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

The most accurate statement about Medicare is that it is a federal health insurance program for people 65 and older, some younger people with disabilities, and people with end-stage renal disease — but it has real limits on what it pays for. Medicare does not cover dental care, vision care, hearing aids, or long-term custodial care in a nursing home. It also does not pay for all prescription drugs, only those on its approved list, and you pay a share of most costs through premiums, deductibles, and copayments.

Many people think Medicare is "free" once they turn 65, or that it covers everything a doctor orders. Neither is true. Understanding what Medicare actually covers — and what it does not — shapes every decision you make about your health care and your money in retirement.

Key Takeaways

  • Medicare Part A covers hospital stays and some skilled nursing care; Part B covers doctor visits and outpatient care; Part D covers prescription drugs; Part C (Medicare Advantage) combines Parts A, B, and D through private insurers.
  • Medicare does not cover dental, vision, hearing aids, or long-term nursing home care, no matter which part you choose.
  • You pay premiums for Part B and Part D, and you pay deductibles and copayments when you use care, even after Medicare pays its share.
  • Original Medicare (Parts A and B) has no annual spending cap, but Medicare Advantage plans do have out-of-pocket limits.
  • Medigap (supplemental insurance) can cover some costs Medicare does not, but it is a separate purchase from a private insurer.

What each part of Medicare actually covers

Part A covers inpatient hospital care, skilled nursing facility care (up to 100 days per stay, with conditions), hospice care, and some home health services. You do not pay a premium for Part A if you or your spouse paid Medicare taxes for at least 10 years. You do pay a deductible when you enter the hospital, and you pay copayments for days 61–90 of a hospital stay and for skilled nursing care after day 20.

Part B covers doctor visits, outpatient surgery, diagnostic tests, physical therapy, and durable medical equipment like wheelchairs or oxygen. You pay a monthly premium (the standard amount changes each year), an annual deductible, and then 20 percent of the cost of most services after Medicare pays its 80 percent share. Part B does not cover routine dental, vision, or hearing care.

Part D covers prescription drugs through a plan you choose from private insurers. Each plan has a different list of covered drugs, a monthly premium, an annual deductible, and copayments. There is a coverage gap (sometimes called the "donut hole") where you pay more out of pocket once your total drug costs reach a certain amount, though this gap has been shrinking in recent years.

Part C (Medicare Advantage) is an alternative to Original Medicare (Parts A and B). Private insurers offer these plans, which must cover everything Part A and Part B cover, but often with lower premiums and copayments. The trade-off is that you usually must use doctors and hospitals in the plan's network, and the plan sets its own rules about which services need prior approval. Most Medicare Advantage plans include Part D drug coverage.

What Medicare does not cover, no matter which plan you choose

Dental care — including cleanings, fillings, root canals, and dentures — is not covered by any Medicare plan. Vision care, including eye exams, glasses, and contact lenses, is also not covered. Hearing aids and hearing exams are not covered. Long-term custodial care in a nursing home (care that helps you with daily activities but is not skilled nursing) is not covered.

Medicare also does not cover cosmetic surgery, most weight-loss surgery, acupuncture (with rare exceptions), or routine foot care. If you need any of these services, you pay the full cost yourself, or you purchase a separate private insurance policy that covers them.

How much you actually pay out of pocket

Original Medicare (Parts A and B) has no annual limit on what you pay out of pocket. If you have a serious illness or injury, your costs can climb very high. Medicare Advantage plans must have an annual out-of-pocket limit — in 2024, this is typically $7,550 for in-network care — but after you reach that limit, the plan pays 100 percent of covered services for the rest of the year.

Many people buy Medigap (supplemental insurance) to cover some of the costs Medicare does not pay. Medigap is sold by private insurers, not by Medicare, and you pay a separate monthly premium. Different Medigap plans cover different combinations of deductibles, copayments, and coinsurance. Medigap does not cover services Medicare does not cover — it only helps pay for the costs Medicare does cover.

Common statements about Medicare that are misleading or false

"Medicare is free." This is not accurate. You pay premiums for Part B and Part D, and you pay out-of-pocket costs when you use care. Part A is free if you paid Medicare taxes long enough, but you still pay deductibles and copayments.

"Medicare covers everything a doctor says you need." This is not true. Medicare covers services it deems medically necessary, and doctors must order them in a way Medicare recognizes. Some services require prior approval from Medicare or your plan before you have them done. If Medicare denies a service, you can appeal, but you may have to pay for it upfront while the appeal is pending.

"Once you turn 65, you automatically get Medicare." You must sign up. If you do not sign up for Part B or Part D when you first become may be able to access, you may pay a penalty for the rest of your life, even if you sign up later. The exception is if you are still working and covered by your employer's health plan — you can delay without penalty.

"All Medicare plans are the same." They are not. Original Medicare and Medicare Advantage have different networks, costs, and coverage rules. Part D plans vary widely in which drugs they cover and what you pay. Medigap plans cover different combinations of costs. You need to compare your options each year during the enrollment period.

What to ask your doctor or Medicare counselor

If you are newly may be able to access for Medicare or thinking about changing plans, ask your doctor which Medicare plan works best for the care you use most often. Ask whether the doctors and hospitals you see are in the network of any Medicare Advantage plan you are considering. Ask your pharmacist which Part D plans cover your current prescription drugs and at what cost.

You can also contact your State Health Insurance information Program (SHIP) for free, unbiased counseling about Medicare options. SHIP counselors can review your specific situation and help you understand what each plan would cost you. To find your local SHIP, search online for "[your state] SHIP" or call 1-800-MEDICARE.

When to contact Medicare or your plan

Contact Medicare (1-800-MEDICARE) if you have questions about what a service costs, whether a service is covered, or how to appeal a denial. Contact your specific plan if you need to know whether a doctor is in network, whether a service needs prior approval, or how much you will pay for a specific drug or service.

If you believe Medicare or your plan made a mistake, you have the right to appeal. Appeals can take time, so ask about the timeline and whether you need to pay upfront while the appeal is pending.

Frequently Asked Questions

Does Medicare cover my prescription drugs?

Part D covers prescription drugs, but only those on the plan's formulary (approved drug list). You choose a Part D plan when you first become may be able to access for Medicare, and you can change plans each year during open enrollment. If a drug you need is not covered, you can ask your doctor for an alternative or request that the plan make an exception.

What happens if I do not sign up for Medicare when I turn 65?

If you do not sign up for Part B or Part D when you first become may be able to access, you will pay a penalty for each month you were may be able to access but not enrolled. This penalty is added to your premium for the rest of your life. The only exception is if you were covered by an employer's health plan when you turned 65 — you can delay without penalty as long as you are still working.

Can I switch from Original Medicare to Medicare Advantage or back again?

Yes, but only during certain times. The Annual Enrollment Period runs from October 15 to December 7 each year, and you can make any changes you want. If you have Original Medicare and want to switch to Medicare Advantage, you can do so during this period. If you have Medicare Advantage and want to switch back to Original Medicare, you can also do so during this period, though you should buy Medigap at the same time if you want it.

Does Medicare cover hearing aids or glasses?

No. Medicare does not cover hearing aids, hearing exams, glasses, contact lenses, or routine eye exams. Some Medicare Advantage plans offer discounts on these services through partnerships with retailers, but coverage is not may provide. You can purchase a separate vision or hearing plan if you want this coverage.

What is the difference between Medicare and Medicaid?

Medicare is a federal program for people 65 and older and some younger people with disabilities. Medicaid is a joint federal and state program for people with low income. They are separate programs with different rules, and you can be enrolled in both at the same time if you meet the income limits for Medicaid in your state.