The Core of Basic Medicare: Hospital and Doctor Visits

Basic Medicare — officially called Original Medicare — covers three main categories: hospital stays, doctor visits, and some preventive care. It does not cover everything, and understanding what is and is not included helps you plan for out-of-pocket costs and decide whether you need additional coverage.

Medicare Part A pays for inpatient hospital care, skilled nursing facility stays after a hospital stay, hospice care, and some home health services. Medicare Part B pays for doctor office visits, outpatient procedures, lab tests, imaging, and durable medical equipment like wheelchairs or oxygen. Together, these two parts form the foundation of basic coverage.

You pay a deductible before Medicare starts paying, and you share the cost of care after that through copayments and coinsurance. The exact amounts change each year. For 2024, Part A has a deductible of $1,632 per hospital stay, and Part B has a deductible of $240 per year, though these figures vary annually.

Key Takeaways

  • Part A covers hospital stays, skilled nursing care after hospitalization, and hospice; Part B covers doctor visits, outpatient care, and some equipment.
  • Basic Medicare does not cover dental, vision, hearing aids, or most prescription drugs — you need separate coverage for these.
  • You pay a deductible each year and share costs through copayments and coinsurance for most services.
  • Preventive services like cancer screenings and vaccines are covered at no cost to you if you see an in-network provider.
  • If you travel outside the United States, basic Medicare generally does not cover care received abroad.

What Part A Covers: Hospital and Facility Care

Part A covers the full cost of your hospital room, meals, nursing care, and necessary medications and supplies while you are admitted as an inpatient. An inpatient stay means you are formally admitted to the hospital, not just treated in the emergency room or observation unit. The coverage includes semi-private rooms, intensive care, and emergency room visits that lead to admission.

After a hospital stay, Part A also covers up to 100 days in a skilled nursing facility if you need rehabilitation — physical therapy, occupational therapy, or skilled nursing care. You must have been hospitalized for at least three consecutive days first, and the care must be for the same condition that caused the hospitalization. Part A pays the full cost for the first 20 days, then you pay a daily coinsurance amount (in 2024, $204 per day) for days 21 through 100.

Part A covers hospice care for people with a terminal illness expected to live six months or less. It pays for pain management, symptom relief, counseling, and some medications and equipment. Part A also covers some home health services — nursing visits, physical therapy, and medical equipment — if you are homebound and your doctor orders the care.

What Part B Covers: Doctor Visits and Outpatient Care

Part B covers visits to your primary care doctor, specialists, and other healthcare providers. It pays for office visits, emergency room care that does not result in admission, urgent care visits, and outpatient surgery. After you meet your annual deductible, you typically pay 20 percent of the cost for most services, and Medicare pays 80 percent.

Part B also covers diagnostic tests and imaging ordered by your doctor: blood work, X-rays, CT scans, ultrasounds, and EKGs. It covers chemotherapy, dialysis, and radiation therapy. It pays for durable medical equipment — wheelchairs, walkers, oxygen equipment, diabetic supplies — if your doctor prescribes it and you rent or buy it from a Medicare-approved supplier.

Mental health services are covered under Part B at the same rate as physical health services. This includes therapy, psychiatric visits, and counseling for depression, anxiety, and other conditions. Substance abuse treatment is also covered, including inpatient rehabilitation and outpatient programs.

Preventive Services Covered at No Cost

Medicare covers certain preventive services with no deductible or copayment if you see a provider who accepts Medicare. These include annual wellness visits with your primary care doctor, cancer screenings (mammograms, colonoscopies, Pap tests), cardiovascular screenings, bone density scans, diabetes screenings, and vaccines like flu shots, pneumonia vaccines, and shingles vaccines.

Preventive services are covered only when they are ordered as preventive care, not when they are part of treatment for an existing condition. For example, a colonoscopy for screening is free, but a colonoscopy to treat a diagnosed condition is subject to your deductible and coinsurance. Your doctor's office can tell you whether a service is being billed as preventive or diagnostic.

What Basic Medicare Does Not Cover

Basic Medicare does not cover dental care, including cleanings, fillings, extractions, and dentures. It does not cover routine vision care, eyeglasses, contact lenses, or hearing aids. These are significant gaps for many seniors, and you will need to purchase separate coverage or pay out of pocket.

Prescription drugs are not covered by Part A or Part B. You must enroll in a separate Part D prescription drug plan, or your coverage will have a late enrollment penalty if you join later. Long-term care in a nursing home — custodial care for activities of daily living — is not covered. Part A covers skilled nursing care only, which is different from long-term residential care.

Basic Medicare does not cover routine foot care, most acupuncture, most chiropractic care, or experimental treatments not yet approved by the Food and Drug Administration. It does not cover care received outside the United States, except in limited circumstances near the border or on a cruise ship within specific conditions. Cosmetic surgery is not covered unless it is medically necessary to restore function after an injury or illness.

Your Out-of-Pocket Costs Under Basic Medicare

Under basic Medicare, you are responsible for deductibles, copayments, and coinsurance. Part A has a deductible per hospital stay; Part B has an annual deductible. After you meet the deductible, you pay coinsurance — typically 20 percent of the approved amount — for most Part B services. Some services, like office visits, may have a fixed copayment instead.

There is no annual limit on what you pay out of pocket under basic Medicare. If you have a serious illness or injury requiring extensive care, your costs can be very high. Many seniors purchase supplemental insurance (called Medigap) to cover the deductibles and coinsurance that basic Medicare does not pay. Others choose Medicare Advantage plans, which are an alternative to basic Medicare and often include prescription drug coverage and dental or vision benefits.

When to Choose Additional Coverage

If you have basic Medicare and no other coverage, you are responsible for all costs that Medicare does not cover. Consider supplemental insurance if you want predictable costs and do not want to worry about deductibles and coinsurance. Consider a Medicare Advantage plan if you want prescription drug coverage, dental, vision, or hearing benefits included, though these plans typically have networks and may require referrals.

If you have limited income, you may be able to get help paying your Medicare premiums and cost-sharing through programs like the Medicare Savings Program or the Low-Income Subsidy for prescription drugs. Your state Medicaid office or a local Area Agency on Aging can tell you whether you meet the income limits.

Questions to Ask Your Doctor

Before a procedure or service, ask your doctor whether it is covered by Medicare and what your out-of-pocket cost will be. Ask whether the provider accepts Medicare assignment, which means they accept Medicare's approved amount as payment in full. Ask whether a service is being billed as preventive or diagnostic, because that affects your cost. If you are unsure about coverage, call Medicare at 1-800-MEDICARE before the service, and they can tell you what you will owe.

Frequently Asked Questions

Does Medicare cover my annual physical exam?

Yes. Medicare Part B covers one annual wellness visit with your primary care doctor at no cost if the visit is for preventive care and your doctor accepts Medicare. This visit includes a health assessment and a plan for preventive services. If your doctor diagnoses a new condition during the visit and treats it, you may owe a copayment for that treatment.

What happens if I need care while traveling outside the United States?

Basic Medicare does not cover care received outside the United States. If you travel abroad, you will pay the full cost of any medical care you receive. Some seniors purchase travel insurance or supplemental plans that cover emergency care outside the country. If you live part of the year outside the U.S., talk to Medicare about your options.

Do I have to pay anything for preventive screenings like mammograms or colonoscopies?

No, if the screening is ordered as preventive care and your provider accepts Medicare. You pay nothing for the service itself. However, if the doctor finds something during the screening and performs a biopsy or treatment, you may owe a copayment or coinsurance for that additional service.

Can I see any doctor I want with basic Medicare?

Yes, you can see any doctor, hospital, or provider that accepts Medicare. There are no networks or referrals required. However, if a provider does not accept Medicare assignment, they can charge you more than Medicare's approved amount, and you will pay the difference out of pocket.

What is the difference between basic Medicare and Medicare Advantage?

Basic Medicare (Original Medicare) is run by the federal government and covers hospital, doctor, and some preventive care. You can see any provider that accepts Medicare. Medicare Advantage is run by private insurance companies and includes all basic coverage plus usually prescription drugs, dental, and vision. Advantage plans have networks and may require referrals, and your costs depend on the plan you choose.