What Medicare Covers -- And What It Doesn't

One of the most important things Florida seniors need to understand about Medicare is what it actually covers -- and where the gaps are. Knowing this helps you choose the right supplemental coverage and avoid surprise bills.

Medicare Part A covers inpatient care and related services.

Part A covers:

• Inpatient hospital care (semi-private room, meals, nursing care, medications during stay)
• Skilled nursing facility care (after a qualifying 3-day hospital stay)
• Hospice care
• Some home health care (skilled nursing, physical therapy, speech therapy)
• Inpatient mental health care

Part A does NOT cover:

• Private room (unless medically necessary)
• Personal care items (TV, phone)
• Long-term custodial care (help with daily activities)
• Care in a nursing home that is not skilled nursing

Medicare Part B covers outpatient medical services.

Part B covers:

• Doctor visits (primary care and specialists)
• Outpatient surgery and procedures
• Emergency room visits
• Ambulance services
• Diagnostic tests (X-rays, MRIs, lab work)
• Durable medical equipment (wheelchairs, walkers, oxygen)
• Preventive services (annual wellness visit, flu shots, cancer screenings, mammograms)
• Mental health services (outpatient)
• Physical, occupational, and speech therapy
• Chemotherapy and radiation (outpatient)
• Diabetes supplies and self-management training

Part B does NOT cover:

• Routine dental care (cleanings, fillings, dentures)
• Routine vision care (eye exams for glasses, contact lenses)
• Routine hearing exams and hearing aids
• Cosmetic surgery
• Acupuncture (except for chronic low back pain)
• Most care outside the United States
• Prescription drugs (covered under Part D)

Part D covers prescription medications through private insurance plans.

Part D covers:

• Most FDA-approved prescription drugs
• Vaccines not covered under Part B
• Insulin and diabetes supplies (in some plans)

Part D does NOT cover:

• Over-the-counter medications
• Drugs for weight loss or cosmetic purposes
• Most vitamins and supplements
• Drugs covered under Part A or Part B

The most significant gaps in Original Medicare coverage are:

1. Dental care Original Medicare does not cover routine dental care -- cleanings, fillings, extractions, dentures, or implants. This is a major gap for many seniors.

2. Vision care Routine eye exams for glasses or contacts are not covered. Medicare does cover treatment for eye diseases like glaucoma and cataracts.

3. Hearing care Routine hearing exams and hearing aids are not covered by Original Medicare.

4. Long-term care Medicare does not cover custodial care -- help with daily activities like bathing, dressing, and eating. This is one of the most significant and expensive gaps in Medicare coverage.

5. Care outside the U.S. Original Medicare generally does not cover care received outside the United States (with very limited exceptions). Some Medigap plans cover 80% of foreign travel emergency costs.

6. The 20% coinsurance Original Medicare pays 80% of covered Part B services. You are responsible for the remaining 20% -- with no cap. A single major illness can result in thousands of dollars in out-of-pocket costs.

For the 20% coinsurance and deductibles: A Medicare Supplement (Medigap) plan or Medicare Advantage plan covers most or all of these costs.

For dental, vision, and hearing: Many Medicare Advantage plans include these benefits. Standalone dental, vision, and hearing plans are also available.

For prescription drugs: Medicare Part D covers prescription medications. If you have a Medicare Advantage plan, drug coverage is often included.

For long-term care: Long-term care insurance or a hybrid life/LTC policy can help cover these costs. This is a separate planning conversation.

As an independent broker, I help Florida seniors identify their coverage gaps and find the right combination of plans to fill them -- at the lowest possible cost.

Call me at (386) 871-3858 or schedule a free coverage review at calendly.com/themedicaredude/75.