Part A covers hospital stays, skilled nursing, hospice, and some home health care

Medicare Part A is hospital insurance. It pays for inpatient care — meaning you stay overnight — at a hospital or skilled nursing facility. It also covers hospice care and some home health services, but only under specific conditions.

Part A covers the full cost of your hospital room, meals, nursing care, and most medical supplies while you are admitted as an inpatient. If you need surgery, Part A pays for the operating room, anesthesia, and surgical instruments. It does not cover the surgeon's fee — that is Part B. Part A also pays for blood transfusions, X-rays, and lab tests done during your hospital stay.

For skilled nursing facilities — places that provide medical care beyond what a regular nursing home offers — Part A covers up to 100 days per benefit period, but only if you were hospitalized for at least three days first and admitted within 30 days of leaving the hospital. The first 20 days are fully covered. Days 21 through 100 require you to pay a daily amount out of pocket.

Hospice care is covered by Part A when a doctor says you have six months or less to live. Part A pays for pain relief, symptom management, and emotional support, though you may pay a small amount for prescription drugs and respite care.

Part B covers doctor visits, outpatient care, and medical equipment

Medicare Part B is medical insurance. It pays for services from doctors, nurse practitioners, and other providers, whether you see them in an office, a hospital outpatient department, or your home. Part B also covers outpatient surgery, diagnostic tests, and durable medical equipment.

Part B covers office visits with your primary care doctor or any specialist. It pays for the doctor's time and the basic tests done in the office — blood draws, EKGs, straightforward X-rays. If your doctor orders lab work or imaging at a separate facility, Part B covers that too. Part B also pays for mental health visits, whether in person or by video, and for preventive care like annual wellness visits, cancer screenings, and vaccinations.

Outpatient surgery — procedures where you go home the same day — is covered by Part B. This includes colonoscopies, cataract surgery, and many orthopedic procedures. Part B pays for the facility, the surgeon, anesthesia, and post-operative care on the day of surgery.

Durable medical equipment such as wheelchairs, walkers, oxygen equipment, and diabetic supplies is covered by Part B after you meet your deductible. Part B also covers some rehabilitation services: physical therapy, occupational therapy, and speech therapy, though the number of visits may be limited depending on medical necessity.

Key Takeaways

  • Part A covers overnight hospital stays, skilled nursing facility care for up to 100 days, hospice, and some home health services, but you pay a deductible and daily amounts for days 21 through 100 in a nursing facility.
  • Part B covers doctor visits, outpatient procedures, mental health care, preventive screenings, and durable medical equipment, but you pay a monthly premium and a yearly deductible before coverage begins.
  • Part A and Part B together do not cover dental care, vision care, hearing aids, or long-term custodial nursing home care.
  • You must be enrolled in both Part A and Part B to have full basic Medicare coverage, though you can decline Part B if you have other insurance.
  • Both parts require you to pay a share of costs — a deductible, copayments, or coinsurance — so your actual out-of-pocket expense depends on the type of care and where you receive it.

What Part A and Part B do not cover

Medicare Part A and Part B together have significant gaps. Neither covers dental work, including cleanings, fillings, root canals, or dentures. Vision care — eye exams for glasses or contacts, eyeglasses, and contact lenses — is not covered. Hearing aids and hearing exams are not covered, though some preventive hearing tests may be.

Long-term custodial care in a nursing home is not covered by Part A or Part B. Part A covers skilled nursing care for a limited time after a hospital stay, but if you need ongoing help with daily activities like bathing, dressing, and eating — and no skilled medical care — that is custodial care and Medicare does not pay for it. Many people confuse this distinction and assume Medicare will cover a nursing home indefinitely.

Routine foot care, including toenail trimming, is not covered unless you have diabetes or a related condition. Cosmetic surgery is never covered. Most over-the-counter medications are not covered, though some prescription drugs are covered under Part D if you enroll in a prescription drug plan.

How costs work under Part A and Part B

Part A is free for most people who paid Medicare taxes while working. You do not pay a monthly premium for Part A, but you do pay a deductible when you are admitted to a hospital. The deductible amount changes each year and covers your first 60 days of hospitalization per benefit period. If your hospital stay lasts longer than 60 days, you pay a daily coinsurance amount for days 61 through 90, and a higher daily amount for days 91 through 150.

Part B requires a monthly premium, which most people pay through Social Security. The standard premium changes each year. You also pay a yearly deductible before Part B coverage starts, and then you typically pay 20 percent of the cost of covered services after that. For example, if your doctor visit costs $100 and you have met your deductible, you pay $20 and Part B pays $80.

Some services have different cost-sharing rules. Preventive care — annual wellness visits, cancer screenings, vaccinations — is covered at no cost to you after you meet your Part B deductible. Mental health visits follow the same 20 percent coinsurance as other doctor visits. Outpatient surgery may have a copayment instead of coinsurance, depending on the facility and the procedure.

Part A and Part B versus Medigap and Medicare Advantage

Original Medicare — Part A and Part B together — leaves you responsible for deductibles, coinsurance, and copayments. Many people buy additional coverage to reduce these costs. Medigap (also called Supplemental Insurance) is a private insurance policy that pays some or all of the costs that Part A and Part B do not cover. Medigap does not cover dental, vision, or hearing, but it can reduce or eliminate your deductible and coinsurance.

Medicare Advantage (Part C) is an alternative to Original Medicare. Instead of Part A and Part B, you enroll in a private insurance plan that must cover everything Part A and Part B cover, but often includes dental, vision, and hearing benefits. Medicare Advantage plans usually have lower premiums and out-of-pocket limits than Original Medicare plus Medigap, but they typically require you to use doctors and hospitals in their network.

If you choose Original Medicare, you can enroll in Part D (prescription drug coverage) separately. If you choose Medicare Advantage, prescription drug coverage is usually included in the plan.

When Part A and Part B coverage begins and ends

Part A and Part B coverage begins on the first day of the month you turn 65, if you enroll during your initial enrollment period. Your initial enrollment period is the seven-month window that starts three months before the month you turn 65 and ends three months after. If you delay enrolling in Part B past this window, you may pay a penalty for as long as you have Medicare.

If you are still working and have health insurance through your employer, you may be able to delay Part B enrollment without penalty, but you must tell Medicare that you have group health coverage. Part A enrollment cannot usually be delayed without penalty.

Coverage continues as long as you pay your Part B premium and remain a U.S. citizen or permanent resident. You can drop Part B during the annual enrollment period (October 15 to December 7 each year) if you have other insurance, but dropping Part A is not usually an option.

Frequently Asked Questions

Does Part A or Part B cover my doctor's visit if I go to the emergency room?

Yes, Part B covers emergency room visits. If the emergency room doctor decides you need to be admitted to the hospital, Part A takes over and covers your inpatient stay. If you are treated and released the same day, Part B covers the emergency room visit and any tests or procedures done there, and you pay your coinsurance.

What happens if I need physical therapy after surgery?

Part B covers physical therapy ordered by your doctor, typically for up to 42 visits per year, though your doctor can request more if medically necessary. You pay 20 percent coinsurance after you meet your Part B deductible. The therapy can happen in an outpatient clinic, a hospital, or your home.

Does Part A cover the cost of my medications while I am in the hospital?

Yes. Part A covers medications administered to you during a hospital stay — injections, IV medications, and oral medications given by hospital staff. Medications you take yourself at home are not covered by Part A or Part B; those are covered by Part D if you enroll in a prescription drug plan.

If I have both Part A and Part B, do I need anything else?

Part A and Part B cover basic hospital and doctor care, but they leave gaps. You may want Part D for prescription drugs, Medigap to reduce out-of-pocket costs, or Medicare Advantage for broader coverage including dental and vision. The choice depends on your health needs and budget.

Can I use any doctor with Part B, or do I have to use a specific network?

With Original Medicare Part B, you can see any doctor or specialist who accepts Medicare, anywhere in the country. There is no network restriction. However, some doctors do not accept Medicare, so it is worth confirming before your visit.