Medicare covers hospital stays, doctor visits, and preventive care, but not everything

Medicare is divided into four parts, and each covers different things. Part A covers hospital stays and skilled nursing care. Part B covers doctor visits, outpatient care, and some equipment. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative to A and B offered by private insurers. What you pay depends on which parts you have and which services you use.

The biggest gap most people face is that Medicare does not cover dental, vision, hearing aids, or long-term custodial care — the kind of help you need at home or in a facility when you cannot manage daily tasks on your own. Many people buy a Medigap policy (supplemental insurance) to cover costs Medicare leaves behind, or they choose a Medicare Advantage plan that may include some of those extras.

Key Takeaways

  • Part A covers hospital inpatient stays, skilled nursing facility care after hospitalization, hospice, and some home health services with no monthly premium if you paid Medicare taxes for 10 years.
  • Part B covers doctor office visits, outpatient surgery, diagnostic tests, and preventive screenings, and costs about $165 per month in 2024 (the amount changes yearly).
  • Part D covers prescription drugs through a plan you choose, and the cost varies by plan and by which drugs you take.
  • Medicare does not cover dental, vision, hearing aids, long-term care, or most routine foot care, and you will pay the full cost for these unless you have a separate plan.
  • A Medigap policy or Medicare Advantage plan can cover some or all of the gaps, but each has different rules about which doctors you can see and which hospitals you can use.

What Part A covers: hospital and facility care

Part A covers inpatient hospital stays — meaning you are admitted and stay overnight. It pays for your room, meals, nursing care, and most tests and procedures done while you are in the hospital. You pay a deductible (a set amount you pay before Medicare starts paying) for each hospital stay. In 2024, that deductible is $1,676 per stay, but this amount changes each year.

Part A also covers skilled nursing facility care after a hospital stay — but only if you were hospitalized for at least three days first, and only if the care is for the same condition you were hospitalized for. It covers up to 100 days per stay. You pay nothing for days 1 through 20, and a daily amount (about $209 per day in 2024) for days 21 through 100.

Part A covers home health services if a doctor says you are homebound and need skilled care — such as a nurse visiting to manage wounds or check your heart rhythm. It does not cover help with bathing, dressing, or meals unless skilled care is also being provided. Part A also covers hospice care if you have a terminal illness and choose comfort care instead of treatment.

What Part B covers: doctor visits and outpatient care

Part B covers doctor office visits, whether your doctor is in a hospital, clinic, or private practice. It covers diagnostic tests ordered by your doctor — blood work, X-rays, ultrasounds — and outpatient surgery. It also covers preventive services at no cost to you: annual wellness visits, cancer screenings (mammogram, colonoscopy, Pap test), cardiovascular screening, diabetes screening, bone density testing, and vaccines (flu, pneumonia, shingles, COVID-19).

Part B covers some medical equipment and supplies: wheelchairs, walkers, oxygen, diabetic testing supplies, and some others. It covers mental health visits — both therapy and psychiatry — at the same rate as physical health visits. It covers physical therapy, occupational therapy, and speech therapy if ordered by your doctor.

You pay a monthly premium for Part B (about $165 in 2024), a yearly deductible (about $240 in 2024), and then 20 percent of the cost of most services after that. Your doctor's office or the facility will bill Medicare first, and Medicare will tell you what you owe.

What Part D covers: prescription drugs

Part D is prescription drug coverage, and you choose which plan to join from a list of private insurers. Different plans cover different drugs at different costs. When you sign up for Medicare at 65, you have a window to join a Part D plan without penalty. If you wait and join later, you may pay a higher premium for as long as you have Part D.

Each Part D plan has a formulary — a list of drugs it covers — and you can search your plan's formulary on Medicare.gov before you join. Plans usually charge a monthly premium, a yearly deductible, and a copay or coinsurance (a percentage of the drug cost) when you fill a prescription. The costs vary widely by plan and by drug.

If you have limited income, you may be able to get help paying Part D premiums and copays through a program called Extra Help. You can learn whether you may be may be able to access by contacting Social Security or visiting Medicare.gov.

What Medicare does not cover

Dental care — including cleanings, fillings, root canals, and dentures — is not covered by any part of Medicare. Some Medicare Advantage plans include dental benefits, but they usually have limits on what they pay. Many people buy a separate dental plan or pay out of pocket.

Vision care — eye exams, glasses, and contact lenses — is not covered. Medicare covers cataract surgery (removal of the clouded lens) and treatment for eye diseases like glaucoma, but not the glasses you need afterward. Some Medicare Advantage plans include vision benefits.

Hearing aids are not covered, though Medicare does cover hearing tests ordered by a doctor. Hearing aids can cost hundreds to thousands of dollars. Some states offer hearing aid programs for older adults with low income; your local Area Agency on Aging can tell you whether your state does.

Long-term care — help with bathing, dressing, eating, and toileting at home or in a facility — is not covered by Medicare, even if you need it for years. Medicaid covers long-term care for people with low income and assets, but Medicare does not. Some people buy long-term care insurance years before they need it, and others plan to pay out of pocket or rely on family.

Medicare also does not cover routine foot care (unless you have diabetes), most cosmetic surgery, weight loss surgery, acupuncture, or routine dental work.

How Medigap and Medicare Advantage fill the gaps

A Medigap policy (also called supplemental insurance) is sold by private insurers and works alongside Original Medicare (Parts A and B). It pays some or all of the costs Medicare leaves behind — deductibles, copays, and coinsurance. There are ten standardized Medigap plans, labeled A through N, and each covers a different combination of costs. Plan G, for example, covers the Part B deductible and 20 percent coinsurance for most services. Plan N covers coinsurance but not the deductible.

You can buy a Medigap policy anytime, but the best time is within six months of turning 65 and enrolling in Part B. During this window, insurers cannot turn you down or charge you more because of health problems. After this window closes, insurers can deny you or charge higher premiums based on your health history.

Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurers like UnitedHealthcare, Humana, and Aetna. It includes Parts A, B, and usually D in one plan. Many Medicare Advantage plans include dental, vision, and hearing benefits that Original Medicare does not. However, Medicare Advantage plans usually have networks — you must use doctors and hospitals in the plan's network, or pay more. Plans also often require referrals to see specialists.

Medicare Advantage plans have out-of-pocket maximums, meaning once you spend a certain amount on copays and coinsurance in a year, the plan pays 100 percent of covered services for the rest of the year. Original Medicare has no out-of-pocket maximum, which is why many people buy Medigap.

Understanding your costs: deductibles, copays, and coinsurance

Medicare uses three ways to charge you for services. A deductible is an amount you pay before Medicare starts paying. Part A has a deductible per hospital stay. Part B has a yearly deductible. After you meet the deductible, you usually pay coinsurance — a percentage of the cost. For most Part B services, you pay 20 percent and Medicare pays 80 percent.

A copay is a flat amount you pay for a specific service — for example, $15 for a doctor visit or $5 for a prescription. Medicare Advantage plans use copays more often than Original Medicare does. If you have a Medigap policy, it usually covers your deductibles and coinsurance, so you may have little or no out-of-pocket cost.

Your costs also depend on whether your doctor accepts Medicare. Most doctors do, but some do not. If your doctor does not accept Medicare, you will pay the full bill and Medicare will not reimburse you. Before you see a new doctor, ask whether they accept Medicare.

Frequently Asked Questions

Does Medicare cover my annual physical exam?

Yes. Part B covers one "Welcome to Medicare" preventive visit in your first year of coverage, and one annual wellness visit after that. These visits are free — you pay nothing. The visit includes a health history, measurements, and screening tests. However, if your doctor does additional work during the visit (such as treating a new problem), you may be charged for that additional work.

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

Original Medicare does not cover care outside the U.S., except in very limited cases (Canada and Mexico in certain border situations). Medicare Advantage plans vary — some cover emergency care worldwide, and some do not. If you travel internationally, ask your plan what is covered before you leave, and consider travel insurance that includes medical care.

Do I have to pay for preventive services like cancer screenings?

No. Medicare Part B covers preventive services — mammograms, colonoscopies, Pap tests, blood pressure checks, diabetes screening, and vaccines — at no cost to you. You pay nothing for the service itself, though you still pay your Part B premium. If your doctor finds something during a preventive visit and treats it, you may be charged for that treatment.

Can I switch from Original Medicare to Medicare Advantage or back again?

Yes, during the Annual Enrollment Period (October 15 to December 7 each year), you can switch plans. You can also switch during the Medicare Advantage Open Enrollment Period (January 1 to March 31). If you switch from Original Medicare to Medicare Advantage, you lose your Medigap coverage, so understand what you are giving up before you switch.

What if I cannot afford my Medicare premiums and copays?

If your income is low, you may be able to get help through programs like Medicaid (which varies by state), the Medicare Savings Program, or Extra Help for Part D. Contact your local Social Security office or your state Medicaid agency to learn what programs may be available in your state.