Medicare Part A covers hospital stays, skilled nursing, and hospice care

Medicare Part A is hospital insurance. It pays for inpatient hospital care, stays in a skilled nursing facility after a hospital stay, hospice care for people with terminal illness, and some home health services. You do not pay a monthly premium for Part A if you or your spouse paid Medicare taxes for at least 10 years while working.

Part A has a deductible you pay once per benefit period — a benefit period starts when you enter the hospital and ends 60 days after you leave. In 2024, that deductible is $1,632 for each benefit period. After you meet the deductible, Medicare pays all covered hospital costs for the first 60 days. Days 61 through 90 require a daily copay. Beyond 90 days, you pay a much higher daily amount, and Medicare covers only a limited number of lifetime reserve days.

For skilled nursing facilities, Part A covers up to 100 days per benefit period, but only if you spent at least three days in the hospital first. Medicare pays all costs for the first 20 days. Days 21 through 100 require a daily copay. Many people assume Part A covers long-term nursing home care — it does not. Once your skilled nursing stay ends, you pay out of pocket unless you have additional coverage.

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

Medicare Part B is medical insurance. It covers doctor visits, outpatient hospital services, diagnostic tests, physical therapy, mental health services, and durable medical equipment like wheelchairs and oxygen. Part B also covers preventive services such as annual wellness visits, cancer screenings, and vaccinations at no cost to you.

Part B requires a monthly premium, which varies by income. In 2024, the standard premium is $164.90 per month for most people, but higher earners pay more. You also pay a yearly deductible — $240 in 2024 — before Medicare starts paying. After you meet the deductible, you typically pay 20 percent of the cost for most services, and Medicare pays 80 percent. For office visits to your doctor, you may pay a fixed copay instead of a percentage.

Part B does not cover routine dental care, vision exams for glasses or contacts, hearing aids, or long-term care. It also does not cover prescription drugs — that is Part D. Understanding what Part B excludes matters because many seniors assume their coverage is broader than it actually is.

Key Takeaways

  • Part A covers hospital stays, skilled nursing facility care after hospitalization, and hospice, with no monthly premium if you worked and paid Medicare taxes for 10 years.
  • Part B covers doctor visits, outpatient services, and preventive care, and requires a monthly premium and a yearly deductible before Medicare begins to pay.
  • Part A has limits: hospital coverage ends after 90 days unless you use lifetime reserve days, and skilled nursing coverage ends after 100 days per benefit period.
  • Neither Part A nor Part B covers dental, vision, hearing aids, long-term nursing home care, or prescription drugs.
  • You pay a deductible and copays or coinsurance under both parts, so your actual out-of-pocket costs depend on the type and length of care you receive.

How Part A and Part B work together

Part A and Part B are designed to work as a pair, but they cover different settings. Part A pays for care you receive as an inpatient — admitted to a hospital or nursing facility overnight. Part B pays for care you receive as an outpatient — you go to a doctor's office, clinic, or hospital for a procedure and go home the same day.

The same hospital can bill Part A for an inpatient stay and Part B for outpatient services on different days. For example, if you go to the emergency room and are sent home, Part B covers the ER visit. If you are admitted to the hospital, Part A takes over. This distinction matters for your costs: Part A has a deductible per benefit period, while Part B has a yearly deductible that resets January 1.

Many people have both parts automatically. If you start receiving Social Security at 65, Medicare Part A and Part B enroll you without you asking. If you delay Social Security, you must sign up for Part B during your initial enrollment window or pay a penalty for late enrollment.

What you pay out of pocket under Part A and Part B

Your costs depend on what type of care you receive and how long you need it. For a brief hospital stay, you pay the Part A deductible and then nothing more for up to 60 days. For a longer stay, daily copays add up quickly. For outpatient care, you pay 20 percent coinsurance after you meet the Part B deductible, which can be substantial if you need expensive tests or procedures.

Many seniors buy Medigap insurance (also called supplemental insurance) to cover the deductibles, copays, and coinsurance that Part A and Part B do not pay. Medigap plans are sold by private insurance companies and have their own monthly premiums. Others choose Medicare Advantage (Part C), an alternative to Original Medicare that combines Part A and Part B coverage through a private plan, usually with lower premiums but restricted networks.

Keeping track of what you have paid toward your deductible is important. Medicare sends you an Explanation of Benefits (EOB) after each service. Your EOB shows what Medicare paid, what you owe, and how much of your deductible you have met. Save these documents so you know when you have reached your deductible and can stop paying it.

Services Part A and Part B do not cover

Part A does not cover routine nursing home care, assisted living, or custodial care — help with bathing, dressing, and eating when skilled nursing is not needed. It also does not cover private duty nurses or home care aides unless you are homebound and a doctor orders skilled care. Many families are surprised to learn that Part A's skilled nursing benefit ends quickly, leaving them to pay thousands per month for ongoing care.

Part B excludes routine dental work, eye exams for glasses, hearing aids, and most routine foot care. It does not cover weight loss programs, cosmetic surgery, or acupuncture (with rare exceptions). Prescription drugs are covered under Part D, not Part B. If you need these services, you must pay out of pocket or purchase separate coverage.

Neither part covers care received outside the United States, except in limited circumstances near the border. If you travel internationally, you may want to purchase travel health insurance. Understanding these gaps helps you plan for costs that Medicare will not cover.

When to contact Medicare or your doctor

Contact Medicare if you receive a bill you believe Part A or Part B should have paid, if you are unsure whether a service is covered before you receive it, or if you need help understanding your Explanation of Benefits. You can call Medicare at 1-800-MEDICARE (1-800-633-4227) or visit Medicare.gov. Have your Medicare card handy.

Ask your doctor's office before a procedure or test whether it is covered by Part B and what your out-of-pocket cost will be. Many offices can tell you on the spot. If the office is unsure, they can contact Medicare to verify coverage. Getting this information before the service protects you from surprise bills.

Seek when ready care if you have chest pain, difficulty breathing, sudden weakness, or other signs of a medical emergency. Part A covers emergency room visits whether you are admitted or sent home. Do not delay emergency care because of cost concerns — address the bill afterward.

Frequently Asked Questions

Does Part A cover nursing home care for as long as I need it?

No. Part A covers skilled nursing facility care for up to 100 days per benefit period, and only if you spent at least three days in the hospital first. After 100 days, you pay the full cost. Long-term nursing home care is not covered by Medicare. You would need to pay out of pocket, use Medicaid if you may have access to, or have long-term care insurance.

What is the difference between Part A and Part B deductibles?

Part A has a deductible per benefit period (a benefit period starts when you enter the hospital and ends 60 days after discharge). Part B has a yearly deductible that resets January 1. You pay each deductible once, then Medicare begins to pay its share. The amounts change yearly.

Do I have to pay for preventive services under Part B?

No. Medicare Part B covers many preventive services at no cost, including annual wellness visits, cancer screenings, vaccinations, and blood pressure checks. You pay nothing if the service is preventive and your doctor does not find a problem. If the visit leads to treatment for a condition, you may owe a copay or coinsurance.

Can I use Part A and Part B outside the United States?

Generally no. Medicare does not cover care received outside the U.S., except in limited cases near the Canadian or Mexican border. If you travel internationally, you should purchase travel health insurance before you leave. Some Medigap plans offer limited emergency coverage abroad.

What happens if I do not sign up for Part B when I turn 65?

You may have to pay a penalty for late enrollment. The penalty is 10 percent of your Part B premium for each full year you were may be able to access but did not sign up. This penalty is permanent and added to your monthly premium for life. You can sign up during the General Enrollment Period (January 1 to March 31 each year), but the penalty applies unless you have a may have access to reason for the delay.