Medicare covers hospital stays, doctor visits, and some medical equipment — but not everything
Medicare is divided into four parts, and each one covers different things. Part A covers inpatient hospital care, skilled nursing facilities, hospice, and some home health services. Part B covers doctor visits, outpatient care, lab tests, and some preventive services. Part D covers prescription drugs. Part C (Medicare Advantage) is an alternative to Parts A and B offered by private insurers, and the coverage varies by plan.
What Medicare does not cover is just as important to know: dental care, vision care, hearing aids, long-term custodial care in a nursing home, and most prescription drugs until you reach a certain spending threshold. Knowing the difference between what is covered and what is not helps you plan for out-of-pocket costs and decide whether you need supplemental coverage.
Key Takeaways
- Part A covers hospital stays and skilled nursing care; Part B covers doctor visits and outpatient services; Part D covers prescription drugs.
- Medicare does not cover dental, vision, hearing aids, or long-term nursing home care, and you will pay out-of-pocket for these unless you buy a separate policy.
- You pay a deductible before Medicare starts paying, and you share the cost of most services through copayments or coinsurance.
- Preventive services like annual wellness visits, cancer screenings, and vaccines are covered at no cost when you use an in-network provider.
- Part C plans (Medicare Advantage) bundle coverage differently and often include dental or vision, but limit you to specific networks of doctors and hospitals.
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. This includes your room, meals, nursing care, and most tests and procedures done while you are admitted. You pay a deductible for each benefit period (the amount changes yearly), and then Medicare covers the full cost for days 1 through 60. From day 61 to day 90, you pay a daily coinsurance amount. Beyond 90 days, you can use lifetime reserve days, but you pay a higher coinsurance.
Part A also covers skilled nursing facility care — not regular nursing home care, but short-term care after a hospital stay when you need skilled medical services like wound care or physical therapy. Medicare covers this only if you were hospitalized for at least three days first, and only for up to 100 days per benefit period. You pay nothing for days 1 through 20, and a daily coinsurance from day 21 to day 100.
Hospice care is covered under Part A when a doctor certifies you have six months or less to live. Home health services are also covered if you are homebound and need skilled care, such as nursing visits or physical therapy ordered by your doctor.
What Part B Covers: Doctor Visits and Outpatient Services
Part B covers visits to your doctor, whether for a routine checkup or treatment of an illness. It also covers outpatient hospital services, emergency room visits, urgent care, lab tests, X-rays, and imaging like CT scans or MRIs when ordered by your doctor. Mental health services, including therapy and psychiatry, are covered under Part B.
Durable medical equipment — items like wheelchairs, walkers, oxygen equipment, and diabetic supplies — is covered under Part B when your doctor prescribes it. You typically pay 20 percent of the cost after you meet your annual deductible, and Medicare pays 80 percent.
Preventive services are covered at no cost to you when you see an in-network provider. These include an annual wellness visit, cancer screenings (mammograms, colonoscopies, Pap tests), bone density tests, cardiovascular screenings, diabetes screenings, and vaccines like the flu shot, pneumonia vaccine, and shingles vaccine. You do not pay a copayment or coinsurance for these preventive visits.
What Part D Covers: Prescription Drugs
Part D is prescription drug coverage, and you must enroll during your initial enrollment period or face a penalty if you join later. Part D plans are offered by private insurers approved by Medicare, and coverage varies by plan. Each plan has a formulary — a list of drugs it covers — and drugs are placed in tiers that determine how much you pay.
You typically pay a monthly premium, an annual deductible (which varies by plan), and then a copayment or coinsurance for each prescription. There is a coverage gap, sometimes called the "donut hole," where you pay a higher share of drug costs once your total spending reaches a certain amount. Once you spend enough out-of-pocket to reach catastrophic coverage, Medicare pays most of the cost for the rest of the year.
Not all drugs are covered. Your plan's formulary determines which ones are, and you can ask your doctor or pharmacist whether a drug is on your plan's list before you fill a prescription. If a drug is not covered or is in a higher tier, you can ask your doctor to request an exception, and the plan may cover it at a lower cost.
What Medicare Does Not Cover
Dental care — cleanings, fillings, root canals, extractions, and dentures — is not covered by any part of Medicare. 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 now include limited hearing benefits.
Long-term custodial care in a nursing home is not covered. If you need to stay in a nursing home for more than 100 days or for reasons other than recovery from a hospital stay, you pay out-of-pocket or through Medicaid if you may have access to. Cosmetic surgery is not covered unless it is medically necessary after an injury or illness.
Other services not covered include routine foot care (unless you have diabetes), acupuncture (with limited exceptions), and most over-the-counter medications. Experimental treatments and procedures not yet approved by the Food and Drug Administration are not covered.
How You Pay: Deductibles, Copayments, and Coinsurance
You pay for Medicare services in three ways. A deductible is the amount you pay out-of-pocket before Medicare starts paying. Part A and Part B each have their own annual deductible. A copayment is a fixed amount you pay for a specific service — for example, $15 for a doctor visit. Coinsurance is a percentage of the cost you pay after you meet your deductible — for example, 20 percent of the cost of an outpatient procedure.
Part A and Part B together have an annual out-of-pocket maximum. Once you reach this limit, Medicare covers 100 percent of covered services for the rest of the year. Part D has its own out-of-pocket maximum. Part C plans set their own deductibles, copayments, and out-of-pocket maximums, which may be lower or higher than Original Medicare.
Medicare Advantage (Part C) and Supplemental Coverage
Medicare Advantage plans are an alternative to Original Medicare (Parts A and B). These plans are offered by private insurers and must cover everything Original Medicare covers, but they often add benefits like dental, vision, or hearing. However, they limit you to a network of doctors and hospitals, and you usually need referrals to see specialists.
Supplemental insurance, also called Medigap, works alongside Original Medicare to cover costs that Medicare does not — such as copayments, coinsurance, and deductibles. There are ten standardized Medigap plans (labeled A through N), and each covers a different combination of costs. Medigap does not cover dental, vision, or hearing.
Some people with low income and limited resources may may have access to for Medicaid, which can cover services Medicare does not, including dental and long-term care. You can have both Medicare and Medicaid at the same time.
Frequently Asked Questions
Does Medicare cover dental work?
No, Original Medicare does not cover any dental services. Some Medicare Advantage plans include limited dental coverage, usually up to $1,000 or $1,500 per year. You can also buy a standalone dental plan, though these have waiting periods and may not cover major work right away.
Will Medicare pay for my glasses or hearing aids?
Original Medicare does not cover glasses, contact lenses, or hearing aids. Some Medicare Advantage plans now offer limited vision or hearing benefits, but coverage is usually capped. You would need to buy these services separately or enroll in a plan that includes them.
What happens if I need to stay in a nursing home for more than 100 days?
Medicare Part A covers up to 100 days of skilled nursing facility care per benefit period, but only if you were hospitalized first. After 100 days, you pay the full cost yourself unless you may have access to for Medicaid. Long-term custodial care is not a Medicare benefit.
Do I have to pay anything for preventive services like cancer screenings?
No, preventive services covered by Medicare are free when you use an in-network provider. This includes annual wellness visits, mammograms, colonoscopies, flu shots, and other screenings. You do not pay a copayment or coinsurance for these services.
What is the donut hole in Part D, and how does it affect what I pay?
The donut hole is a coverage gap in Part D. Once your total drug spending reaches a certain amount, you enter the gap and pay a higher share of drug costs until you reach catastrophic coverage. The gap amount changes yearly. Once you hit catastrophic coverage, Medicare pays most of your drug costs for the rest of the year.