Medicare coverage changes every year, and 2025 brings shifts in what each plan type covers

The four main Medicare plan types — Original Medicare (Part A and B), Medicare Advantage (Part C), Medigap, and Part D — each cover different services and have different costs. What you pay for the same service can vary dramatically depending on which plan you have. Understanding what your plan covers before you need care helps you avoid surprise bills and find the right doctors and pharmacies.

Coverage details for 2025 are set by Medicare and your specific plan. Your plan's coverage document — called the Summary of Benefits and Coverage — lists exactly what is and is not covered under your plan. You can find this document on Medicare.gov or by calling your plan directly.

Key Takeaways

  • Original Medicare Part A covers hospital stays, skilled nursing, hospice, and some home health; Part B covers doctor visits, outpatient care, and preventive services.
  • Medicare Advantage plans must cover everything Original Medicare covers, but add dental, vision, or hearing benefits that Original Medicare does not, and often have lower monthly premiums.
  • Medigap plans pay some or all of the costs that Original Medicare leaves you responsible for, such as deductibles and coinsurance.
  • Part D prescription drug plans cover medications, but which drugs are covered and at what cost depends on your specific plan's formulary.
  • Your plan's Summary of Benefits and Coverage document is the official source for what is covered in 2025 — not a website summary or a phone representative's guess.

What Original Medicare Part A and Part B cover

Part A covers inpatient hospital care, skilled nursing facility care (after a hospital stay), hospice, and some home health services. Part A does not cover custodial care — help with bathing, dressing, or meals when that is the only service you need. It also does not cover most long-term care in a nursing home.

Part B covers doctor office visits, outpatient hospital services, physical therapy, mental health counseling, ambulance transport, durable medical equipment (like wheelchairs or oxygen), and preventive services such as cancer screenings and vaccines. Part B does not cover routine dental care, eyeglasses, or hearing aids, though it does cover some eye exams and hearing tests ordered by a doctor for a medical reason.

With Original Medicare, you pay a deductible before coverage begins, then you pay coinsurance (a percentage of the cost) for most services. You are responsible for any charges above what Medicare considers reasonable. Many people add a Medigap plan to cover these out-of-pocket costs.

Medicare Advantage plan coverage in 2025

Medicare Advantage plans (Part C) are sold by private insurance companies and must cover everything Original Medicare Part A and Part B cover. However, they often do so with different rules: you may have a network of doctors you must use, you may need prior approval before certain procedures, and you may pay different amounts depending on whether you see an in-network or out-of-network provider.

The main difference is what Medicare Advantage adds. Most plans include dental coverage (cleanings, fillings, sometimes dentures), vision coverage (eye exams, glasses or contacts), and hearing coverage (exams and hearing aids). Some plans also cover fitness programs, transportation to medical appointments, or over-the-counter health items. These extras vary widely by plan and by region.

Medicare Advantage plans often have lower or zero monthly premiums than Original Medicare plus Medigap, but you typically pay more when you use services — through copays, coinsurance, or deductibles. You also have an out-of-pocket maximum: once you reach it in a calendar year, the plan pays 100 percent of covered services for the rest of that year.

Medigap coverage and how it works alongside Original Medicare

Medigap (supplemental insurance) is sold by private companies and works only with Original Medicare. It does not replace Original Medicare; instead, it pays some or all of the costs that Original Medicare leaves you responsible for — such as deductibles, coinsurance, and copays. Medigap does not cover services that Original Medicare does not cover.

There are ten standardized Medigap plans, labeled A through N. Plan G and Plan N are the most common choices for new enrollees in 2025. Each plan covers a different combination of out-of-pocket costs. For example, Plan G covers the Part B deductible and coinsurance, while Plan N covers coinsurance but not the Part B deductible. You can compare what each plan covers on Medicare.gov.

Medigap premiums vary by insurance company, your age, and your location. Unlike Medicare Advantage, Medigap has no network restrictions — you can see any doctor who accepts Medicare. You also have no out-of-pocket maximum; you pay your Medigap premium plus any costs your Medigap plan does not cover.

Part D prescription drug coverage and formularies

Part D is prescription drug coverage. If you have Original Medicare, you must enroll in a standalone Part D plan. If you have Medicare Advantage, prescription drug coverage is usually included (though some plans do not include it, so check before you enroll).

Each Part D plan has a formulary — a list of medications the plan covers and the tier (cost level) for each drug. A drug on Tier 1 costs less than a drug on Tier 4. Your plan may not cover the exact medication your doctor prescribes; if it does not, you can ask your doctor for an alternative that is on the formulary, or you can ask the plan for an exception.

Part D coverage has stages: you pay a copay or coinsurance until you reach your deductible, then you pay coinsurance until you hit the coverage gap (sometimes called the "donut hole"), then you pay a higher percentage until you reach your out-of-pocket maximum, after which the plan pays most costs. The deductible, copays, and out-of-pocket maximum amounts change each year.

Services and items not covered by any Medicare plan

No Medicare plan covers routine dental care, eyeglasses, hearing aids (though Medicare Advantage often does), long-term custodial care, most weight-loss surgery, cosmetic surgery, or acupuncture. Medicare also does not cover care received outside the United States, except in limited circumstances (such as emergency care in Canada or Mexico if you are traveling from the U.S.).

If you need a service that Medicare does not cover, you pay the full cost yourself, or you can look into whether a supplemental policy, a discount program, or a community health center might help reduce the cost. Your doctor's office or local Area Agency on Aging can sometimes point you toward low-cost options.

How to find your specific plan's coverage details

The best way to know what your 2025 plan covers is to read your plan's Summary of Benefits and Coverage or call your plan's customer service number. Both are more reliable than a website summary, because coverage can vary by region and by plan version.

If you have Original Medicare and no Medigap or Part D plan, you can call Medicare directly at 1-800-MEDICARE (1-800-633-4227). If you have a Medicare Advantage or Medigap plan, call the insurance company that sold you the plan — the number is on your insurance card. Have your member ID ready.

You can also visit Medicare.gov and use the Plan Finder tool to search for plans in your area and see what each one covers. The tool shows you the formulary for Part D plans and the covered services for Medicare Advantage plans.

Frequently Asked Questions

Does Medicare cover physical therapy or occupational therapy?

Original Medicare Part B covers physical therapy and occupational therapy when ordered by a doctor for a medical condition. You pay your Part B coinsurance (usually 20 percent). Medicare Advantage plans must cover these services too, though your copay or coinsurance may differ. There is a limit on the number of visits per year, though your doctor can request an exception.

What happens if my doctor prescribes a drug that is not on my Part D formulary?

You can ask your doctor to prescribe a different drug that is on the formulary, or you can ask your Part D plan for a formulary exception. The plan will review your request and decide whether to cover the drug your doctor prescribed. This usually takes a few days. If the plan denies the exception, you can appeal or pay out of pocket.

Does Medicare cover mental health or therapy visits?

Original Medicare Part B covers mental health counseling and therapy visits with a psychiatrist, psychologist, or licensed clinical social worker. You pay your Part B coinsurance. Medicare Advantage plans must cover these services. Some plans also cover additional mental health services like support groups or telehealth therapy that Original Medicare does not.

Can I switch plans if I realize my 2025 plan does not cover what I need?

You can switch during the Annual Enrollment Period (October 15 to December 7 each year), which takes effect January 1. If you have a may have access to life event — such as losing other coverage or moving to a new state — you may be able to switch outside the enrollment period. Call Medicare at 1-800-MEDICARE to ask whether your situation qualifies.

Does Medicare Advantage cover out-of-network doctors?

Medicare Advantage plans must cover emergency and urgent care from any provider, even out of network. For routine care, coverage depends on your plan. Some plans cover out-of-network care at a higher cost; others do not cover it at all. Check your plan's Summary of Benefits and Coverage to see your plan's network rules.