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

Medicare Part A is hospital insurance. It pays for inpatient hospital care — meaning you stay overnight — plus skilled nursing facilities, hospice care, 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 covers the cost of your hospital room, meals, nursing care, and most medicines and supplies you receive while admitted. If you need to move to a skilled nursing facility after a hospital stay — for example, to recover from surgery or a stroke — Part A covers up to 100 days, though you pay a daily amount after day 20. Hospice care, which focuses on comfort rather than cure for people with a terminal illness, is also covered.

Home health care is covered when a doctor orders it and you are homebound — meaning leaving home is difficult and requires help. A nurse or therapist visits your home to provide skilled care. This is different from help with daily tasks like bathing or cooking, which Part A does not cover.

Medicare Part B covers doctor visits, outpatient care, tests, and preventive services

Medicare Part B is medical insurance. It covers visits to doctors and specialists, outpatient hospital services (you go in and out the same day), lab tests, imaging like X-rays and ultrasounds, and preventive care such as screenings and vaccines. You pay a monthly premium for Part B, which varies by income.

Part B pays for services in a doctor's office, urgent care clinic, hospital outpatient department, or your home if a doctor visits. It covers mental health counseling, physical therapy, and occupational therapy. Preventive services — like mammograms, colonoscopies, blood pressure checks, and flu shots — are covered at no cost to you when you see an in-network provider.

Part B also covers durable medical equipment such as wheelchairs, walkers, oxygen equipment, and diabetic supplies. You typically pay 20 percent of the cost after you meet your yearly deductible; Medicare pays 80 percent.

Key Takeaways

  • Part A covers overnight hospital stays, skilled nursing facilities for up to 100 days after hospitalization, hospice care, and home health services ordered by a doctor.
  • Part B covers doctor visits, outpatient services, lab tests, imaging, preventive care, mental health counseling, therapy, and durable medical equipment.
  • Part A has no monthly premium if you paid Medicare taxes for 10 years; Part B requires a monthly premium based on your income.
  • Both parts require you to pay deductibles and coinsurance amounts, and both cover only services from in-network providers unless you have a supplemental plan.
  • Neither Part A nor Part B covers dental, vision, hearing aids, long-term custodial care, or prescription drugs — you may need separate coverage for these.

What Part A and Part B do not cover

Part A does not cover custodial care — help with bathing, dressing, toileting, and meals — even if you receive it at home or in a nursing home. It also does not cover prescription drugs, dental work, vision care, hearing aids, or routine foot care. If you need ongoing help with daily living tasks, you may need to pay out of pocket or look into Medicaid, which has different rules.

Part B does not cover routine dental cleanings, eyeglasses, hearing aids, or most cosmetic procedures. It also does not pay for prescription drugs filled at a pharmacy. Many people add Part D (prescription drug coverage) or a Medigap (supplemental) plan to cover these gaps.

How much you pay out of pocket with Part A and Part B

With Part A, you pay a deductible for each hospital stay — the amount changes yearly. After you pay this, Part A covers all costs for days 1 through 60. For days 61 through 90, you pay a daily coinsurance amount. If you stay longer than 90 days, you can use lifetime reserve days, but you pay more per day. For skilled nursing facilities, you pay nothing for days 1 through 20, then a daily amount for days 21 through 100.

With Part B, you pay a yearly deductible, then 20 percent of the cost of most services after that. Medicare pays the other 80 percent. For preventive services with no deductible — like cancer screenings and vaccines — you pay nothing if you see an in-network provider.

These amounts change each year. You can find the current deductibles and coinsurance amounts on Medicare.gov or by calling 1-800-MEDICARE.

In-network providers and what happens if you see someone out of network

Part A and Part B both pay more when you use in-network providers — doctors, hospitals, and clinics that have agreed to accept Medicare's payment. If you see an out-of-network provider, you may pay more out of pocket, and the provider may bill you for the difference between what they charge and what Medicare pays.

To find in-network providers, use the Medicare Provider Search tool on Medicare.gov. You can search by location and specialty. Before scheduling an appointment or procedure, it is worth checking whether the provider is in-network, especially for expensive services.

When Part A and Part B start and how to avoid penalties

Part A and Part B coverage normally start on the first day of the month you turn 65, as long as you sign up during your Initial Enrollment Period. This period runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after.

If you delay signing up for Part B after your Initial Enrollment Period ends, you may pay a penalty for as long as you have Part B. The penalty is a percentage added to your monthly premium. There are some exceptions — for example, if you are still working and have health insurance through your job, you may be able to delay without penalty — but you must report this to Medicare.

If you are already receiving Social Security when you turn 65, you are automatically signed up for Part A and Part B. If you are not receiving Social Security, you need to sign up yourself through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

Frequently Asked Questions

Do I have to take Part B, or can I just have Part A?

You can have Part A without Part B, but most people take both. If you delay Part B and later change your mind, you may owe a penalty. The exception is if you are still working and have health insurance through your job — you can delay Part B without penalty, but you must tell Medicare.

What is the difference between Part A and Part B and a Medigap plan?

Part A and Part B are your basic Medicare coverage. A Medigap (supplemental) plan is separate insurance you buy from a private company to help pay the deductibles, coinsurance, and copays that Part A and Part B do not cover. It is not the same as Medicare Advantage, which is an alternative way to get Part A and Part B coverage.

Does Part B cover my doctor's office visit if I have not met my deductible yet?

No. You pay the full cost of the visit until you meet your yearly Part B deductible. After that, you pay 20 percent and Medicare pays 80 percent. Preventive services like screenings and vaccines are an exception — these have no deductible and cost you nothing with an in-network provider.

If I have Part A and Part B, am I covered for prescription drugs?

No. Part A and Part B do not cover prescription drugs filled at a pharmacy. You need to add Part D (prescription drug coverage) or join a Medicare Advantage plan that includes drug coverage. You can add Part D during your Initial Enrollment Period or during the annual open enrollment period in the fall.

Can I use my Part A and Part B coverage at any hospital or doctor's office?

Part A and Part B work at any hospital or provider that accepts Medicare, but you pay less if you use in-network providers. Out-of-network providers may charge you more. Use the Medicare Provider Search tool on Medicare.gov to check whether a hospital or doctor is in-network before you schedule care.