What Does Medicare Cover and What Does It Not Cover?
For many new retirees, one of the biggest questions about Medicare is what it actually includes. While Medicare provides a wide range of essential healthcare benefits, it does not cover everything. Understanding what is and is not included can help retirees plan for both expected and unexpected expenses.
What Medicare Covers
Hospital Care (Part A)
Medicare Part A helps cover inpatient hospital stays, care in a skilled nursing facility (after a hospital stay), hospice care, and some home health services.
Medical Services (Part B)
Medicare Part B includes coverage for doctor visits, outpatient care, preventive services, lab tests, and durable medical equipment such as walkers or wheelchairs. It also covers certain screenings and vaccinations recommended for older adults.
Medicare Advantage (Part C)
Part C, or Medicare Advantage Plans, are offered by private insurers approved by Medicare. These plans provide all Part A and Part B benefits and may include additional coverage, such as dental, vision, hearing, or prescription drugs, depending on the plan.
Prescription Drug Coverage (Part D)
Part D helps cover the cost of prescription medications. Plans vary by insurer, and each has its own list of covered drugs, known as a formulary.
What Medicare Does Not Cover
Long-Term Care
Custodial care in a nursing home or assisted living facility is generally not covered by Medicare. This type of care is often one of the largest potential expenses in retirement.
Routine Dental, Vision, and Hearing
Services such as dental cleanings, eyeglasses, contact lenses, and hearing aids are not part of standard Medicare coverage. Some Medicare Advantage Plans may include these benefits, but Original Medicare does not.
Cosmetic Procedures
Elective or cosmetic surgeries, such as facelifts or procedures for appearance only, are not covered.
Certain Alternative Therapies
Services like acupuncture (with some exceptions) or naturopathic treatments are typically excluded from Medicare benefits.
Why This Matters for Retirees
Knowing what Medicare covers—and where gaps exist—allows retirees to prepare for out-of-pocket expenses or consider supplemental coverage. Being informed ahead of time helps avoid surprises when care is needed.
Planning Ahead for Healthcare
Medicare provides a strong foundation of hospital, medical, and prescription coverage, but it does not cover every health-related need. By understanding these limits, retirees can make more informed decisions about additional coverage or savings strategies to protect their long-term well-being.
