Even though you’ve contributed to Medicare Part A throughout your working years and pay monthly premiums for Part B, Original Medicare doesn’t cover all your medical expenses. There are significant gaps in both hospital and outpatient coverage, and prescription drug coverage must be purchased separately. These gaps can add up quickly, making it important to understand what’s not covered—and how to protect yourself from unexpected costs.

Part A Costs (Hospital Insurance) in 2025

Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. However, beneficiaries are still responsible for considerable out-of-pocket costs

Part A Cost Type 2025 Amount
Inpatient hospital deductible $1,676
Daily coinsurance for 61st–90th day $419 per day
Daily coinsurance for lifetime reserve days $838 per day
Skilled Nursing Facility coinsurance (days 21–100) $209.50 per day

  • Inpatient Hospital Stay:

    • Deductible: $1,676 per benefit period

    • Days 1–60: $0 coinsurance after deductible

    • Days 61–90: $419 per day

    • Days 91–150: $838 per day (lifetime reserve days)

    • Beyond 150 days: All costs

  • Skilled Nursing Facility Care:

    • Days 1–20: $0

    • Days 21–100: $209.50 per day

    • Days 101 and beyond: All costs

  • Home Health Care:

    • $0 for covered services

    • 20% of the Medicare-approved amount for durable medical equipment

  • Hospice Care:

    • $0 for hospice care

    • Up to $5 for each prescription drug related to symptom control

    • 5% of the Medicare-approved amount for inpatient respite care

Note: Medicare does not cover custodial care (assistance with bathing, dressing, eating, etc.) when that is the only care you need, whether at home or in a facility.

Part B Costs (Medical Insurance) in 2025

Medicare Part B covers doctor visits, outpatient services, preventive care, and certain home health services. It also comes with its own set of out-of-pocket costs.

Part B Cost Type 2025 Amount
Standard monthly premium $185.00 (higher for high-income earners)
Annual deductible $257
Coinsurance 20% of Medicare-approved amount (after deductible)
Out-of-pocket maximum None under Original Medicare

  • Standard monthly premium: $185 (may be higher based on income)

  • Annual deductible: $257

  • After the deductible, you generally pay 20% of the Medicare-approved amount for covered services

  • No out-of-pocket maximum under Original Medicare

This 20% coinsurance applies to most doctor visits, outpatient procedures, durable medical equipment, mental health services, and more. Since there’s no cap on what you might pay in a given year, large medical bills can quickly become a burden.

Prescription Drug Coverage (Part D) in 2025

Original Medicare does not cover most prescription medications. For that, you’ll need to enroll in a stand-alone Part D plan or choose a Medicare Advantage plan that includes drug coverage.

In 2025, there is a new out-of-pocket cap of $2,000 for covered prescription drugs under Part D plans. Once you reach that limit, you won’t pay anything more for covered medications for the rest of the year.

How to Fill the Gaps

To manage these costs, most people enroll in either:

  • A Medicare Supplement Insurance (Medigap) policy, which helps pay your deductibles, coinsurance, and other out-of-pocket expenses under Original Medicare; or

  • A Medicare Advantage Plan (Part C), which often includes additional benefits like dental, vision, hearing, and prescription drug coverage—but comes with its own provider networks and rules.

Taking time to compare your options can help you choose a coverage strategy that fits your health needs and budget.