Medicare Part A covers hospital care, Part B covers doctor visits and outpatient services

Medicare Part A pays for inpatient hospital stays, skilled nursing facility care after a hospital stay, hospice care, and some home health services. Medicare Part B pays for doctor visits, outpatient care, lab tests, imaging, and medical equipment like wheelchairs or oxygen. Together, they form the foundation of Original Medicare — the government-run plan most people turn to at age 65.

Most people do not pay a monthly premium for Part A because they or their spouse paid Medicare taxes while working. Part B does have a monthly premium, which varies based on your income. Both parts come with deductibles and copayments that you pay out of pocket when you use services.

Understanding what each part covers helps you know what to expect when you go to the hospital or see a doctor, and whether you might need additional coverage to fill the gaps.

Key Takeaways

  • Part A covers hospital stays and skilled nursing care after hospitalization; Part B covers doctor visits, outpatient procedures, and preventive services.
  • Most people pay no monthly premium for Part A but do pay a monthly premium for Part B, with amounts based on income.
  • Both parts require you to pay a deductible before coverage begins each year, plus copayments or coinsurance when you receive care.
  • Original Medicare (Parts A and B together) does not cover prescription drugs, dental, vision, or hearing aids — you may need separate coverage for those.

What Medicare Part A Covers

Part A covers inpatient hospital care for up to 60 days per benefit period. A benefit period begins the day you enter the hospital and ends 60 days after you leave without receiving any inpatient care. If you return to the hospital after that 60-day gap, a new benefit period starts. During your hospital stay, Part A pays for your room, meals, nursing care, and most hospital services — but you pay a deductible first (the amount changes each year).

After a hospital stay, if your doctor says you need skilled nursing care — such as physical therapy or wound care — Part A covers up to 100 days in a skilled nursing facility. You pay nothing for the first 20 days, then a daily copayment for days 21 through 100. After 100 days in a benefit period, you pay all costs yourself.

Part A also covers hospice care if you have a terminal illness and your doctor believes you have six months or less to live. Hospice focuses on comfort rather than cure and is covered at home, in a hospice facility, or in a hospital. You typically pay nothing for hospice services, though you may pay a small copayment for prescription drugs and respite care (temporary relief for your caregiver).

Home health services are covered by Part A when you are homebound and your doctor orders skilled care such as nursing visits, physical therapy, or occupational therapy. Part A covers these visits at no cost to you, as long as you meet the homebound requirement.

What Medicare Part B Covers

Part B covers doctor visits, whether in an office, clinic, or hospital outpatient department. This includes routine checkups, sick visits, and specialist consultations. After you pay your annual deductible, you typically pay 20 percent of the cost of the visit, and Medicare pays 80 percent.

Preventive services are covered at no cost under Part B — these include annual wellness visits, cancer screenings (mammograms, colonoscopies, prostate exams), cardiovascular screenings, diabetes screenings, and vaccinations like flu shots and pneumonia vaccines. You do not pay a copayment or coinsurance for these preventive services even before you meet your deductible.

Part B also covers outpatient procedures and tests ordered by your doctor, such as lab work, X-rays, ultrasounds, and CT scans performed in a hospital outpatient department or imaging center. Mental health services, including therapy and psychiatry visits, are covered at the same 80/20 split after your deductible.

Durable medical equipment — items like wheelchairs, walkers, oxygen equipment, and diabetic supplies — is covered by Part B. You pay 20 percent of the approved amount after your deductible; Medicare pays 80 percent. Ambulance services to a hospital or skilled nursing facility are also covered by Part B.

How Deductibles and Copayments Work

Part A has a deductible that applies per benefit period. Once you pay this deductible during a hospital stay, you are covered for most hospital costs for the rest of that benefit period. If you have a new benefit period (after a 60-day gap without inpatient care), you pay the deductible again. The deductible amount changes each year and is set by Medicare.

Part B has an annual deductible that resets every January 1. Once you meet it, you typically pay 20 percent coinsurance for most services for the rest of the year. Some preventive services have no deductible and no coinsurance. The Part B deductible amount also changes yearly.

Copayments are fixed dollar amounts you pay for specific services — for example, you might pay a set copayment for an office visit or a lab test. Coinsurance is a percentage of the cost you pay after meeting your deductible. Understanding the difference helps you budget for healthcare costs throughout the year.

What Parts A and B Do Not Cover

Original Medicare does not cover prescription drugs. You need a separate Part D plan (prescription drug coverage) to pay for medications, or you can choose a Medicare Advantage plan that includes drug coverage. Without drug coverage, you pay the full cost of prescriptions yourself.

Dental care, vision care, and hearing aids are not covered by Parts A and B. Many seniors purchase standalone dental and vision plans, or choose a Medicare Advantage plan that includes these benefits. Hearing aids are expensive and rarely covered by any Medicare plan.

Long-term care in a nursing home (custodial care) is not covered by Medicare. Part A covers skilled nursing care for a limited time after a hospital stay, but if you need ongoing help with daily activities and no skilled medical care, you pay out of pocket or turn to Medicaid if you meet income limits.

Routine foot care, most dental work, and cosmetic procedures are not covered. Some exceptions exist — for example, foot care is covered if you have diabetes — but these are limited.

How Part A and Part B Work Together

When you are hospitalized, Part A covers your inpatient stay. If your doctor orders tests or procedures while you are an inpatient, Part A covers those as well. Once you are discharged, Part B takes over for any follow-up doctor visits or outpatient services your doctor orders.

If you need skilled nursing care after leaving the hospital, Part A covers that facility stay. During your time in the skilled nursing facility, if you see a doctor for a visit unrelated to your skilled care, Part B covers that doctor visit.

The two parts are designed to work as a team, but they have separate deductibles and separate rules about what they cover. Knowing which part covers which service helps you understand your bills and avoid unexpected costs.

Medicare Part B Premiums and Income

Your Part B monthly premium is based on your modified adjusted gross income (MAGI) from two years prior. If your income is at or below a certain threshold, you pay the standard premium. If your income is higher, you pay an additional amount called an Income-Related Monthly Adjustment Amount (IRMAA).

The income thresholds and premium amounts change each year. If your income drops — because you retire, lose a spouse, or have other life changes — you can ask Medicare to recalculate your premium. This is called a life-changing event, and you must report it within 60 days.

Part A premiums are free for most people, but if you did not pay Medicare taxes for at least 40 quarters (10 years) while working, you may pay a monthly premium. The amount depends on how many quarters of coverage you have.

When to Enroll in Parts A and B

You become may be able to access for Medicare at age 65. If you are already receiving Social Security benefits, Medicare Part A and Part B are enrolled automatically. If you are not yet receiving Social Security, you must contact Social Security to enroll in Medicare.

Your Initial Enrollment Period is the seven-month window that includes the month you turn 65, plus three months before and three months after. If you enroll during this window, your coverage begins the month you turn 65 (or the first of the month after you turn 65, depending on your birthday).

If you miss your Initial Enrollment Period and do not have other health coverage, you may face a permanent penalty on your Part B premium. It is important to enroll on time or confirm you have other coverage that counts as "creditable coverage" under Medicare rules.

Frequently Asked Questions

Do I have to take Part B if I have employer health insurance?

If your employer has 20 or more employees and you are still working, you can delay Part B without penalty. However, you must enroll in Part A at 65. Once you leave your job or lose employer coverage, you have eight months to enroll in Part B without penalty. If you miss this window, you pay a permanent surcharge on your premium.

What happens if I go to an out-of-network doctor with Part B?

Original Medicare Part B works nationwide — there is no network. Any doctor who accepts Medicare can treat you, and you pay the same 20 percent coinsurance regardless of location. Some doctors do not accept Medicare assignment, meaning they may charge more than Medicare approves, so ask before your visit.

Can I switch from Original Medicare to a Medicare Advantage plan later?

Yes, but only during specific enrollment periods. You can switch during the Annual Enrollment Period (October 15 to December 7 each year), and coverage begins January 1. If you miss this window, you cannot switch until the next year unless you have a may have access to life event.

What if my Part B deductible is very high and I cannot afford it?

If your income is low, you may be may be able to access for Medicaid or a Medicare Savings Program, which can help pay your deductibles and copayments. Contact your state Medicaid office or local Area Agency on Aging to learn whether you may have access to.

Does Part A cover all my hospital bills?

Part A covers most inpatient hospital costs after you pay the deductible, but it does not cover all charges. If you see a doctor who does not accept Medicare assignment, you may receive a separate bill. Always ask the hospital whether all doctors on staff accept Medicare to avoid surprise bills.