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

Medicare is federal health insurance for people 65 and older, and some younger people with disabilities or end-stage renal disease. It 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 medical equipment. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative to Parts A and B offered by private insurers, and coverage varies by plan.

What Medicare does not cover is just as important to know. Dental work, vision care, hearing aids, long-term custodial care in a nursing home, and most prescription drugs (unless you have Part D) are not covered. Cosmetic surgery, routine foot care, and acupuncture are also excluded. Understanding these gaps helps you plan for out-of-pocket costs or supplemental coverage.

Key Takeaways

  • Medicare Part A covers hospital stays and skilled nursing care; Part B covers doctor visits and outpatient services; Part D covers prescription drugs through a separate plan you choose.
  • Dental, vision, hearing aids, and long-term nursing home care are not covered by original Medicare, though some Medicare Advantage plans include limited dental or vision benefits.
  • You pay deductibles, copayments, and coinsurance for most services, and these amounts vary by part and by service type.
  • Medigap (supplemental insurance) can cover some out-of-pocket costs, but it is a separate policy you purchase from a private insurer.

What Medicare Part A covers

Part A covers inpatient hospital stays, including room, meals, and standard nursing care. You pay a deductible per hospital stay (the amount changes yearly), and then Medicare covers the full cost for the first 60 days. Days 61 through 90 require a daily copayment. After 90 days, you enter a "lifetime reserve" of 60 additional days, each with a higher daily copayment.

Part A also covers skilled nursing facility care — not regular nursing home care, but short-term rehabilitation after a hospital stay. You must have been in the hospital for at least three days, and a doctor must order the care. Medicare covers the first 20 days fully, then requires a daily copayment for days 21 through 100. After 100 days in a benefit period, you pay all costs yourself.

Hospice care and some home health services are also Part A benefits. Home health is covered if you are homebound and a doctor orders it, and there is no copayment for skilled nursing or therapy visits. Hospice is covered for people with a terminal diagnosis, and you pay little to nothing for hospice services themselves, though you may pay copayments for drugs and respite care.

What Medicare Part B covers

Part B covers doctor visits, whether in an office, hospital outpatient department, or urgent care center. It covers preventive services like annual wellness visits, cancer screenings, and vaccinations at no cost to you. It also covers lab tests, X-rays, and imaging ordered by your doctor, as well as outpatient surgery and emergency room visits.

Medical equipment and supplies fall under Part B if a doctor orders them: wheelchairs, walkers, oxygen, diabetic supplies, and similar items. Durable medical equipment (DME) requires a prescription and is usually subject to a 20 percent copayment after you meet your Part B deductible. Mental health services, including therapy and psychiatry, are covered at the same rate as other doctor visits.

Part B does not cover routine foot care, most dental work, eyeglasses or contact lenses, or hearing aids. It also does not cover cosmetic surgery or most acupuncture. Physical therapy and occupational therapy are covered only if ordered by a doctor and provided in a medical setting, not as standalone wellness services.

What Medicare Part D covers

Part D is prescription drug coverage, and you must choose a plan from a private insurer during your enrollment period. Each plan has a different formulary — the list of drugs it covers — so two people with the same prescriptions may pay different amounts depending on which plan they choose. Part D is optional, but if you do not sign up when you first become may be able to access and go without coverage for 63 days or more, you pay a permanent penalty.

Part D plans have a deductible (usually $100 to $500 per year), then you pay a copayment or coinsurance for each prescription. Once you and your plan have spent a certain amount on drugs in a year, you enter the "coverage gap" or "donut hole," where you pay a larger share of the cost. After you spend enough out of pocket, catastrophic coverage kicks in and you pay a small copayment for the rest of the year.

Not all drugs are covered by all plans. Insulin, cancer drugs, and common blood pressure medications are usually covered, but newer or brand-name drugs may not be. If your plan does not cover a drug your doctor prescribes, you can ask the plan for an exception, or your doctor can request a coverage review.

What Medicare does not cover

Dental care is not covered by original Medicare, including cleanings, fillings, root canals, and dentures. Some Medicare Advantage plans include limited dental benefits, but they usually have a separate deductible and annual maximum. Vision care — eye exams, glasses, and contact lenses — is also not covered, though Medicare does cover cataract surgery and treatment for eye diseases like glaucoma.

Hearing aids and hearing exams are not covered by original Medicare. Routine foot care, such as trimming toenails or removing calluses, is not covered unless you have diabetes and a doctor orders it as part of your diabetes management. Long-term custodial care in a nursing home — care that helps you with daily activities but is not skilled medical care — is not covered by Medicare at all. Medicaid may cover it if you meet income and asset limits, but Medicare will not.

Cosmetic surgery, weight loss surgery (unless medically necessary), and most acupuncture are excluded. Routine physical exams for work or travel are not covered. Over-the-counter drugs are not covered by Part D, though some plans offer limited coverage for certain OTC items through a separate benefit.

How much you pay out of pocket

Original Medicare has deductibles, copayments, and coinsurance. Part A has a deductible per hospital stay and daily copayments for extended stays. Part B has an annual deductible (currently $240, though this changes yearly) and then you pay 20 percent coinsurance for most services after that. Part D has a deductible, copayments during the coverage gap, and then a small copayment during catastrophic coverage.

Your actual costs depend on which services you use and how much care you need. Someone with one doctor visit and no prescriptions pays far less than someone with a hospital stay and multiple medications. Medicare Advantage plans have different cost structures — some have lower premiums but higher copayments, others the reverse. Medigap plans cover some out-of-pocket costs but require a separate monthly premium.

You can see what you will owe before you receive care by asking your doctor's office or the hospital for an estimate. Medicare also publishes the current deductible and copayment amounts on Medicare.gov each year.

Supplemental coverage options

Medigap (Medicare Supplement Insurance) is a policy sold by private insurers that covers some of the costs Medicare does not — deductibles, copayments, and coinsurance. There are ten standardized Medigap plans (labeled A through N), and each covers a different combination of out-of-pocket costs. Plan G, for example, covers the Part B deductible and 20 percent coinsurance; Plan N covers most costs but leaves some copayments to you.

Medicare Advantage (Part C) is an alternative to original Medicare offered by private insurers. It includes Part A and B coverage, usually includes Part D, and often includes dental or vision benefits. The trade-off is that you must use doctors and hospitals in the plan's network, and you may need prior authorization for some services. Costs and coverage vary widely by plan and by region.

Long-term care insurance is a separate product that covers nursing home care, assisted living, or home care for extended periods. It is not part of Medicare and must be purchased before you need care, usually years in advance. Medicaid covers long-term nursing home care if you meet income and asset limits, but it is a needs-based program, not an insurance plan.

Frequently Asked Questions

Does Medicare cover eye exams and glasses?

Original Medicare does not cover routine eye exams, glasses, or contact lenses. It does cover cataract surgery and treatment for eye diseases like glaucoma or diabetic retinopathy. Some Medicare Advantage plans include vision benefits, but they usually have a separate deductible and annual limit.

Does Medicare cover dental work?

Original Medicare does not cover dental cleanings, fillings, root canals, or dentures. Some Medicare Advantage plans offer limited dental benefits, typically covering one or two cleanings per year and basic procedures, but with a separate deductible and annual maximum. You can also purchase standalone dental insurance.

Does Medicare cover nursing home care?

Medicare covers skilled nursing facility care for up to 100 days per benefit period, but only after a hospital stay of at least three days and only if the care is medical rehabilitation, not custodial help with daily activities. Long-term custodial care is not covered by Medicare. Medicaid covers it if you meet income and asset limits.

Does Medicare cover hearing aids?

Original Medicare does not cover hearing aids or hearing exams. Some Medicare Advantage plans include hearing benefits, usually covering one hearing aid per ear every few years. You can also purchase hearing aids directly from a provider or through a hearing aid insurance plan.

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

If you go 63 days or more without Part D coverage and later enroll, you pay a permanent penalty on top of your plan premium for as long as you have Medicare. The penalty is about 1 percent of the national average Part D premium per month you were without coverage. There are exceptions if you had other creditable drug coverage during that time.