What It Covers—And What It Doesn’t

Medicare is a foundational piece of retirement healthcare, but it’s not a one-size-fits-all solution—and it’s not a blank check for every kind of care. Here’s a breakdown of the basics:

Medicare Part A – Hospital Insurance 

Helps cover inpatient hospital stays, care in a skilled nursing facility (after a hospital stay), hospice care, and some limited home health care. Most retirees receive Part A premium-free if they’ve paid into Medicare during their working years.

Medicare Part B – Medical Insurance

Covers outpatient services like doctor visits, lab tests, preventive screenings, physical therapy, and durable medical equipment. Part B requires a monthly premium and usually pays 80% of approved services—leaving you with 20% coinsurance and no annual out-of-pocket maximum unless you add supplemental coverage.

Medicare Part D – Prescription Drug Coverage

Offers help with the cost of medications. Plans are provided by private insurers and vary widely in terms of which drugs are covered and how much you’ll pay, making annual plan reviews especially important.

Here’s the key: Medicare covers a lot—but not everything. Understanding the difference between what’s included—and what’s not—can help you plan for small predictable costs, while shielding your savings from larger, unexpected medical bills. This is especially true for services like custodial care at home or in a facility, which Medicare doesn’t cover at all. With the right education and support from a Medicare expert, you can build an affordable, long-term plan that offers both peace of mind and financial protection—even in rural areas with limited provider networks.

• Understand what Medicare does and does not cover—including gaps like custodial care.
• Learn the difference between Skilled Care (short-term and covered) vs. Custodial Care (long-term and not covered).
• Confirm eligibility and enroll in Parts A and B during the correct window to avoid late penalties.
• Carefully compare Part D plans based on your current and potential prescription needs.
• Evaluate whether a Medigap (Supplement) or Medicare Advantage plan fits your health needs and rural provider access.
• Build a strategy to limit your out-of-pocket exposure—especially for the 20% coinsurance Part B doesn’t cap.
• Explore Short-Term Care Plans that can help bridge coverage gaps for home or facility-based care.
• Schedule a Medicare Review with a licensed expert to design a personalized, sustainable plan.