Medicare covers hospital stays, doctor visits, and prescription drugs, but not everything

Medicare is a federal health insurance program for people 65 and older. It has four parts, and what you pay for depends on which parts you have. Part A covers hospital care. Part B covers doctor visits and outpatient services. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative to Parts A and B offered by private insurers. Medicare does not cover dental, vision, hearing aids, or long-term care in a nursing home — those are gaps you may need to plan for separately.

Most people become may be able to access for Medicare the month they turn 65. You do not have to be retired. If you wait past 65 to sign up, you may pay a penalty for the rest of your life, so the timing matters even if you are still working.

Key Takeaways

  • Part A (hospital insurance) is usually free if you or your spouse paid Medicare taxes for at least 10 years; Part B (medical insurance) costs a monthly premium that increases if you delay signing up.
  • Part A covers inpatient hospital stays, skilled nursing facility care after hospitalization, and some home health services, but you pay a deductible and copays.
  • Part B covers doctor office visits, lab tests, imaging, outpatient surgery, and preventive care like cancer screenings and annual wellness visits at no copay.
  • Part D (prescription drug coverage) is optional but recommended; if you do not sign up when first may be able to access, you pay a penalty if you join later.
  • Medicare does not cover dental, vision, hearing aids, or nursing home care, and you may want supplemental insurance (Medigap) or a Medicare Advantage plan to fill those gaps.

What Part A Covers: Hospital and Skilled Nursing Care

Part A is hospital insurance. It covers inpatient hospital stays (when you are admitted and stay overnight), skilled nursing facility care after you leave the hospital, and some home health services. You pay a deductible for each hospital stay — the amount changes each year. After you meet the deductible, Medicare pays most of the cost, but you also pay a daily copay if your stay goes beyond 60 days.

Part A also covers hospice care if you have a terminal illness and choose comfort care instead of treatment. It does not cover custodial care — help with bathing, dressing, or meals in a nursing home — unless you also need skilled nursing or rehabilitation services. If you need long-term care in a nursing home, you pay out of pocket or through Medicaid, which is a separate program.

Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes for at least 10 years. If you did not work that long, you can still buy Part A, but the premium is higher.

What Part B Covers: Doctor Visits and Outpatient Care

Part B is medical insurance. It covers doctor office visits, urgent care, lab tests, imaging (X-rays, ultrasounds, MRIs), outpatient surgery, and mental health services. It also covers preventive care at no copay: annual wellness visits, cancer screenings (mammograms, colonoscopies, Pap smears), cardiovascular screenings, diabetes screenings, and vaccinations like flu shots and pneumonia vaccines.

You pay a monthly premium for Part B — the standard amount is set each year by Medicare, and it increases if you delay signing up after you turn 65. You also pay a yearly deductible, and then you typically pay 20 percent of the cost for most services after that. Some preventive services have no copay at all.

Part B does not cover routine dental care, eye exams for glasses or contacts, or hearing aids. It does cover some eye care related to diabetes or age-related macular degeneration, and it covers hearing tests ordered by a doctor, but not the hearing aids themselves.

What Part D Covers: Prescription Drugs

Part D is prescription drug coverage. It is optional, but if you do not sign up when you first become may be able to access at 65, you pay a penalty for every month you delay — even if you do not take any medications now. The penalty is added to your premium permanently.

Part D plans are offered by private insurance companies approved by Medicare. Each plan has a different list of covered drugs (called a formulary), different copays, and different monthly premiums. You choose the plan that covers the drugs you take. If your medications or income change, you can switch plans during the annual enrollment period (October 15 to December 7 each year).

Part D has a coverage gap called the "donut hole." Once you and your plan spend a certain amount on drugs in a year, you enter the gap and pay more out of pocket until you reach catastrophic coverage, where Medicare pays most of the cost again. The amounts change each year.

Part C (Medicare Advantage): An Alternative to Original Medicare

Part C, also called Medicare Advantage, is an alternative way to get Part A and Part B coverage. Private insurance companies offer these plans. Instead of going to any doctor who accepts Medicare, you typically use doctors and hospitals in the plan's network. Many Medicare Advantage plans include Part D (drug coverage) and may also cover dental, vision, or hearing — benefits that Original Medicare does not.

Medicare Advantage plans often have lower monthly premiums than Original Medicare plus Medigap, but you may pay more when you use services (higher copays or coinsurance). You also need to follow the plan's rules: you may need referrals to see specialists, and you may need prior approval for certain treatments.

You can switch between Original Medicare and Medicare Advantage during the annual enrollment period. If you switch to Medicare Advantage, you can later switch back to Original Medicare, but there are important date and rules about when you can do so.

What Medicare Does Not Cover

Medicare does not cover dental care (cleanings, fillings, root canals, dentures), routine eye exams or glasses, or hearing aids. It does not cover long-term care in a nursing home or assisted living facility. It does not cover most cosmetic surgery, weight loss surgery (unless medically necessary), or experimental treatments not yet approved by the FDA.

It also does not cover routine foot care, acupuncture (with rare exceptions), or most chiropractic care. If you need these services, you pay out of pocket or through a supplemental insurance plan (Medigap) if your plan covers them.

Many seniors buy Medigap (supplemental insurance) to cover some of these gaps and to reduce copays and deductibles under Original Medicare. Medigap plans are sold by private insurers and are standardized by the federal government, so Plan G from one company covers the same services as Plan G from another. You can buy Medigap only if you have Original Medicare (Part A and Part B), not if you have Medicare Advantage.

Preventive Services at No Cost

Medicare Part B covers many preventive services with no copay or deductible. These include an annual wellness visit (a check-up where your doctor reviews your health and medications), cancer screenings (mammogram, colonoscopy, Pap smear, prostate screening), cardiovascular screening, diabetes screening, bone density screening, depression screening, and vaccinations (flu, pneumonia, shingles, COVID-19).

You must see a doctor who accepts Medicare assignment (which most do) to get these services at no cost. If you see a doctor who does not accept assignment, you may pay more. Ask your doctor's office before your visit whether they accept Medicare assignment.

How to Sign Up and When important date Matter

You become may be able to access for Medicare the month you turn 65. You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. You should sign up during your initial enrollment period, which is the three months before the month you turn 65, the month you turn 65, and the three months after.

If you miss this window, you can still sign up, but you may pay a penalty. For Part B, the penalty is 10 percent of the premium for each full year you delayed — and it is permanent. For Part D, the penalty is 1 percent of the national average premium for each month you delayed. These penalties add to your premium for life, so signing up on time saves money.

If you are still working at 65 and have health insurance through your employer, you may be able to delay Part B without penalty. Ask your employer's benefits office or call Medicare to confirm.

Frequently Asked Questions

Do I have to sign up for all four parts of Medicare?

No. Part A is usually automatic if you are receiving Social Security. Part B is optional but recommended; if you delay, you pay a penalty. Part D is optional but carries a penalty if you delay. Part C is an alternative to Parts A and B, not an addition. Most people choose either Original Medicare (Parts A, B, and D) or Medicare Advantage (Part C, which includes A and B).

What if I am still working at 65?

If you have health insurance through your employer, you may be able to delay Part B without penalty. You must tell Medicare you are still working and have employer coverage. Part A is still recommended because it covers hospital care. Talk to your employer's benefits office and call Medicare at 1-800-MEDICARE to understand your options.

Does Medicare cover eye exams and glasses?

Medicare Part B covers one eye exam every two years if you have diabetes or age-related macular degeneration. It does not cover routine eye exams, glasses, or contact lenses. Some Medicare Advantage plans include vision coverage. If you need glasses, you pay out of pocket or through a vision discount plan.

Can I switch from Medicare Advantage back to Original Medicare?

Yes, but only during the annual enrollment period (October 15 to December 7) or if you have a may have access to life event (moving out of the plan's service area, losing employer coverage, or becoming may be able to access for Medicaid). If you switch back to Original Medicare, you can buy Medigap, but insurers may deny coverage or charge more if you have pre-existing conditions, depending on your state's rules.

What is the difference between Medicare and Medicaid?

Medicare is a federal program for people 65 and older, regardless of income. Medicaid is a joint federal-state program for people with low income, regardless of age. Some people may have access to for both (called "dual may be able to access"). They are separate programs with different rules, coverage, and costs.