Medicare Part A does not cover routine doctor visits
Medicare Part A covers inpatient hospital stays, skilled nursing facility care after hospitalization, hospice care, and some home health services. It does not pay for office visits to your doctor, lab work in an outpatient setting, or X-rays at a clinic. If you go to your doctor's office for a checkup, blood work, or treatment of a chronic condition, Part A will not cover that bill.
This is a critical distinction because many people assume Part A is their main coverage and are surprised when they receive bills for doctor visits. Part A is designed to cover care you receive as an inpatient — meaning you are admitted to a hospital or facility overnight — or care provided at home under specific circumstances.
If you need coverage for office visits and outpatient services, you need Medicare Part B, which is a separate coverage type. Many seniors have both Part A and Part B together, often called "Original Medicare."
Key Takeaways
- Medicare Part A covers inpatient hospital stays, skilled nursing care after hospitalization, and some home health services, but not office visits to your doctor.
- Part B, not Part A, is the coverage that pays for routine doctor visits, lab work, imaging, and outpatient procedures.
- You can have Part A without Part B, which leaves you uninsured for doctor visits unless you have another source of coverage.
- If you receive care as an outpatient (meaning you go home the same day), Part A does not cover it even if you are at a hospital facility.
What Part A actually covers in a hospital
When you are admitted to a hospital as an inpatient, Part A covers your room, meals, nursing care, medications given in the hospital, and most tests and procedures performed during your stay. You will pay a deductible for the first 60 days of a hospital stay in each benefit period, and then coinsurance for days 61 through 90, and higher coinsurance for days 91 and beyond.
The key word is inpatient. Your doctor may order the same test or procedure whether you are admitted overnight or treated in the hospital's outpatient department and sent home the same day. Part A covers it only if you are admitted. If you are treated in the hospital's outpatient clinic or emergency department and discharged, Part B covers it instead.
This matters because hospitals sometimes use "observation status" instead of admitting patients as inpatients. You may spend the night in a hospital bed under observation, but if you are not formally admitted, Part A does not cover your stay — Part B does. Always ask the hospital whether you are being admitted as an inpatient or placed on observation status.
Skilled nursing facility care covered by Part A
Part A covers up to 100 days in a skilled nursing facility per benefit period, but only if you meet two conditions: you must have been an inpatient in a hospital for at least three consecutive days first, and you must enter the facility within 30 days of leaving the hospital.
A skilled nursing facility is not the same as a regular nursing home or assisted living. It provides medical care and rehabilitation — physical therapy, occupational therapy, or skilled nursing services — under a doctor's orders. If you need only custodial care (help with bathing, dressing, meals), Part A does not cover it.
You pay nothing for the first 20 days, then coinsurance of about $200 per day for days 21 through 100. After 100 days in a benefit period, you pay all costs yourself.
Home health services Part A may cover
Part A covers some home health services if a doctor orders them, you are homebound, and you receive care from a Medicare-certified home health agency. Covered services include skilled nursing visits, physical therapy, occupational therapy, and speech-language pathology services.
Part A does not cover custodial care at home — help with bathing, dressing, or meals — or homemaker services like cleaning or laundry. It also does not cover routine doctor visits that happen to take place in your home; those are covered by Part B instead.
Home health services under Part A are covered at no cost to you after you meet your Part A deductible, with no visit limit. However, the services must be medically necessary and ordered by your doctor.
Hospice care covered by Part A
Part A covers hospice care for people with a terminal illness when a doctor certifies that you have six months or less to live. Hospice focuses on comfort and quality of life rather than curing the illness. Part A covers doctor visits, nursing care, medications related to your terminal condition, counseling, and respite care (temporary care to give family caregivers a break).
You typically pay nothing for hospice services covered by Part A, though you may pay a small copay for medications and respite care. You must receive care from a Medicare-certified hospice provider.
Why you need Part B for doctor visits
Medicare Part B is the coverage that pays for office visits to your doctor, whether for a routine checkup or treatment of a chronic condition. Part B also covers lab work, imaging (X-rays, ultrasounds, CT scans), outpatient surgery, and most preventive services like cancer screenings and vaccines.
Part B requires a monthly premium, currently $164.90 per month for most people in 2024, though the amount changes each year and may be higher if you have higher income. You also pay an annual deductible ($240 in 2024) and then 20% coinsurance for most services after the deductible is met.
If you have Part A but not Part B, you are uninsured for doctor visits. Some people choose to skip Part B to save the premium, but this leaves them paying the full cost of any doctor visit out of pocket. If you did not sign up for Part B when you first became may be able to access, you may face a permanent penalty if you sign up later.
What to ask your doctor about coverage
Before your appointment, call your doctor's office and confirm that they accept Medicare. Ask whether the visit will be covered under Part A or Part B — this matters mainly if you are in a hospital or facility, because office visits are always Part B.
If your doctor orders a test or procedure, ask whether it will be done in the office (Part B) or in a hospital outpatient department (also Part B, even though it is at a hospital). Ask what your out-of-pocket cost will be after insurance.
If you receive a bill for a doctor visit that you believe Part A should have covered, contact Medicare at 1-800-MEDICARE to ask. You can also ask your doctor's billing office to submit the claim to Medicare and explain why they think Part A applies.
When to contact Medicare about coverage questions
Call Medicare at 1-800-MEDICARE (1-800-633-4227) if you are unsure whether a service is covered by Part A or Part B, if you received a bill you think Medicare should have paid, or if you are considering whether to sign up for Part B. You can also visit Medicare.gov and use the "Coverage" tool to search for specific services.
If you are hospitalized and unsure whether you are admitted as an inpatient or on observation status, ask the hospital's patient advocate or billing department. This status affects which part of Medicare pays and what you owe.
Keep copies of any bills or explanation of benefits (EOB) statements you receive. These documents show what Medicare paid and what you owe, and they help Medicare staff answer your questions about coverage.
Frequently Asked Questions
Can Part A cover a doctor visit if I am in the hospital?
Only if you are admitted as an inpatient. If you are in the hospital's emergency department or outpatient clinic and sent home the same day, Part B covers the doctor visit, not Part A. Ask the hospital to confirm your admission status in writing.
What happens if I have Part A but not Part B?
You are uninsured for doctor visits and outpatient services. You will pay the full cost out of pocket. If you did not sign up for Part B when first may be able to access, you may face a permanent 10% premium increase if you sign up later, for as long as you have Part B.
Does Part A cover my doctor's visit to my home?
No. Home visits by your doctor are covered by Part B. Part A covers home health services like nursing care or physical therapy ordered by your doctor through a home health agency, but not routine doctor visits that happen to occur at your home.
If I am on observation status in a hospital, what covers my care?
Part B covers observation status stays, not Part A. You pay Part B coinsurance (usually 20% after your deductible) rather than Part A inpatient costs. This can be more expensive, so ask the hospital whether they can admit you as an inpatient instead if medically appropriate.
Does Part A cover blood work ordered by my doctor?
Only if the blood work is done as part of an inpatient hospital stay. If your doctor orders lab work in an outpatient setting — at a lab, clinic, or hospital outpatient department — Part B covers it, not Part A.