Medicare covers hospital stays, doctor visits, and some prescription drugs, but not dental, vision, hearing aids, or long-term care

Medicare has four parts, and each covers different things. Part A covers inpatient hospital care, skilled nursing facilities, hospice, and some home health services. Part B covers doctor visits, outpatient care, lab tests, and some equipment. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative to Parts A and B offered by private insurers, and the coverage varies by plan.

What Medicare does not cover is often what people need most: dental work, eyeglasses, hearing aids, routine foot care, and long-term custodial care in a nursing home or at home. You pay the full cost of these services unless you buy a separate policy to cover them. Understanding which services require you to pay out of pocket helps you plan for costs that will come later.

Key Takeaways

  • Part A covers hospital and skilled nursing stays; Part B covers doctor visits and outpatient services; Part D covers prescription drugs; Part C is a private alternative that bundles A and B with different coverage rules.
  • Medicare does not cover dental, vision, hearing aids, routine foot care, or long-term custodial care — you pay the full cost unless you buy supplemental coverage.
  • You pay deductibles, copayments, and coinsurance for services Medicare does cover, and these amounts vary by part and by service.
  • Medigap policies and Medicare Advantage plans can reduce your out-of-pocket costs, but they cost money and have different coverage limits.

What Part A covers and what you pay

Part A covers inpatient hospital stays, up to 100 days in a skilled nursing facility after a hospital stay, 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. If you did not, you can buy Part A, but the monthly premium is high.

For a hospital stay, you pay a deductible for each benefit period (the amount changes each year). After you meet the deductible, Medicare pays all covered costs for the first 60 days. Days 61 through 90 require a daily copayment. Beyond 90 days, you pay a much higher daily copayment, and coverage is limited. For skilled nursing facilities, you pay nothing for the first 20 days after a hospital stay, then a daily copayment for days 21 through 100.

What Part B covers and what you pay

Part B covers doctor office visits, preventive care (like annual wellness visits and cancer screenings), outpatient surgery, lab tests, imaging, physical therapy, and durable medical equipment like wheelchairs and oxygen. You pay a monthly premium for Part B, and the amount depends on your income. Higher earners pay more.

For most Part B services, you pay a yearly deductible, then 20 percent of the cost as coinsurance. Medicare pays the other 80 percent. For some services like office visits, you may pay a fixed copayment instead. The exact amount varies by service and by whether your doctor accepts Medicare assignment (agrees to accept Medicare's approved amount as full payment).

What Part D covers and how to choose a plan

Part D is prescription drug coverage, and you must choose a plan from a private insurer. There is no single Part D plan — each insurer offers different plans with different drug lists, copayments, and deductibles. You enroll during the annual enrollment period (October 15 to December 7 each year), and coverage begins January 1.

Each plan has a formulary, which is the list of drugs it covers. If your regular medication is not on the formulary, you either pay out of pocket or ask your doctor to prescribe a different drug that is covered. You also pay a deductible (if the plan has one), then copayments or coinsurance for each prescription. Once you spend a certain amount out of pocket, you enter the "donut hole," where you pay a higher share of drug costs until your total spending reaches a cap.

What Medicare Advantage (Part C) changes

Medicare Advantage is an alternative to Original Medicare (Parts A and B). A private insurer runs the plan and covers everything Part A and Part B cover, plus often dental, vision, and hearing. However, the copayments, deductibles, and out-of-pocket maximums are different from Original Medicare, and you must use doctors and hospitals in the plan's network.

Some Medicare Advantage plans have zero premium, but most have a monthly cost. The trade-off is that you may pay less out of pocket for some services but more for others, depending on the plan. You also cannot use a Medigap policy alongside Medicare Advantage — the two are not compatible. If you switch back to Original Medicare later, you may not be able to buy a Medigap policy at the same price.

Gaps in coverage: what you must pay for

Dental care is not covered by any part of Medicare. Cleanings, fillings, root canals, and dentures all cost you the full amount. Some Medicare Advantage plans include basic dental, but coverage is limited and copayments are high. Many people buy standalone dental insurance or pay out of pocket.

Vision care is also not covered. Eye exams, eyeglasses, and contact lenses are your responsibility. Hearing aids are not covered, though some Medicare Advantage plans offer a discount. Routine foot care, including toenail trimming, is not covered unless you have diabetes or a related condition. Long-term care — whether in a nursing home or at home — is not covered by Medicare. Medicaid covers long-term care for people with low income and assets, but Medicare does not.

Medigap policies: what they cover and how much they cost

A Medigap policy is supplemental insurance sold by private insurers. It pays some or all of the deductibles, copayments, and coinsurance you would otherwise pay under Original Medicare (Parts A and B). It does not cover services Medicare does not cover, like dental or vision.

There are ten standardized Medigap plans, labeled A through N. Plan A is the most basic and cheapest; Plan G and Plan N are more comprehensive. The exact coverage of each plan is the same across all insurers, but the monthly premium varies. You can enroll in a Medigap policy during the six-month period after you turn 65 and enroll in Part B. If you wait, insurers can charge you more or deny you coverage based on your health history.

Frequently Asked Questions

Does Medicare cover preventive care like cancer screenings and vaccines?

Yes. Part B covers preventive services with no copayment or coinsurance if your doctor accepts Medicare assignment. This includes mammograms, colonoscopies, flu shots, pneumonia vaccines, and shingles vaccines. You still pay the Part B deductible if you have not met it yet, but after that, the service is free.

What happens if I need care outside the United States?

Original Medicare does not cover care outside the U.S., except in limited cases near the border. Medicare Advantage plans vary — some offer emergency coverage abroad, others do not. If you travel internationally, you may want to buy a travel health insurance policy.

Does Medicare cover mental health or therapy?

Part B covers mental health services, including therapy and psychiatry visits, at the same rate as other doctor visits. You pay the deductible and coinsurance. Some services, like certain types of counseling, may require prior authorization from Medicare before you receive care.

Can I use my Medicare to see any doctor I want?

With Original Medicare (Parts A and B), you can see any doctor who accepts Medicare, anywhere in the country. With Medicare Advantage, you must use doctors and hospitals in your plan's network, except in emergencies. Check your plan's provider directory before you schedule an appointment.

What if I cannot afford my out-of-pocket costs?

Medicare has programs for people with low income. The may have access to Medicare Beneficiary (QMB) program pays your Part B premium, deductible, and coinsurance. The Specified Low-Income Medicare Beneficiary (SLMB) program pays your Part B premium. Your state Medicaid office determines whether you may have access to based on income and assets.