What Medicare Covers in 2025 — Here’s What May No Longer Be Included This Year
Medicare keeps millions of seniors covered, but every year the details shift. In 2025, some benefits remain steady, while others may look very different. Hospital stays and doctor visits are still the backbone of Medicare, but changes in drug lists, Advantage plan extras, and state-by-state rules could affect your wallet.
Think of Medicare like your household budget — the essentials are always there, but extras can change depending on what’s available. Knowing what’s covered, what’s not, and where you might face surprises is the best way to stay protected.
At Palmetto Mutual, we specialize in helping seniors across South Carolina and North Carolina navigate these updates. Whether you live in Myrtle Beach (29572, 29577, 29588), Florence (29501, 29505), or smaller towns like Marion (29571) or Bennettsville (29512), we’re here to guide you through 2025’s Medicare changes with clear answers — not confusing fine print.
The Basics: What Medicare Parts A and B Cover in 2025
Medicare’s foundation hasn’t changed — Parts A and B are like the gas pedal 🚗 of your coverage. When you press it, you move forward with the most important benefits: hospital stays, doctor visits, and outpatient care. These basics keep you running, even when other extras may slow down or disappear in 2025.
Even though plan extras like dental or gym memberships can change, the core benefits under Parts A and B remain steady. Seniors in ZIP codes like 29582 (North Myrtle Beach) or 28358 (Lumberton, NC) can count on the same hospital and outpatient coverage no matter what.
✅ Understanding Your Hospital Coverage (Part A)
Part A is your safety net when you need hospital care. It helps cover:
- Inpatient hospital stays 🏨
- Skilled nursing facility care
- Hospice care
- Limited home health services
💬 Jacqueline’s Experience
⚠️ Disclaimer: The following testimonial is a fictional example based on real-life Medicare situations commonly experienced by seniors across the United States.
“I thought programs like Extra Help weren’t for people like me, so I ignored them. Then my Medicare costs jumped and I almost couldn’t keep up. I found out I did qualify after all. I wish I hadn’t waited until the last minute.”
— Jacqueline, Recently Retired City Worker
This shows how important it is to review your options regularly. Even with core Medicare benefits in place, extra savings programs can make a big difference.
💊 Your Outpatient Benefits (Part B)
Part B covers care you get outside the hospital, including:
- Doctor visits 👨⚕️
- Lab tests and X-rays
- Outpatient surgeries
- Preventive services like flu shots
If you live near McLeod Regional Medical Center in Florence (ZIP 29506) or New Hanover Regional in Wilmington (ZIP 28401), your Part B coverage applies there just the same as in smaller rural clinics.
🔍 Core Medicare Benefits That Remain the Same in 2025
Even with all the changes in 2025, some benefits stay exactly the same. Use this quick quiz table to check what’s included:
Coverage Fit Quiz — What’s Still Covered in 2025?
| Benefit | Still Covered in 2025? | Alternatives if Not Covered |
|---|---|---|
| Vision Exams | ❌ Basic exams not covered | Medicare Advantage may include |
| Hearing Aids | ❌ Not covered by Original Medicare | Some MA plans offer allowances |
| Funeral/Cremation Costs | ❌ Never covered | Consider separate burial insurance |
| Help with Bills | ✅ If you qualify for Extra Help/Medicaid | Check income requirements |
📌 Key takeaway: Your hospital and outpatient benefits haven’t changed, but the gaps — like vision and hearing — remain. Seniors in Darlington (ZIP 29532) or Conway (ZIP 29526) will still need add-on coverage if those services matter to them.
Preventive Services That Remain Fully Covered
When it comes to staying healthy, Medicare’s preventive services work like a game of Chutes & Ladders 🎲. Every free check-up or screening is a ladder that helps you climb toward better health, while skipping them can feel like sliding down a chute — costing you more later.
The good news? In 2025, preventive care is still fully covered under Original Medicare. Whether you live in Florence (29505), Moncks Corner (29461), or Myrtle Beach (29588), these no-cost benefits are there for you.
🎯 Annual Wellness Visits and Screenings
Every year, you get a free wellness visit. Think of it as your yearly “health report card.” Your doctor checks weight, blood pressure, medications, and asks about memory or balance issues. Catching small changes now can help prevent bigger problems later.
💉 Vaccines and Immunizations That Stay Free
Vaccines are another ladder that keeps you climbing toward good health. In 2025, you still pay $0 for flu shots, pneumonia vaccines, and COVID-19 boosters under Medicare. If you’re in ZIP 29582 (North Myrtle Beach), you can get these shots at Walgreens on Hwy 17 or local clinics like Little River Medical Center.
🔬 Cancer Screenings Without Copays
Screenings like mammograms, colonoscopies, and prostate exams remain fully covered. These preventive checks are your guardrails against costly surprises. For seniors in Sumter (ZIP 29150) or Georgetown (ZIP 29440), Medicare covers these at no cost if done on schedule.
💵 Local Cost Insight
📊 Cost Format #63 — Suburban ZIP Advantage
“ZIP codes in suburban areas typically see lower Medicare Supplement rates — around $112/month for Plan G — compared to rural areas where premiums edge closer to $124. Your location impacts your options, but preventive services remain free nationwide.”
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Drug formularies change each year — Palmetto Mutual can confirm if your prescriptions are still covered in 2025.
Prescription Drug Coverage Changes Under Part D
Prescription coverage in 2025 is like an airplane tray table ✈️ — sometimes it’s steady and reliable, other times it suddenly drops down and surprises you with less room than you expected. This year, many seniors are finding that certain extras they counted on have been reduced or removed, leaving them with higher out-of-pocket costs.
Whether you live in Florence (29506), Conway (29526), or smaller towns like Latta (29565), staying ahead of these changes is critical.
📋 Understanding the 2025 Formulary Changes
Every Medicare drug plan (Part D) uses a formulary, which is the list of drugs it covers. In 2025:
- Some generic drugs moved up a tier, meaning higher copays 💵
- Certain brand-name medications were dropped from coverage ❌
- Over-the-counter (OTC) card benefits have been reduced in many plans
💬 Irene’s Story
⚠️ Disclaimer: The following testimonial is a fictional example based on real-life Medicare situations commonly experienced by seniors across the United States.
“I signed up for a dental and vision plan at a health fair in the park, thinking it was part of Medicare. When I went in for a check-up, nothing was covered. I learned Medicare doesn’t include everything, and you have to be careful about what’s real.”
— Irene, Nature-Loving Widow
💰 The Donut Hole in 2025
The “donut hole” is the coverage gap where drug costs suddenly jump. In 2025, it still exists — but thanks to recent laws, insulin and certain vaccines remain capped at low prices even if you hit the gap.
For seniors in Darlington (29532) or Georgetown (29440), this means more predictable costs for life-saving prescriptions.
💵 Insulin Cap and What It Means
The insulin cap is still in place at $35 per month. No matter where you live — whether it’s North Myrtle Beach (29582) or Lumberton, NC (28358) — you cannot be charged more than $35 for a month’s supply of covered insulin.
💬 Lynne’s Story
⚠️ Disclaimer: The following story is a fictional example based on real-life Medicare situations commonly experienced by seniors across the United States.
Lynne prided herself on staying healthy with vitamins and supplements she bought each month using her Medicare OTC card. In 2025, the benefit was gone, and she had to pay out-of-pocket. After reviewing her choices, she switched into a plan that restored her OTC credits.
“I didn’t know they could just drop it — now I check carefully every year.” — Lynne
Updates to Medicare Advantage (Part C) Benefits in 2025
Medicare Advantage in 2025 is like following a recipe 🍲. Some ingredients stay the same, but others are swapped out or reduced — and if you’re not careful, the “meal” you expected may taste different.
For seniors in Myrtle Beach (29577), Sumter (29150), or Whiteville, NC (28472), Advantage plans remain a popular choice. But the ingredients — networks, perks, and extra benefits — have changed in ways that matter for your budget and care.
🏥 Network Changes to Watch For
- Some hospital systems in South Carolina and North Carolina have shifted in or out of certain networks.
- Seniors in Florence (29501) should confirm if McLeod Regional Medical Center is still covered under their 2025 Advantage plan.
- Travelers in coastal areas like Georgetown (29440) may notice tighter restrictions if they spend part of the year in another state.
🎁 Extra Benefits That May Be Reduced
Many Advantage plans once included extras like OTC allowances, gym memberships, or dental credits. In 2025, some of these are being scaled back:
- Fewer plans now cover fitness programs like SilverSneakers 🏋️
- OTC credits are smaller or dropped entirely
- Dental/vision allowances may not stretch as far
📊 Comparing 2024 vs 2025 Coverage
Here’s a snapshot comparing what stayed the same and what changed:
Table #92 — What Stayed vs. What Changed in Medicare Advantage
| Coverage Area | 2024 Coverage | 2025 Coverage | Action Needed |
|---|---|---|---|
| Dependent Coverage | Not available | Still not available | Consider separate plans |
| Multi-State Coverage | Varies by plan | More restrictions | Check network if you travel |
| Moving to New ZIP | Usually seamless | May require new plan | Verify before moving |
| Supplemental Cancer | Some MA plans included | Many dropped this | Review during AEP |
📌 Key takeaway: Advantage plans can still be a strong option, but you need to double-check the ingredients in your “coverage recipe” before serving it up in 2025.
Dental, Vision, and Hearing — Still Limited in 2025
Think of Medicare’s dental, vision, and hearing coverage like a pop-up tent at the beach ⛺. It gives you a little shade, but it won’t protect you from the whole sun. In 2025, these benefits are still limited under Original Medicare, and seniors often need separate coverage or an Advantage plan add-on to stay fully protected.
Whether you’re in Myrtle Beach (29572), Bennettsville (29512), or Wilmington, NC (28401), this remains one of the biggest gaps in Medicare.
🦷 What Original Medicare Won’t Cover
- Routine dental cleanings and exams ❌
- Fillings, crowns, dentures, and implants ❌
- Comprehensive dental care at local practices like Carolina Dental in Florence (29501) or Moncks Corner Dental (29461) ❌
📌 Unless you add a stand-alone dental plan or an Advantage plan with dental perks, you’ll be paying out-of-pocket.
👂 Hearing Aid Coverage Gaps
Medicare still does not cover hearing aids. Seniors in Darlington (29532) or North Myrtle Beach (29582) may find partial allowances through certain Advantage plans, but Original Medicare offers no help here.
💬 Janet’s Experience
⚠️ Disclaimer: The following testimonial is a fictional example based on real-life Medicare situations commonly experienced by seniors across the United States.
“When my wife and I enrolled, I thought I was adding her to my Medicare coverage. Turns out, I’d signed her up for a completely different plan. We couldn’t fix it until the next enrollment period. Medicare can be confusing — double-check everything before you hit submit.”
— Janet, Grandfather With Sleep Apnea
👁️ Vision Services and Limitations
- Routine eye exams ❌
- Glasses and contact lenses ❌
- Cataract surgery (with basic lens implants) ✅ Covered under Medicare Part B
If you live in Sumter (29150) or Loris (29569), cataract surgery is still covered — but glasses or upgraded lenses will come out of pocket unless you have extra coverage.
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Some Advantage plan perks, like dental or vision, may be reduced — Palmetto Mutual’s experts will show you what’s changed in your ZIP code for 2025.
Services and Treatments Medicare May No Longer Include
Medicare changes can catch you off guard if you don’t check your plan every year. It’s a little like the neighbor who says, “Don’t be that guy” — the one who skips reading the fine print and ends up paying for benefits he thought were included.
In 2025, some extra services that many seniors enjoyed are being cut back. Whether you’re in Myrtle Beach (29577), Marion (29571), or Georgetown (29440), here’s what you need to watch.
💬 Lois’s Story
⚠️ Disclaimer: The following story is a fictional example based on real-life Medicare situations commonly experienced by seniors across the United States.
Lois loved taking cruises, but when she was home in Myrtle Beach, her gym membership kept her active. Last year her Medicare plan included SilverSneakers, but in 2025 it was dropped. After some research, she switched to a plan that restored her fitness benefit.
“It pays to check what’s changed every year.” — Lois
🏋️ Fitness Benefits Being Phased Out
Programs like SilverSneakers or Renew Active are disappearing from more Advantage plans. If staying active at places like Planet Fitness in Conway (29526) or YMCA in Florence (29501) is important to you, confirm your plan still covers it.
🛒 OTC Card Allowances Reduced
In many counties across the Carolinas, OTC (over-the-counter) card credits have been cut back or removed. That means everyday items like vitamins, bandages, and cold medicine may no longer be free. Seniors in Bennettsville (29512) and Whiteville, NC (28472) should double-check their 2025 benefits.
🚗 Transportation Benefits Cut
Some Advantage plans offered free or low-cost rides to doctor visits. In 2025, this perk is being scaled down in many rural areas. If you live in Darlington (29532) or Williamsburg County (ZIP 29556 for Kingstree), ask your plan if transportation is still included.
📌 Don’t be that guy who finds out after the fact — review your benefits before you need them.
How Medicare Coverage Varies by Plan and State
Medicare coverage can stretch and snap back like a rubber band 🪢 — flexible in some places, tighter in others. What you pay and what’s included in your plan depends heavily on where you live. A senior in Myrtle Beach (29572) may see very different benefits than someone in Lumberton, NC (28358), even though both are in the Carolinas.
🗺️ Why Your ZIP Code Matters
ZIP codes control which Advantage and Part D drug plans you can choose. For example:
- Seniors in Florence (29505) may have access to more plan options than those in Marion (29571).
- Rural counties often have fewer carriers, meaning higher premiums or smaller networks.
📌 Key Tip: Always enter your exact ZIP when reviewing Medicare coverage — even neighboring towns can have different options.
🏥 Network Differences Across States
If you live near the border — like in Dillon, SC (29536) or Whiteville, NC (28472) — crossing into another state for care may not always be covered by your Advantage plan. Original Medicare works nationwide, but Advantage plans often limit you to state or regional networks.
💲 Premium Variations by Location
📊 Cost Format #64 — ZIP-Based Risk Pool Effect
“In larger metropolitan areas, broader risk pools help stabilize costs, keeping Plan N near $104/month — but smaller surrounding areas may see sharper increases when coverage changes. Whether you live in a big city, a rural town, or somewhere in between, understanding these variations helps you make better choices.”
Examples:
- Charleston County (29401) → larger pool, more stable premiums
- Williamsburg County (29556) → smaller pool, sharper premium shifts
📌 Bottom line: Like a rubber band, Medicare flexes differently in every state and ZIP. Seniors in Georgetown (29440) and Sumter (29150) may face higher or lower costs simply because of where they live.
Common Misunderstandings About “What’s Covered”
Medicare can feel like driving down a winding country road 🚗. The guardrails are there to keep you safe, but if you don’t pay attention, you might swerve into confusion. Many seniors in Myrtle Beach (29588), Florence (29501), and Whiteville, NC (28472) face the same misunderstandings every year about what Medicare actually covers.
Here are some of the most common myths and how to stay between the guardrails.
🤔 Medicare Myths vs Reality
- Myth: Medicare covers everything at age 65.
Reality: It covers hospital and outpatient basics. Extras like dental, vision, and hearing usually need add-ons. - Myth: If a plan says “$0 premium,” it means everything is free.
Reality: Copays and deductibles still apply.
📱 Scams and Misleading Information
⚠️ Watch out for calls, mailers, or door-knockers in Horry County (29526 – Conway, 29572 – Myrtle Beach) pretending to be from Medicare. Medicare will never call you directly to sell a plan.
If you get mail that looks “urgent” with red letters or fake deadlines, toss it — or bring it to Palmetto Mutual to review safely.
✅ How to Verify Your Coverage
Use this quick table to keep the facts straight:
Table #93 — Medicare Coverage Snapshot
| Common Concern | Yes/No | What This Means |
|---|---|---|
| Worried about sharing SSN for verification | ✅ Valid concern | Only share with official Medicare or licensed agents |
| Uncomfortable with online forms | ✅ Common | In-person and phone options available |
| Think “nothing is really free” | ⚠️ Partially true | Some benefits are truly $0, others have hidden costs |
| Believe Medicare is run by private companies | ❌ Misconception | Original Medicare is federal; MA plans are private |
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Don’t wait until a bill arrives to find out — Palmetto Mutual can help you check your 2025 coverage details today.
How to Fill the Gaps in Medicare Coverage This Year
Original Medicare leaves holes — but the good news is, you don’t have to face them alone. Think of it like using a magnifying scope 🔎 at a science fair. At first glance, things look fine, but when you zoom in, you see tiny gaps and details that need attention. Medicare works the same way in 2025: the basics are solid, but when you look closer, there are gaps that need extra coverage.
🏥 Understanding Medigap Options
Medigap (Medicare Supplement) plans are designed to cover what Original Medicare doesn’t. For example:
- Plan G helps pay for deductibles and copays 💵
- Seniors in Florence (29505) or Georgetown (29440) often choose Medigap for predictable bills and wider doctor choice
- You can see any doctor who accepts Medicare nationwide, making it great for retirees who travel 🚙
💊 Standalone Part D Plans
If you stick with Original Medicare, you’ll likely need a standalone Part D plan for prescriptions. Each plan has its own formulary (list of covered drugs), so it’s important to double-check if your medications are included.
- Seniors in Myrtle Beach (29572, 29577) should compare pharmacies like CVS on Hwy 501 vs. Walgreens on Kings Hwy, since costs can differ.
- Even in rural towns like Marion (29571), Part D coverage can vary by plan and ZIP code.
🎯 Special Programs for Low Income
For seniors worried about costs, special programs can help:
- Extra Help: Lowers prescription drug costs for those who qualify
- Medicare Savings Programs (MSPs): Can pay your Part B premium if your income is low
- Available statewide, whether you’re in Sumter (29150) or Lumberton, NC (28358)
📌 Many seniors qualify and don’t even know it — it’s worth checking every year.
Steps Seniors Should Take to Stay Protected in 2025
Think of your Medicare coverage like a game plan for football 🏈. You don’t just show up on the field — you prepare, review your plays, and make adjustments so you don’t get blindsided. In 2025, seniors in Myrtle Beach (29588), Florence (29501), and Sumter (29150) can avoid costly mistakes by following a clear coverage game plan.
📅 Important Dates and Deadlines
- Annual Enrollment Period (AEP): October 15 – December 7
- Open Enrollment Period (OEP): January 1 – March 31
- Special Enrollment Periods (SEPs): Available if you move ZIP codes, lose coverage, or qualify for Extra Help
📌 Example: A senior in North Myrtle Beach (29582) who moves to Wilmington, NC (28401) will likely qualify for a Special Enrollment Period to choose a new plan.
📋 Annual Review Checklist
Every fall, before AEP begins, run through this checklist:
✅ Review your current plan’s coverage for prescriptions and doctors
✅ Check if your ZIP code (like 29526 – Conway or 29540 – Darlington) still has the same plan availability
✅ Compare premiums, deductibles, and copays against other options
✅ Ask about extras (OTC cards, dental, or fitness benefits) that may have changed
📞 Getting Professional Help
Medicare can be overwhelming, especially with so many carriers and rules that vary by county. That’s why many seniors prefer local help:
- In Florence, you can sit down with a licensed agent who knows which Advantage networks include McLeod Regional.
- In Georgetown (29440) or Bennettsville (29512), local agents can confirm which 2025 plans kept fitness and OTC benefits.
📌 Game plan tip: Don’t wait until the 4th quarter — review early so you’re not stuck with last-minute surprises.
❓ Frequently Asked Questions
Your Medicare coverage shouldn’t come with surprises. Let’s review together what Medicare does and doesn’t include in 2025. With Palmetto Mutual’s local guidance, you’ll be prepared for changes before they affect your wallet.
📞 Call today for a no-cost review — and make sure your 2025 Medicare coverage is the best fit for you.
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About the Author
Dvir Mosche is an award-winning independent insurance agent and the founder of Palmetto Mutual, a trusted insurance brokerage specializing in Medicare, final expense, and senior benefits in North and South Carolina and across the country. Since entering the industry in 2017, he has been recognized multiple times as a top agent for his dedication to educating and assisting seniors in finding the proper coverage. His mission is to simplify the process, provide honest and personalized guidance, and ensure that every client gets coverage they can depend on for life.
