Original Medicare, Medicare Advantage, or a Medicare Supplement plan, we’re dedicated to helping you find a solution that fits your needs and budget.

Medicare can be a bit overwhelming with all its parts and the variety of plans. But don’t worry, we’re here to break it down for you, focusing on what Medicare covers and what it doesn’t. Let’s get started!

Medicare Part A: Hospital Insurance

Original Medicare consists of Part A and Part B. Part A is hospital insurance, and it primarily helps with inpatient hospital care. If you meet the eligibility requirements, Part A often doesn’t come with a premium. You’ve paid into Medicare through your payroll taxes while working, so your premium is waived if you’ve worked enough years.

What Medicare Part A Covers

• Inpatient hospital care: If you’re admitted to the hospital, Part A helps cover the costs of your stay, including room and board, medical procedures, and surgery.

• Skilled nursing facility care: After a hospital stay, you might need skilled nursing care, which Part A covers for a certain period.

• Home health services: If you’re receiving care at home, Part A may help cover services like physical therapy and skilled nursing.

• Hospice care: Part A covers hospice care for those with terminal illnesses.

What Medicare Part A Doesn’t Cover

However, Part A won’t cover long-term care, such as care in a nursing home, or services that don’t meet Medicare’s definition of medically necessary services. For example, concierge care or personal care that doesn’t require skilled medical staff will not be covered.

Medicare Part B: Medical Insurance

Part B of Original Medicare covers a wide range of outpatient services, such as doctor visits, preventive care, and durable medical equipment. Part B also helps cover certain items and services that aren’t covered by Part A. Medicare Part B is essential if you need regular medical care, but keep in mind that there is a monthly premium for it, which in 2025 is about $185, along with a deductible of $257.

What Part B Covers

• Doctor visits: Whether it’s a visit to your primary care doctor or a specialist, Part B covers the medical costs associated with these visits.

• Preventive services: Medicare offers preventive services to help prevent illness, such as flu shots, cancer screenings, and routine physical exams.

• Durable medical equipment: Part B can help cover the cost of medically necessary equipment, such as wheelchairs, oxygen tanks, or a walker.

• Outpatient services: This includes services like lab tests, outpatient surgeries, and emergency care when you are not admitted to the hospital.

What Part B Doesn’t Cover

• Dental care: Routine dental care, such as cleanings, fillings, dentures, or braces, is not covered by Original Medicare.

• Routine hearing and vision exams: Part B doesn’t cover the cost of hearing aids, routine hearing exams, or vision exams for glasses or contact lenses.

• Cosmetic surgery: If a procedure is cosmetic in nature, Medicare won’t cover it. However, if a doctor prescribes a surgery for medical reasons, it may be covered.

• Certain services or supplies: Medicare won’t cover services like most chiropractic treatments, and some items or supplies may not be covered under Part B.

Medicare Part C: Medicare Advantage Plans

If you’re looking for more comprehensive coverage, you might want to explore Medicare Advantage (also known as Part C). These plans are offered by private insurers but must cover everything that Original Medicare (Part A and Part B) covers. Many Medicare Advantage plans also provide extra benefits, like dental care, vision, and hearing aids, which Original Medicare doesn’t cover.

What Medicare Advantage Plans May Offer

• Extra benefits: Medicare Advantage plans may offer extra benefits that Original Medicare doesn’t, like dental care, routine vision care, and even wellness programs.

• Prescription drug coverage: Many Medicare Advantage plans include Part D coverage, which helps pay for prescription drugs.

• Lower out-of-pocket costs: Some people find that Medicare Advantage plans offer lower out-of-pocket costs compared to Original Medicare.

However, keep in mind that Medicare Advantage plans are offered through private companies, so coverage and costs can vary. Some services may require prior authorization and you might need to use healthcare providers that are in-network.

What’s Not Covered by Medicare Advantage

• Concierge care: Private healthcare services that offer extra attention and personalized care may not be covered.

• Out-of-network services: If you go outside your Medicare Advantage plan’s network, you might face higher costs or no coverage at all.

Medicare Part D: Prescription Drug Coverage

For many people, prescription drug costs are a major concern. Part D helps with the cost of prescription medications. You can get Part D coverage either as a standalone plan if you have Original Medicare or as part of a Medicare Advantage plan.

What Part D Covers

• Prescription drugs: Part D covers a wide range of prescription drugs, from generic to brand-name medications. The specifics of what’s covered will depend on your plan.

• Out-of-pocket costs: Part D includes an annual out-of-pocket limit to help protect you from excessive prescription drug costs.

What Part D Doesn’t Cover

• Cosmetic drugs: If the medication is for a cosmetic procedure, Part D won’t cover it.

• Over-the-counter medications: Most over-the-counter drugs, like pain relievers or cold medications, aren’t covered by Part D.

Medicare Supplement Insurance (Medigap)

Medicare helps cover a lot of health care costs, but it doesn’t cover everything. That’s where Medigap comes in. Medicare Supplement Insurance plans help cover some of the out-of-pocket costs you might face, like coinsurance, deductibles, and copayments. These plans are sold by private insurance companies and can help pay for things Original Medicare doesn’t cover.

What Medicare Doesn’t Cover

Even with all the comprehensive coverage that Medicare provides, there are still some gaps. Knowing what Medicare doesn’t cover is just as important as knowing what it does.

Common Services Not Covered by Medicare

• Long-term care: Medicare won’t cover nursing home care or other types of long-term custodial care unless it’s medically necessary, and even then, coverage is limited.

• Routine dental care: Original Medicare doesn’t cover routine dental services like cleanings, fillings, and dentures.

• Routine vision and hearing exams: While Part B may cover eye exams related to certain conditions, it doesn’t cover routine exams for glasses or contact lenses. Similarly, hearing aids and exams for hearing loss are generally not covered.

• Cosmetic procedures: If a surgery or treatment is for cosmetic purposes, it’s not covered by Medicare unless deemed medically necessary by a health care provider.

Services Medicare Won’t Cover

• Concierge care: If you want personalized, luxury medical care, it’s generally not covered by Medicare.

• Prior authorization: Some services may require prior approval, and Medicare won’t cover certain items and services unless they meet specific requirements.

• Foreign travel: Medicare won’t cover health care outside the U.S., so if you plan to travel abroad, you might need additional travel insurance.

The Bottom Line

At Overton Agency, we believe that understanding your Medicare plan options is crucial to getting the care you deserve. Whether you opt for Original Medicare, Medicare Advantage, or need extra coverage with Medigap, we are here to guide you every step of the way.

We understand that healthcare costs can be overwhelming, but knowing what Medicare will cover and what’s not covered can help you make an informed decision. If you need help understanding your options, we’re here to assist. Contact us at  501-881-2050today to discuss your Medicare needs. We’re proud to serve our community with affordable, high-quality service and personalized care.

Don’t navigate the complexities of Medicare alone—let us help you get the coverage you need and deserve. Reach out to Overton Agency today!