What Medicare Covers: Hospital, Doctor, and Prescription Drug Benefits

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

Medicare has four parts, and each one covers different things. Part A covers hospital stays, skilled nursing care, and hospice. Part B covers doctor visits, outpatient care, and medical equipment. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative way to get Parts A and B through a private insurance company, often bundled with Part D and extra benefits. What Medicare does not cover includes dental, vision, hearing aids, long-term custodial care, and most routine foot care.

The coverage you get depends on which parts you have enrolled in and whether you have Original Medicare or a Medicare Advantage plan. Most people pay premiums, deductibles, and copayments or coinsurance for the services they use. Understanding what is covered before you need care helps you plan for costs and know where to go.

Key Takeaways

Part A covers inpatient hospital care, skilled nursing facilities, and hospice; Part B covers doctor visits and outpatient services; Part D covers prescription drugs.
Medicare covers preventive services like annual wellness visits, cancer screenings, and vaccinations at no cost to you when you use an in-network provider.
Dental, vision, hearing aids, and long-term custodial care are not covered by Original Medicare, though some Medicare Advantage plans offer limited dental or vision benefits.
You pay a deductible before Medicare starts paying, then you share costs through copayments or coinsurance for most services.
Out-of-pocket costs vary widely depending on the type of care and your plan; understanding your specific coverage prevents surprise bills.

What Part A covers: Hospital and skilled nursing care

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. You pay a deductible for each benefit period (the amount changes yearly), and then Part A covers all approved costs for the first 60 days. After 60 days, you pay coinsurance — a daily amount you share with Medicare — until day 90. If you stay longer than 90 days, you can use lifetime reserve days, but those are limited.

Part A also covers skilled nursing facility care when you need it after a hospital stay. You must have been in the hospital for at least three consecutive days, and a doctor must order the skilled care. Part A covers the first 20 days fully, then you pay coinsurance per day from day 21 to day 100. After day 100, you pay all costs yourself.

Part A covers hospice care when a doctor says you have six months or less to live. You pay little to nothing for hospice services, though you may pay a small copayment for drugs and respite care (temporary care that gives your family a break).

What Part B covers: Doctor visits and outpatient services

Part B covers visits to doctors, specialists, and other healthcare providers in outpatient settings — meaning you do not stay overnight. It pays for office visits, lab tests, X-rays, and diagnostic imaging like CT scans and ultrasounds. It also covers physical therapy, occupational therapy, and speech-language pathology when medically necessary.

Part B covers medical equipment and supplies, including wheelchairs, walkers, oxygen, diabetic testing supplies, and wound care supplies. You typically pay 20 percent of the cost after you meet your annual deductible, and Medicare pays 80 percent. Some equipment requires prior authorization from Medicare before you buy or rent it.

Part B also covers mental health services, including therapy and psychiatric visits. You pay the same 20 percent coinsurance as other Part B services. Emergency room visits are covered under Part B when you are treated and released (if you are admitted to the hospital, Part A takes over).

Preventive services covered at no cost

Medicare covers many preventive services — screenings and tests meant to catch disease early — at no cost to you when you see an in-network provider. These include an annual wellness visit with your primary care doctor, colorectal cancer screening (colonoscopy or other approved tests), mammography for breast cancer, and prostate cancer screening. You also get cardiovascular screening, diabetes screening, and bone density testing if your doctor orders it.

Vaccinations are covered at no cost, including the flu shot, pneumonia vaccine, shingles vaccine, and COVID-19 vaccine. Preventive services for mental health, including depression screening, are also covered. The key is that these services must be ordered by your doctor and delivered by an in-network provider; if you go out of network, you may pay more.

What Part D covers: Prescription drugs

Part D is prescription drug coverage offered by private insurance companies approved by Medicare. It covers most prescription medications, though not all drugs are on every plan's formulary (the list of covered drugs). You choose a Part D plan during your enrollment period, and coverage begins January 1 of the following year.

You pay a monthly premium for Part D, a yearly deductible (the amount varies by plan), and then copayments or coinsurance for each prescription. The amount you pay changes depending on which "tier" your drug is on — generic drugs usually cost less than brand-name drugs. Once you and Medicare spend a certain amount on drugs in a year, you enter the "coverage gap" (sometimes called the "donut hole"), where you pay a higher percentage of drug costs until you reach catastrophic coverage, when Medicare pays most costs again.

Part D does not cover over-the-counter drugs, vitamins, or supplements unless they are prescribed by a doctor and meet specific criteria. It also does not cover drugs used for cosmetic purposes or weight loss.

What Medicare does not cover

Dental care is not covered by Original Medicare, including cleanings, fillings, root canals, and dentures. Some Medicare Advantage plans offer limited dental benefits, but they usually have waiting periods and annual maximums. Vision care, including eye exams, glasses, and contact lenses, is also not covered. Hearing aids and hearing exams are not covered, though some Medicare Advantage plans include limited hearing benefits.

Long-term custodial care — help with daily activities like bathing, dressing, and eating in your home or a nursing home — is not covered by Medicare. This is different from skilled nursing care, which Medicare does cover for a limited time after a hospital stay. Routine foot care, including nail trimming and callus removal, is not covered unless you have diabetes or a related condition. Cosmetic surgery is not covered unless it is medically necessary after an injury or illness.

Medicare also does not cover most acupuncture (though some plans cover it for chronic lower back pain), most chiropractic care (except spinal manipulation for acute lower back pain), or naturopathic services. Experimental treatments and drugs not yet approved by the Food and Drug Administration are generally not covered.

How costs work: Deductibles, copayments, and coinsurance

Original Medicare has separate deductibles for Part A and Part B. Part A deductible applies per benefit period (a hospital stay or series of related stays). Part B deductible is annual — you pay it once per year, then Medicare starts sharing costs. The exact amounts change yearly.

After you meet your deductible, you pay either a copayment (a fixed dollar amount per visit or service) or coinsurance (a percentage of the cost). For example, Part B typically charges 20 percent coinsurance after the deductible. Some services, like preventive care, have no copayment or coinsurance at all.

Medicare Advantage plans have their own deductibles, copayments, and coinsurance, which vary by plan. Some plans have lower out-of-pocket costs than Original Medicare, while others have higher costs. You also pay a monthly premium for Medicare Advantage in addition to your Part B premium.

Frequently Asked Questions

Does Medicare cover physical therapy?

Yes, Part B covers physical therapy when ordered by a doctor for a medical condition. You pay 20 percent coinsurance after your Part B deductible. Medicare limits the number of visits per year unless your doctor documents medical necessity for more visits.

Does Medicare cover eye exams and glasses?

Original Medicare does not cover routine eye exams or glasses. Some Medicare Advantage plans include limited vision benefits, such as one eye exam per year and a small allowance toward glasses. You would need to check your specific plan.

What happens if I go to an out-of-network doctor?

With Original Medicare Part B, you can see any doctor who accepts Medicare, and they are considered in-network. If a doctor does not accept Medicare, you may pay the full cost yourself. Medicare Advantage plans have specific networks, and going out of network usually costs you more or may not be covered at all.

Does Medicare cover home health care?

Yes, Part A and Part B cover home health care when ordered by a doctor and provided by a Medicare-approved agency. Services must be medically necessary, and you must be homebound. You typically pay nothing for home health services covered by Medicare.

Are prescription drugs expensive under Medicare?

Costs depend on your Part D plan and which drugs you take. Generic drugs are usually cheaper than brand-name drugs. Once you reach the coverage gap, you pay more out of pocket until catastrophic coverage begins. Some people with low income may receive extra help paying for Part D costs.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.