Medicare covers hospital stays, doctor visits, and some medical equipment, but not everything

Medicare pays for inpatient hospital care, doctor office visits, lab tests, imaging, and certain medical equipment and supplies. It does not pay for dental work, vision care, hearing aids, or long-term custodial care in a nursing home. What you pay out of pocket depends on which part of Medicare you have — Original Medicare (Parts A and B) has deductibles and coinsurance, while Medicare Advantage (Part C) has different cost structures set by each insurance company.

The gap between what Medicare covers and what it does not is where supplemental insurance, Medicare Advantage plans, and Part D prescription drug coverage come in. Understanding what each part pays for helps you predict your costs and decide whether you need additional coverage.

Key Takeaways

  • Medicare Part A covers hospital inpatient stays, skilled nursing facility care for up to 100 days after hospitalization, and hospice care, but you pay a deductible per benefit period.
  • Medicare Part B covers doctor visits, outpatient services, lab tests, and imaging, and you pay a monthly premium plus a deductible and 20 percent coinsurance after the deductible.
  • Medicare does not cover dental, vision, hearing aids, or long-term custodial nursing home care, and these gaps often require separate insurance or out-of-pocket payment.
  • Medicare Advantage plans (Part C) cover everything Parts A and B cover but often with lower out-of-pocket costs, though they typically limit you to in-network providers.
  • Part D prescription drug coverage is separate and optional, and the amount Medicare pays depends on which tier your medication falls into and which plan you choose.

What Medicare Part A Covers

Part A covers inpatient hospital stays, including room, meals, and standard nursing care. It also covers up to 100 days in a skilled nursing facility if you are admitted after a hospital stay of at least three days, though Medicare only pays the full cost for the first 20 days — after that you pay coinsurance. Hospice care is also covered if your doctor certifies you have six months or less to live.

For hospital stays, you pay a deductible per benefit period (the amount changes each year). After that, Medicare pays all covered costs for days 1 through 60. On days 61 through 90, you pay coinsurance per day. If you stay longer than 90 days, you can use lifetime reserve days, but those have higher coinsurance and are limited to 60 total across your lifetime.

Part A does not cover private duty nursing, a private room (unless medically necessary), or meals and lodging if you are not admitted as an inpatient. It also does not cover custodial care — help with bathing, dressing, or eating — unless it is part of skilled nursing care you are receiving for a medical reason.

What Medicare Part B Covers

Part B covers doctor office visits, outpatient hospital services, lab tests, X-rays, and imaging like CT scans and MRIs. It also covers some medical equipment and supplies — wheelchairs, walkers, oxygen, diabetic testing supplies — though Medicare has rules about which brands and suppliers it will pay for. Physical therapy, occupational therapy, and speech therapy are covered when ordered by a doctor for a medical condition.

You pay a monthly premium for Part B (the amount depends on your income). After you meet your annual deductible, Medicare pays 80 percent of the approved amount for most services, and you pay 20 percent coinsurance. Some preventive services — like annual wellness visits, cancer screenings, and vaccinations — are covered at no cost after you meet your deductible, or sometimes with no deductible at all.

Part B does not cover routine dental care, eye exams for glasses or contacts, hearing aids, or most routine foot care. It also does not cover cosmetic surgery or most weight-loss surgery. Prescription drugs taken at home are not covered by Part B — those are covered by Part D if you have it.

What Medicare Does Not Cover

Dental care is not covered at all under Original Medicare, including cleanings, fillings, root canals, and dentures. Some Medicare Advantage plans offer limited dental coverage, but it is usually capped at a low dollar amount per year.

Vision care is not covered, including eye exams, glasses, contacts, or surgery to correct vision problems like LASIK. Medicare covers treatment for eye diseases like glaucoma or diabetic retinopathy, but not the glasses you need afterward. Some Medicare Advantage plans include vision coverage.

Hearing aids are not covered, though Medicare does cover the diagnostic hearing test if your doctor orders it. Hearing aid fitting and the devices themselves are your responsibility. Some Medicare Advantage plans offer hearing aid discounts.

Long-term custodial care in a nursing home or assisted living is not covered by Medicare. Medicare pays for skilled nursing care after a hospital stay, but once that ends, you pay out of pocket or through Medicaid if you meet income and asset limits. This is one of the largest gaps in Medicare coverage.

Prescription drugs taken at home are not covered by Part B. You need Part D coverage, which is optional and purchased separately. Without Part D, you pay the full cost of medications.

How Medicare Advantage Plans Change What You Pay

Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurance companies. These plans must cover everything Parts A and B cover, but they can charge different amounts and have different rules. Most Medicare Advantage plans have lower monthly premiums than Original Medicare plus a Medigap supplement, but they usually require you to use in-network doctors and hospitals.

Instead of the deductible-and-coinsurance model of Original Medicare, Medicare Advantage plans often use copays — a fixed dollar amount per visit or service. Some plans have an annual out-of-pocket maximum, meaning once you reach that limit, the plan pays 100 percent of covered costs for the rest of the year. Original Medicare has no out-of-pocket maximum.

Medicare Advantage plans may also cover some things Original Medicare does not, such as dental, vision, or hearing services, though usually with limits. However, if you travel outside your plan's service area, you may have no coverage or limited coverage, which is a significant drawback for people who spend winters in another state.

Prescription Drug Coverage Under Part D

Part D is optional prescription drug coverage you purchase from a private insurance company. It is separate from Parts A, B, and C. If you do not enroll in Part D when you first become may be able to access and later decide you want it, you may pay a permanent penalty on your premium.

Part D plans vary widely in which drugs they cover and how much you pay. Medications are organized into tiers — tier 1 drugs (usually generics) have the lowest copay, and tier 5 drugs (usually brand-name with no generic) have the highest. You also pay a deductible before coverage kicks in, though some plans have no deductible.

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

Medigap Supplemental Insurance and What It Covers

Medigap (also called Supplement Insurance) is optional coverage you buy from a private insurance company to pay for costs that Original Medicare does not cover — deductibles, coinsurance, and copays. It does not cover dental, vision, or hearing aids, and it does not work with Medicare Advantage plans.

There are ten standardized Medigap plans, labeled A through N. Plan F and Plan G cover the most, including the Part B deductible, but they also have higher premiums. Plans A, B, and D are less expensive but cover fewer gaps. The coverage is the same regardless of which insurance company sells it — the only difference is the premium.

Medigap is most valuable if you use a lot of medical services, because it eliminates the 20 percent coinsurance you would pay under Original Medicare. However, if you are healthy and use few services, the monthly premium may not be worth it.

Frequently Asked Questions

Does Medicare cover physical therapy?

Yes, if a doctor orders it for a medical condition. Medicare Part B covers up to 60 days of physical therapy per benefit period in an outpatient setting, though the limit can be waived if medically necessary. You pay your deductible and 20 percent coinsurance. Physical therapy in a hospital or skilled nursing facility is covered under Part A.

Will Medicare pay for a wheelchair or walker?

Yes, if your doctor orders it and it is medically necessary. Medicare Part B covers durable medical equipment like wheelchairs, walkers, canes, and oxygen. You pay 20 percent coinsurance after your deductible. Medicare only pays for equipment from suppliers on its approved list, so your doctor needs to order it from an authorized provider.

Does Medicare cover mental health or counseling?

Yes. Medicare Part B covers visits with psychiatrists, psychologists, and licensed clinical social workers. You pay your deductible and 20 percent coinsurance, the same as for other doctor visits. Inpatient psychiatric hospital care is covered under Part A. Some limits explore to the number of visits per year.

What happens if I need care that Medicare does not cover?

You pay the full cost out of pocket unless you have supplemental insurance like Medigap or a Medicare Advantage plan that covers it. For large expenses like dental work or long-term nursing home care, many people plan ahead by setting aside savings or exploring Medicaid options if they have low income.

Can I use my Medicare coverage 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 limited emergency coverage abroad, but most do not. If you travel internationally, you may want to purchase travel health insurance.