Healthcare Coverage: An Overview of Original Medicare's Components, Benefits, and Uncovered Services
In the United States, over 68 million individuals are enrolled in the Medicare programme, which provides affordable healthcare to people aged 65 years or older and those with certain health conditions. This article provides an overview of the costs and coverage associated with Original Medicare in 2025.
Original Medicare, which combines Part A (Hospital Insurance) and Part B (Medical Insurance), offers comprehensive coverage for a range of medical services. However, there are some gaps in coverage, such as mental health services in certain settings and dental care.
Medicare Part A (Hospital Insurance) is generally minimal out-of-pocket for most individuals due to the premium-free eligibility based on work history. Most people do not pay a premium for Part A if they or their spouse have worked and paid Medicare taxes for at least 10 years. The deductible for each benefit period is $1,632 in 2025, and coinsurance applies for extended hospital stays. Out-of-pocket costs primarily include deductibles and coinsurance during hospital stays.
Medicare Part B (Medical Insurance) has standard premiums and deductible costs with additional costs for higher earners. The standard monthly premium is $185 in 2025, while the annual deductible is $257. Typically, 20% of the Medicare-approved amount for most services after the deductible is met. Higher-income beneficiaries pay more based on income brackets, with monthly premiums ranging from $259 up to $628.90 for individuals earning above $106,000, with higher tiers increasing up to $628.90 for incomes over $500,000 (doubled for married couples).
A person may want to consider a Medicare Supplement Insurance policy, known as Medigap, for any out-of-pocket costs. Medigap policies can help cover the Part B deductible and other expenses, such as coinsurance and copayments.
Some items or services not covered by Original Medicare Part A include private rooms, cosmetic procedures, private nursing care, televisions or telephones in the room, personal care items, doctors' fees during an inpatient stay, long-term resident fees for nursing homes or assisted living facilities, dentures, and the majority of dental care. Routine vision, hearing, and dental services are not covered by Original Medicare either.
People can check their eligibility for Medicare using an online tool. They should be aware that routine foot care is not covered by Original Medicare, unless for foot problems triggered by health conditions such as diabetes, cancer, or chronic kidney disease. Long-term care in nursing homes or assisted living facilities is also not covered by Original Medicare.
With Original Medicare, people can visit any doctor, clinic, or hospital countrywide, provided it accepts Medicare payment. However, it's essential to note that some services may require prior authorisation or referrals. Original Medicare does not include prescription drug coverage, although a person may enroll in a Medicare Part D plan or some Part C (Advantage) plans offer prescription drug coverage.
Finally, it's crucial to remember that Medicare Supplement Plans C and F (for those eligible before 2020) may cover the Part B deductible, and Medicare Advantage plans may have different cost structures and often do not require the Part B deductible.
[1] Medicare.gov [2] SSA.gov [3] Healthcare.gov [4] Medicaid.gov [5] CMS.gov
- In 2025, Original Medicare, consisting of Part A and Part B, offers extensive coverage for various medical services, yet there are specific areas like mental health services and dental care with gaps.
- Medicare Part A (Hospital Insurance) usually requires minimal out-of-pocket costs due to premium-free eligibility for those who have worked and paid Medicare taxes for at least 10 years.
- The deductible for each benefit period under Part A is $1,632 in 2025, and coinsurance applies for extended hospital stays.
- Medicare Part B (Medical Insurance) has standard premiums and deductible costs, with additional charges for higher-income earners.
- A person might find a Medicare Supplement Insurance policy, known as Medigap, valuable for handling out-of-pocket costs, including the Part B deductible and other expenses.
- Services not covered by Original Medicare Part A comprise private rooms, cosmetic procedures, private nursing care, and routine foot care, except for foot problems connected to health conditions like diabetes, cancer, or chronic kidney disease.
- Routine vision, hearing, dental care, and long-term care in nursing homes/assisted living facilities are not covered by Original Medicare.
- People can verify their eligibility for Medicare by using an online tool.
- It is noteworthy that routine foot care is not covered by Original Medicare, except in the case of foot problems caused by health conditions such as diabetes, cancer, or chronic kidney disease.
- With Original Medicare, one can access any doctor, clinic, or hospital nationwide that accepts Medicare payments, but some services might require prior authorization or referrals.
- Original Medicare does not include prescription drug coverage, although a person may enroll in a Medicare Part D plan or some Part C (Advantage) plans offer prescription drug coverage.
- In healthcare, chronic diseases like cancer, respiratory conditions, and digestive health issues may require specialized therapies and treatments, not all of which are covered by Original Medicare.
- Eye-health problems may necessitate eye exams, prescribed eyeglasses, contact lenses, or surgeries, which may not be completely covered by Original Medicare.
- Hearing loss might require hearing tests, hearing aids, or hearing aid fittings, which could have out-of-pocket costs under Original Medicare.
- Individuals may encounter skin conditions requiring treatments, dermatological consultations, or skin care products, some of which may not be fully covered by Original Medicare.
