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

Medicare Part A is hospital insurance. It pays for inpatient hospital stays (when you are admitted and stay overnight), care in a skilled nursing facility after a hospital stay, hospice care for terminal illness, and some home health services. Part A does not pay for outpatient doctor visits, prescription drugs, dental work, vision care, or hearing aids.

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, though this amount changes yearly. After you meet the deductible, Part A covers all approved 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 coverage becomes limited.

For skilled nursing facilities (nursing homes where you receive medical care, not just information with daily living), Part A covers the first 20 days at no cost after a may have access to hospital stay of at least three days. Days 21 through 100 require a daily copay. Part A does not cover custodial care — help with bathing, dressing, or meals when medical care is not the main reason for the stay.

Medicare Part B covers doctor visits, outpatient care, tests, and some equipment

Medicare Part B is medical insurance. It pays for visits to doctors and specialists, outpatient hospital services (emergency room, surgery center, lab tests), diagnostic tests like X-rays and blood work, physical therapy and occupational therapy, mental health counseling, and durable medical equipment like wheelchairs and oxygen. Part B also covers some preventive services at no cost, including annual wellness visits, cancer screenings, and vaccines.

Part B has a monthly premium (the amount you pay to have the coverage), a yearly deductible, and then a 20 percent coinsurance — you pay 20 percent of the approved cost and Medicare pays 80 percent. In 2024, the standard Part B premium is $164.90 per month and the deductible is $240 per year, though both vary by income and change annually. If you delay signing up for Part B when you first become may be able to access, you may face a permanent penalty on your premium.

Part B does not cover prescription drugs (that is Part D), dental work, vision care, hearing aids, or routine foot care. It also does not cover cosmetic surgery or most treatments outside the United States.

Key Takeaways

  • Part A covers hospital stays, skilled nursing care after hospitalization, and some home health services, with a deductible per benefit period and daily copays for longer stays.
  • Part B covers doctor visits, outpatient services, tests, and preventive care, with a monthly premium, yearly deductible, and 20 percent coinsurance after the deductible is met.
  • Neither Part A nor Part B covers prescription drugs, dental, vision, hearing aids, or long-term custodial care in a nursing home.
  • Part A and Part B together cover roughly 80 percent of approved medical costs, leaving you responsible for deductibles, copays, coinsurance, and services they do not cover.

What Part A and Part B do not cover

The gap between what Medicare covers and what healthcare actually costs is significant. Part A and Part B do not pay for prescription medications — that coverage comes from Part D (prescription drug insurance) or a separate plan. They do not cover dental work, eye exams, eyeglasses, hearing tests, or hearing aids. Long-term care in a nursing home (custodial care) is not covered, though skilled nursing care for a limited time after a hospital stay is.

Part A and Part B also do not cover routine foot care, most chiropractic care, acupuncture, or most treatments you receive outside the United States. If you travel abroad, you are responsible for the full cost of any medical care you receive there. Some preventive services are covered at no cost, but many screening tests and treatments require you to pay part of the cost.

This is why many people buy supplemental insurance (called Medigap) to cover the gaps, or choose Medicare Advantage plans that bundle Part A, Part B, and often Part D into one plan with different cost structures.

How deductibles and copays work under Part A and Part B

Part A uses a benefit period model rather than a calendar year. Each time you are admitted to the hospital, a new benefit period begins. You pay the Part A deductible ($1,632 in 2024) once per benefit period, no matter how many times you are admitted during that period. If you are discharged and readmitted more than 60 days later, a new benefit period starts and you owe a new deductible.

Part B works on a calendar year. You pay the deductible once per year (January through December). After you meet it, Medicare covers 80 percent of approved costs and you pay 20 percent coinsurance. This coinsurance applies to most services — doctor visits, tests, procedures — but not to preventive services, which are covered at 100 percent after the deductible.

The amounts you owe depend on whether your provider is in-network (accepts Medicare) or out-of-network. In-network providers agree to accept Medicare's approved amount as payment in full. Out-of-network providers can charge more, and you may owe the difference. Always ask whether a provider accepts Medicare before scheduling.

Preventive services covered at no cost

Medicare Part B covers certain preventive services at no cost — you do not pay the deductible or coinsurance. These include an annual wellness visit with your primary care doctor, colorectal cancer screening (colonoscopy or other approved tests), breast cancer screening (mammogram), cervical cancer screening (Pap test), prostate cancer screening (PSA test), cardiovascular disease screening, diabetes screening, bone density screening, and vaccines including flu, pneumonia, and shingles.

To receive these services at no cost, you must use an in-network provider and the service must be ordered as preventive care, not diagnostic care. If your doctor finds something during a preventive visit and orders follow-up testing, that follow-up may not be free. Ask your doctor whether a service is being billed as preventive or diagnostic before you proceed.

When Part A and Part B coverage ends or changes

Part A and Part B coverage continues as long as you pay your premiums and remain enrolled. However, coverage for specific services can end. For example, Part A covers skilled nursing care for up to 100 days per benefit period, but only if you were hospitalized for at least three days first. If you do not meet that requirement, Part A does not cover the nursing home stay at all.

Part B coverage for therapy services (physical therapy, occupational therapy, speech therapy) is limited. Medicare sets a dollar limit on how much it will pay per year for these services combined, though this limit is periodically adjusted. Once you reach the limit, you pay the full cost unless your doctor documents medical necessity for continued treatment.

If you move out of the United States, your Part A and Part B coverage generally continues, but you cannot use it to pay for care received outside U.S. territory. If you are out of the country for more than six months, you may lose coverage and have to re-enroll when you return.

Frequently Asked Questions

Do I have to pay anything if I use a preventive service?

No, if the service is classified as preventive and you use an in-network provider, you pay nothing — no deductible, no coinsurance. However, if your doctor orders additional testing or treatment based on what is found during the preventive visit, that follow-up care may not be free. Ask your doctor in advance whether any follow-up is likely to be billed as diagnostic rather than preventive.

What happens if I go to a doctor who does not accept Medicare?

You can still see an out-of-network doctor, but you will likely pay more. Out-of-network providers can charge above Medicare's approved amount, and you are responsible for the difference. Medicare will still pay its share of the approved amount, but you pay both your coinsurance (20 percent) and any amount above the approved rate. Always confirm a provider accepts Medicare before scheduling.

Does Part A or Part B cover nursing home care?

Part A covers skilled nursing care (medical care in a nursing home) for up to 100 days per benefit period, but only after a hospital stay of at least three days. It does not cover custodial care — help with daily living when medical care is not the main reason for the stay. Long-term custodial care is not covered by Medicare and must be paid out of pocket or through long-term care insurance.

What if my doctor prescribes a medication?

Part A and Part B do not cover prescription drugs. You need Part D (prescription drug insurance) or a Medicare Advantage plan that includes drug coverage. If you do not have drug coverage and delay signing up for Part D when you first become may be able to access, you may face a permanent penalty on your premium when you do enroll.

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

No. Part A and Part B do not pay for medical care received outside the United States, with very limited exceptions for emergency care in Canada or Mexico when you are traveling directly between parts of the U.S. If you travel internationally, you are responsible for the full cost of any medical care you receive. Consider travel insurance if you plan extended trips abroad.