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

Medicare Part A is hospital insurance. It pays for inpatient hospital stays (when you are admitted and stay overnight), care in a skilled nursing facility after a hospital stay, hospice care for people with terminal illness, and some home health services. Part A does not cover outpatient doctor visits, prescription drugs, or routine preventive care — that is where Part B comes in.

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

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

Medicare Part B is medical insurance. It covers visits to doctors and specialists, outpatient hospital services (like emergency room visits and same-day surgery), diagnostic tests and imaging, mental health services, and preventive care such as annual wellness visits and cancer screenings. Part B also covers durable medical equipment like wheelchairs, walkers, and oxygen supplies when your doctor prescribes them.

Part B requires a monthly premium, which is based on your income. The standard premium amount changes each year. If your income is higher, you will pay an additional surcharge on top of the standard premium.

Key Takeaways

  • Part A covers hospital stays, skilled nursing facility care, and some home health services, with no monthly premium for most people.
  • Part B covers doctor visits, outpatient care, diagnostic tests, and preventive services, and requires a monthly premium based on your income.
  • Both parts have deductibles and coinsurance amounts you pay out of pocket before and after Medicare pays its share.
  • Part A and Part B together do not cover prescription drugs, dental, vision, or hearing aids — you need separate coverage for those.

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

Even with Part A and Part B, you are responsible for certain costs. Part A has a deductible you pay for each hospital stay — the amount changes yearly. After you meet the deductible, Medicare covers all costs for the first 60 days of a hospital stay. Days 61 through 90 require a daily coinsurance payment from you. Part A also covers up to 100 days in a skilled nursing facility after a may have access to hospital stay, but you pay coinsurance starting on day 21.

Part B has an annual deductible, after which Medicare typically covers 80 percent of the approved amount for most services. You pay the remaining 20 percent coinsurance. For some preventive services — like annual wellness visits and certain screenings — Medicare covers the full cost with no coinsurance if you see an in-network provider.

What Part A and Part B do not cover

Part A and Part B have significant gaps. Neither covers prescription medications — you need Part D or a separate drug plan for that. Neither covers dental work, vision exams, eyeglasses, or hearing aids. Long-term custodial care in a nursing home or assisted living is not covered by either part. Routine foot care, cosmetic surgery, and most acupuncture are also excluded.

If you need coverage for these services, you can buy a Medigap (supplemental insurance) plan to fill some of the gaps, or you can enroll in a Medicare Advantage plan (Part C), which is an alternative to Original Medicare that often includes prescription drug coverage and sometimes dental or vision benefits.

How Part A and Part B work together

Part A and Part B are separate but complementary. If you have a hospital stay, Part A pays the hospital costs after you meet your deductible. If your doctor orders tests or follow-up visits after discharge, Part B covers those. You can have both parts at the same time — in fact, most people do.

When you turn 65, you have a seven-month window to enroll in Part A and Part B without penalty. If you delay enrollment past that window and do not have other may have access to coverage, you will pay a permanent penalty on your Part B premium for as long as you have Medicare. Part A enrollment is automatic for most people at 65 if they are already receiving Social Security, but you must actively enroll in Part B.

Original Medicare versus Medicare Advantage

Part A and Part B together make up Original Medicare, a fee-for-service plan run by the federal government. You can see any doctor or hospital that accepts Medicare. Alternatively, you can choose Medicare Advantage (Part C), which is offered by private insurance companies approved by Medicare. Medicare Advantage plans often include Part D prescription drug coverage and may offer dental, vision, or hearing benefits that Original Medicare does not.

The trade-off is that Medicare Advantage plans usually have a network of doctors and hospitals you must use, and you may need referrals to see specialists. Original Medicare gives you more freedom to choose providers but leaves you responsible for the gaps in coverage unless you buy a Medigap plan.

When to enroll and what happens if you miss the important date

You become may be able to access for Medicare at 65. Your initial enrollment period runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. If you enroll during this window, your coverage starts on the first day of your birth month (or the first day of the following month if you enroll after your birthday month).

If you do not enroll when you are first may be able to access and you do not have other may have access to coverage, you will pay a permanent late enrollment penalty. For Part B, the penalty is 10 percent of the standard premium for each full year you were may be able to access but not enrolled. This penalty stays with you for life. Part A has a similar penalty structure if you do not have may have access to coverage.

Frequently Asked Questions

Do I have to take both Part A and Part B?

No. You can enroll in Part A only and skip Part B if you are still working and have employer health insurance. However, if you do not enroll in Part B when first may be able to access, you will owe a lifetime penalty when you do enroll later, unless you have may have access to coverage like an employer plan.

What is the difference between Original Medicare and Medicare Advantage?

Original Medicare (Part A and Part B) is run by the federal government, lets you see any Medicare-accepting provider, and has no network restrictions. Medicare Advantage is run by private insurers, usually has a network, may include prescription drug and dental coverage, but limits your choice of doctors and hospitals.

Does Part B cover preventive care at no cost?

Part B covers many preventive services — like annual wellness visits, cancer screenings, and vaccinations — at no coinsurance or copay if you see an in-network provider and the service is deemed preventive. You still pay your Part B premium and deductible, but the service itself has no additional out-of-pocket cost.

Can I use Part A and Part B outside the United States?

Original Medicare generally does not cover care outside the U.S., except in limited cases like emergency care in Canada or Mexico near the border. If you travel internationally, you may want to buy a travel insurance policy or consider a Medicare Advantage plan that offers international coverage.

What should I do if I missed my enrollment important date?

Contact Social Security or Medicare to see if you may have access to for a Special Enrollment Period, which waives the late penalty in certain situations — such as losing employer coverage or moving out of your plan's service area. If you do not may have access to for a Special Enrollment Period, you can still enroll, but you will owe a permanent penalty.