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

Medicare Part A is hospital insurance. It pays for inpatient care — meaning you stay overnight — at hospitals, skilled nursing facilities, and hospice programs. It also covers some home health services, but only if a doctor orders them after a hospital or nursing facility stay.

Part A does not cover outpatient care, doctor visits in an office, prescription drugs, or long-term custodial care in a nursing home. If you go to a hospital emergency room but are sent home the same day, Part A does not pay for that visit — Part B does.

Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes for at least 10 years while working. If you did not work that long, you may pay a premium, which varies based on how many years of work history you have.

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

Medicare Part B is medical insurance. It pays for services from doctors and other providers when you are not admitted to a hospital overnight. This includes office visits, lab tests, X-rays, physical therapy, mental health counseling, and ambulance transport.

Part B also covers preventive services at no cost to you — things like annual wellness visits, cancer screenings, vaccinations, and cardiovascular screenings. You pay a monthly premium for Part B, which is deducted from your Social Security check if you receive one. The standard premium amount changes each year.

Part B does not cover routine dental care, vision exams for glasses or contacts, hearing aids, or prescription drugs. Those services fall under separate coverage or are not covered by Medicare at all.

Key Takeaways

  • Part A pays for overnight hospital stays, skilled nursing facility care after hospitalization, hospice, and some home health services ordered by a doctor.
  • Part B pays for doctor office visits, outpatient procedures, lab work, preventive screenings, and mental health services.
  • Part A has no monthly premium for most people; Part B requires a monthly premium that increases if you delay enrollment.
  • Neither part covers dental, vision, hearing aids, or prescription drugs — you need separate coverage for those.
  • You typically pay a deductible and coinsurance for both parts, meaning Medicare does not cover 100 percent of costs.

What you pay out of pocket with Part A and Part B

Medicare Part A and Part B do not cover all costs. You are responsible for a deductible — a set amount you pay before Medicare starts paying — and coinsurance, which is your share of the cost after the deductible is met.

For Part A, the deductible applies per hospital stay. For Part B, you pay an annual deductible, then typically 20 percent coinsurance for most services. The exact amounts change each year. Some services, like preventive care, have no deductible or coinsurance.

If you want to reduce what you pay out of pocket, you can purchase a Medigap policy (also called supplemental insurance) or enroll in a Medicare Advantage plan. Medigap policies help pay your deductibles and coinsurance. Medicare Advantage plans replace Part A and Part B with a different type of coverage, usually with lower out-of-pocket costs but a narrower network of doctors.

The difference between Part A hospital stays and Part B outpatient care

The line between inpatient (Part A) and outpatient (Part B) matters because it determines which part pays and how much you pay. If you are admitted to the hospital and stay overnight, Part A covers it. If you have a procedure at a hospital outpatient department or surgery center and go home the same day, Part B covers it.

Sometimes a hospital will place you under "observation status" instead of admitting you as an inpatient. Observation status is outpatient care, so Part B pays, even if you stay overnight in a hospital bed. This can cost you more out of pocket. If you are unsure whether you have been admitted or placed on observation, ask the hospital directly.

Skilled nursing facility care is covered by Part A, but only if you were admitted to a hospital first and stayed at least three days, and only if a doctor orders the nursing facility care within 30 days of leaving the hospital. Custodial care — help with bathing, dressing, and daily living — is not covered by Medicare at all, even in a nursing home.

Preventive services covered at no cost

Medicare Part B covers many preventive services with no deductible or coinsurance. These include an annual wellness visit with your doctor, cancer screenings (mammogram, colonoscopy, Pap test), cardiovascular screenings, bone density tests, diabetes screenings, and vaccinations like flu and pneumonia shots.

To receive these services at no cost, you must see a doctor who accepts Medicare and who bills Medicare directly. If you see an out-of-network provider or a provider who does not accept Medicare assignment, you may have to pay more.

Preventive services are designed to catch disease early. They are different from treatment services, which do require you to pay a deductible and coinsurance.

What happens if you delay enrolling in Part A or Part B

If you do not enroll in Part B when you first become may be able to access, you may face a late enrollment penalty. The penalty is a percentage increase to your monthly premium, and it is permanent — it stays with you for as long as you have Part B. The longer you wait, the higher the penalty.

There are exceptions. If you are still working and covered by your employer's health plan, you may be able to delay Part B without penalty. If you are receiving benefits from the Veterans Administration or are a federal employee with health coverage, different rules may explore. You should contact Social Security or Medicare to confirm your situation before declining Part B.

Part A generally does not have a late enrollment penalty, but you should still enroll when you become may be able to access to avoid gaps in coverage.

How Part A and Part B work together with other coverage

Part A and Part B are the foundation of Original Medicare. Many people add a Medigap policy on top to cover deductibles and coinsurance. Others choose a Medicare Advantage plan instead, which combines Part A and Part B into one plan run by a private insurance company.

If you have coverage through your employer or a union, that coverage may work alongside Medicare. Your employer plan typically pays first, and Medicare pays second. When you retire or lose employer coverage, you should enroll in Part B within 63 days to avoid a late enrollment penalty.

Prescription drug coverage (Part D) is separate from Part A and Part B. You can add Part D to Original Medicare, or it may be included in your Medicare Advantage plan. If you do not enroll in Part D when you first become may be able to access, you may face a late enrollment penalty on your drug coverage.

Frequently Asked Questions

Does Part A or Part B cover my doctor's office visit?

Part B covers doctor office visits. Part A does not. If your doctor is in the hospital and you are an outpatient, Part B still pays. If you are admitted to the hospital overnight, Part A covers the hospital stay, and Part B covers the doctor's services during that stay.

Will Medicare pay for my hospital stay if I do not have Part A?

No. Part A is hospital insurance. Without it, you are responsible for the full cost of a hospital stay. If you are not yet enrolled, you should contact Social Security or Medicare to enroll as soon as possible. If you are already past your initial enrollment window, you may still be able to enroll during the General Enrollment Period (January 1 to March 31 each year).

What is the difference between Part A and Part B deductibles?

Part A has a deductible per hospital stay. Part B has an annual deductible that resets each calendar year. The amounts change yearly. After you meet the deductible, you typically pay coinsurance (usually 20 percent for Part B services) until you reach your out-of-pocket maximum, if you have one.

Can I have Part B without Part A?

Yes, though it is uncommon. If you are still working and covered by your employer's health plan, you may enroll in Part B only and delay Part A. However, most people enroll in both parts when they become may be able to access at age 65.

Do Part A and Part B cover prescription medications?

No. Prescription drug coverage is Part D, which is separate. You can add Part D to Original Medicare, or it may be included in your Medicare Advantage plan. If you take regular medications, you should enroll in Part D when you first become may be able to access to avoid a late enrollment penalty.