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

Medicare is divided into four parts, and each covers different things. Part A covers inpatient hospital care, skilled nursing, hospice, and some home health. Part B covers doctor visits, outpatient care, lab tests, and some equipment. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative to Parts A and B offered by private insurers, and coverage varies by plan. What Medicare does not cover includes most dental work, vision care, hearing aids, long-term custodial care, and routine foot care — though some of these gaps can be filled by supplemental insurance or by choosing a Medicare Advantage plan that includes them.

The amount you pay depends on which parts you have, which plan you chose, and whether you have supplemental coverage. Original Medicare (Parts A and B) has deductibles, copayments, and coinsurance. Medicare Advantage plans have their own cost structures, often with lower premiums but higher out-of-pocket limits. Understanding what your specific plan covers before you need care prevents surprises at the doctor's office or pharmacy.

Key Takeaways

  • Part A covers hospital inpatient care and skilled nursing; Part B covers doctor visits and outpatient services; Part D covers prescription drugs; Part C is a private alternative that bundles A and B with different coverage rules.
  • Medicare does not cover dental, vision, hearing aids, long-term custodial care in nursing homes, or routine foot care unless you have a supplemental plan or Medicare Advantage plan that includes these benefits.
  • Original Medicare (Parts A and B) requires you to pay a deductible before coverage starts each year, then copayments or coinsurance for each service.
  • Medicare Advantage plans often charge lower premiums but cap your out-of-pocket spending and may cover services Original Medicare does not, such as dental or gym memberships.
  • You should review your plan's coverage details before scheduling care or filling a prescription, because costs and covered services vary widely between plans.

What Part A (Hospital Insurance) Covers

Part A covers inpatient hospital stays, meaning you are admitted to the hospital and stay overnight. It pays for your room, meals, nursing care, and most hospital services. It also covers up to 100 days in a skilled nursing facility after a hospital stay of at least three days, provided a doctor orders the care and you need skilled nursing or rehabilitation. Part A covers hospice care for people with a terminal illness, and it covers some home health services when ordered by a doctor and provided by a Medicare-approved agency.

Part A does not cover custodial care — help with bathing, dressing, or eating — unless it is part of skilled nursing care you are receiving for another reason. It does not cover private-duty nursing, a private room unless medically necessary, or a television or telephone in your room. If you stay in a skilled nursing facility longer than 100 days, you pay the full cost yourself after day 100.

In 2024, the Part A deductible for a hospital stay is $1,632 per benefit period. You pay this once per benefit period (which typically runs 60 days), then Part A covers 100% of approved hospital costs for days 1–60. Days 61–90 require a daily copayment, and days 91 and beyond require a higher daily copayment. For skilled nursing, you pay nothing for days 1–20, then a daily copayment for days 21–100.

What Part B (Medical Insurance) Covers

Part B covers doctor visits, whether in an office, clinic, or hospital outpatient department. It covers preventive services such as annual wellness visits, cancer screenings, cardiovascular screenings, and vaccinations. It covers lab tests, X-rays, and imaging ordered by a doctor. It covers outpatient surgery, emergency room visits, and urgent care. Part B also covers some medical equipment and supplies — wheelchairs, walkers, oxygen, diabetic testing supplies — when a doctor orders them and a Medicare-approved supplier provides them.

Part B does not cover routine eye exams, eyeglasses, or contact lenses. It does not cover hearing exams or hearing aids. It does not cover most dental work, including cleanings, fillings, and extractions. It does not cover routine foot care, such as trimming toenails, unless you have diabetes and a doctor orders it as part of your diabetes management. It does not cover cosmetic surgery unless it is needed to repair an injury or birth defect.

Part B has an annual deductible of $240 in 2024. After you meet the deductible, you typically pay 20% of the approved amount for most services, and Medicare pays 80%. For some preventive services with no deductible, Medicare pays 100%. If your doctor does not accept Medicare assignment (meaning they do not agree to charge only what Medicare approves), you may owe more than 20%.

What Part D (Prescription Drug Coverage) Covers

Part D covers prescription medications dispensed by a pharmacy. You must choose a Part D plan during your initial enrollment or during the annual open enrollment period in October and November. Each plan has a different formulary — a list of covered drugs — so the same medication may be covered under one plan but not another, or may require a higher copayment under one plan than another.

Part D coverage has stages. You pay a monthly premium year-round. After you meet your deductible (which varies by plan, typically $100–$500), you enter the initial coverage stage and pay a copayment or coinsurance for each prescription. Once you and your plan have spent a combined $5,850 in 2024, you enter the coverage gap (sometimes called the "donut hole"), where you pay a higher percentage of the drug cost. Once your out-of-pocket spending reaches $8,550, you enter catastrophic coverage and pay a small copayment for the rest of the year.

Part D does not cover over-the-counter medications, vitamins, or supplements unless they are prescribed by a doctor and meet specific criteria. It does not cover drugs used for cosmetic purposes, such as hair loss treatments, unless medically necessary. Some plans exclude certain drug classes or require prior authorization from the plan before the pharmacy will fill the prescription.

What Medicare Advantage (Part C) Covers Differently

Medicare Advantage plans are offered by private insurance companies approved by Medicare. They must cover everything Original Medicare (Parts A and B) covers, but they can structure costs differently and add extra benefits. Many Medicare Advantage plans include Part D prescription drug coverage, dental, vision, and hearing benefits built into the plan. Some include gym memberships, meal delivery, or transportation to medical appointments.

The trade-off is that Medicare Advantage plans usually have a network of doctors and hospitals you must use (except in emergencies). If you see a doctor outside the network, you pay more or the plan does not cover the visit. Medicare Advantage plans also have an annual out-of-pocket maximum — once you reach it, the plan pays 100% of covered services for the rest of the year. Original Medicare has no out-of-pocket maximum, which means your costs can be unlimited if you need extensive care.

Medicare Advantage plans change their coverage and costs every year. You can switch plans during the annual open enrollment period (October 15 to December 7) or if you move out of the plan's service area. If you are considering a Medicare Advantage plan, check whether your current doctors are in the network and whether the plan covers the medications you take.

Services Medicare Does Not Cover

Medicare does not cover long-term custodial care in a nursing home or assisted living facility. This is one of the largest gaps in Medicare coverage. If you need help with daily activities — bathing, dressing, eating, toileting — for an extended period, Medicare will not pay for it. Medicaid may cover some of this care if you meet income and asset limits, but Medicare does not. Long-term care insurance, if purchased before you need care, can help cover these costs.

Medicare does not cover dental care, including cleanings, fillings, root canals, dentures, or extractions. It does not cover routine eye exams, eyeglasses, contact lenses, or most vision correction procedures. It does not cover hearing exams or hearing aids, which can cost $1,000 to $6,000 per pair. It does not cover most routine foot care, such as toenail trimming, unless you have diabetes and a doctor orders it as diabetes management.

Medicare does not cover weight loss programs, most acupuncture, or most chiropractic care (though it does cover chiropractic manipulation of the spine in limited cases). It does not cover cosmetic surgery unless medically necessary. It does not cover care received outside the United States, except in limited circumstances near the border. Some of these gaps can be filled by a Medigap (supplemental insurance) plan or by choosing a Medicare Advantage plan that includes these benefits.

How to Find Out What Your Specific Plan Covers

Your plan's coverage details are in your Summary of Benefits and Coverage, a document your plan sends you each year. You can also call your plan's customer service number (on your insurance card) and ask whether a specific service or drug is covered. Medicare.gov has a tool called "Plan Finder" where you can enter your zip code and see all available plans, their costs, and what they cover.

Before you schedule a procedure or fill a prescription, it is worth asking your doctor's office or pharmacy to check your coverage. Many offices have staff who can look up what your plan will pay. If your doctor recommends a service and you are unsure whether it is covered, ask your plan directly. Some services require prior authorization — meaning the plan must approve them before you receive them — and your doctor's office can request this.

If you believe Medicare should cover a service and your plan denied it, you have the right to file an appeal. Your plan's denial letter explains how to appeal and the important date to do so. You can also contact your State Health Insurance information Program (SHIP), a free counseling service, for help understanding your coverage or filing an appeal.

Frequently Asked Questions

Does Medicare cover physical therapy?

Yes, but with limits. Part B covers physical therapy ordered by a doctor for a medical condition, up to a certain number of visits per year. You pay 20% of the approved amount after your deductible. If you need ongoing physical therapy, your plan may limit the number of covered visits, and you may need prior authorization.

Will Medicare pay for my blood pressure medication?

Part D (prescription drug coverage) covers most blood pressure medications, but the copayment depends on which plan you have and which medication your doctor prescribes. Some blood pressure drugs are on the plan's preferred list and cost less; others may require prior authorization or a higher copayment. Check your plan's formulary or call your plan to confirm.

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

Original Medicare does not cover care outside the U.S., except in limited cases near the border (Canada and Mexico). Medicare Advantage plans also typically do not cover overseas care. If you travel internationally, you can purchase travel health insurance for the trip, or you can pay out of pocket and seek reimbursement later if the care was medically necessary.

Can I use my Medicare to see any doctor I want?

With Original Medicare (Parts A and B), yes — any doctor who accepts Medicare can see you. With Medicare Advantage, no — you must use doctors in your plan's network, or pay more or receive no coverage. Check your plan's provider directory before scheduling an appointment to confirm your doctor is in the network.

What should I ask my doctor before a procedure to understand my costs?

Ask whether the procedure is covered by your plan, whether it requires prior authorization, what your copayment or coinsurance will be, and whether the doctor's office is in your plan's network (if you have Medicare Advantage). Ask your doctor's office to check your coverage before the procedure so you know your costs in advance.