The Basic Coverage Medicare Provides

Medicare has four parts, and each one covers different things. Part A covers hospital stays, skilled nursing care after a hospital stay, hospice, and some home health services. Part B covers doctor visits, outpatient care, lab tests, imaging, and medical equipment like wheelchairs or oxygen. Part D covers prescription drugs. Part C, also called Medicare Advantage, is an alternative to Parts A and B offered by private insurance companies — it covers everything Parts A and B cover, but often with different costs and networks.

What Medicare does not cover is equally important to know. Medicare does not pay for dental care, vision care, hearing aids, long-term custodial care in a nursing home, or most prescription drugs until you sign up for Part D. It also does not cover routine foot care, most cosmetic surgery, or experimental treatments not yet approved by the FDA.

Key Takeaways

  • Part A covers hospital stays and skilled nursing facilities; Part B covers doctor visits and outpatient services; Part D covers prescription drugs; Part C is a private alternative that bundles A and B coverage.
  • Medicare does not cover dental, vision, hearing aids, long-term nursing home care, or routine foot care, and you must enroll in Part D separately to get prescription drug coverage.
  • You pay a deductible before Medicare starts paying, and you share the cost of most services through copayments or coinsurance even after you meet the deductible.
  • Medigap (supplemental insurance) can cover some of the costs Medicare leaves you responsible for, but it is a separate policy you buy from a private insurer.
  • Your coverage and costs change if you switch from Original Medicare to Medicare Advantage, so comparing your options each year during open enrollment matters.

Hospital and Skilled Nursing Care Under Part A

Part A covers inpatient hospital stays, but only after you pay a deductible. In 2024, that deductible is $1,632 per benefit period — a benefit period starts when you enter the hospital and ends 60 days after you leave. If you go back to the hospital within that 60-day window, you do not pay a second deductible. After you pay the deductible, Medicare covers all hospital costs for the first 60 days. Days 61 through 90 require a daily copayment from you. Beyond 90 days, you can use "lifetime reserve days" — Medicare gives you 60 of these over your entire lifetime, and you pay a daily copayment for each one you use.

Part A also covers skilled nursing facility care, but only if you were hospitalized for at least three days first and enter the facility within 30 days of leaving the hospital. The care must be skilled — meaning a nurse or therapist must provide it — not custodial care like help with bathing or dressing. Medicare covers the first 20 days with no copayment, days 21 through 100 with a daily copayment, and nothing after day 100 in that benefit period.

Doctor Visits and Outpatient Services Under Part B

Part B covers visits to your doctor, preventive care like annual wellness visits and cancer screenings, lab tests, X-rays and other imaging, physical therapy, and durable medical equipment. You pay a monthly premium for Part B, and you also pay a yearly deductible — in 2024, that is $240. After you meet the deductible, you typically pay 20 percent of the cost of most services, and Medicare pays 80 percent. For some preventive services like flu shots or colonoscopies, you pay nothing.

Part B does not cover routine dental work, eye exams for glasses or contacts, hearing aids, or most foot care. It also does not cover services you receive outside the United States, except in very limited situations like emergency care in Canada or Mexico if you are traveling between Alaska and the continental U.S.

Prescription Drug Coverage Under Part D

Part D is optional, but if you do not enroll when you first become may be able to access and later decide you want it, you may pay a penalty for the months you were not covered. You enroll in Part D through a private insurance company, not directly through Medicare. Each company's plan covers a different list of drugs at different costs, so comparing plans during the annual open enrollment period (October 15 to December 7) can save you money.

Part D has a coverage gap, sometimes 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 a higher percentage of drug costs until you reach a spending threshold. After that, catastrophic coverage kicks in and you pay a small copayment for most drugs for the rest of the year. The exact amounts change yearly.

What You Pay: Deductibles, Copayments, and Coinsurance

Medicare is not free. You pay premiums (monthly fees), deductibles (a set amount before coverage starts), and then copayments or coinsurance (your share of the cost after the deductible). The amounts vary by part and by the specific service.

Under Original Medicare (Parts A and B), there is no annual out-of-pocket maximum — meaning if you have a very expensive year, you could pay thousands of dollars. Medicare Advantage plans must have an annual out-of-pocket maximum, which limits how much you pay in a year, but they often have higher copayments for individual services and may require you to use doctors in their network.

Medigap: Supplemental Insurance That Covers What Medicare Leaves Behind

Medigap is a separate insurance policy sold by private companies that covers some of the costs Medicare does not — like copayments, coinsurance, and deductibles. It is not the same as Medicare Advantage. If you have Original Medicare (Parts A and B), you can buy a Medigap policy to reduce your out-of-pocket costs. The best time to buy Medigap is within six months of turning 65 and enrolling in Part B, because during that window, insurance companies cannot deny you or charge you more based on your health history.

There are ten standardized Medigap plans, labeled A through N. Each plan covers a different combination of costs. Plan G, for example, covers the Part B deductible and coinsurance, but not the Part A deductible. Plan N covers most costs but leaves you responsible for some copayments. You choose which plan fits your needs and budget, and you pay the premium directly to the insurance company.

Medicare Advantage: An Alternative to Original Medicare

Medicare Advantage (Part C) is offered by private insurance companies and covers everything Original Medicare covers, plus usually dental, vision, and hearing benefits that Original Medicare does not. However, Medicare Advantage plans typically have networks — you must use doctors and hospitals in the plan's network, or pay more. Many plans require referrals to see specialists, and some cover services only if you get prior approval from the plan first.

Medicare Advantage plans have an annual out-of-pocket maximum, which means your costs are capped. Original Medicare has no such cap. However, Medicare Advantage copayments are often higher per visit, and if you travel or move, your coverage may not follow you. You can switch back to Original Medicare during the annual open enrollment period, but if you do, you should enroll in Medigap at the same time — waiting can cost you more in premiums.

Preventive Services Medicare Covers at No Cost

Medicare Part B covers certain preventive services with no copayment or coinsurance after you meet your deductible — and for some services, you do not even need to meet the deductible first. These include annual wellness visits, cancer screenings (mammograms, colonoscopies, Pap tests), cardiovascular screening, diabetes screening, bone density testing, flu shots, pneumonia shots, and shingles shots.

The exact services covered and how often you can receive them depend on your age, sex, and health history. Your doctor can tell you which preventive services are right for you. Taking advantage of these covered services is one way to manage your health and catch problems early without paying out of pocket.

Frequently Asked Questions

Does Medicare cover dental work or dentures?

Original Medicare (Parts A and B) does not cover routine dental care, cleanings, fillings, or dentures. Some Medicare Advantage plans include dental benefits, but they usually have limits on what they cover and how much they will pay per year. You can also buy a separate dental insurance plan if you want coverage.

What happens if I need care outside the United States?

Medicare generally does not cover care received outside the U.S. The only exception is emergency care in Canada or Mexico if you are traveling between Alaska and the continental United States. If you travel internationally, consider purchasing travel health insurance for the duration of your trip.

Do I have to enroll in Part D when I turn 65?

Part D is optional, but if you delay enrolling and do not have other creditable drug coverage, you will pay a penalty for each month you were not covered. The penalty is added to your Part D premium for as long as you have Medicare. It is usually cheaper to enroll when you first become may be able to access, even if you do not take many medications.

Can I switch from Medicare Advantage back to Original Medicare?

Yes, during the annual open enrollment period (October 15 to December 7), you can switch from Medicare Advantage to Original Medicare. If you do, you should enroll in Medigap at the same time. If you wait to enroll in Medigap later, insurance companies can charge you more or deny you coverage based on your health.

What is the difference between Medigap and Medicare Advantage?

Medigap is supplemental insurance that works alongside Original Medicare to cover costs Medicare leaves you responsible for. Medicare Advantage is an alternative to Original Medicare offered by private companies. You cannot have both Medigap and Medicare Advantage at the same time — you choose one or the other.