Original Medicare covers hospital stays, doctor visits, and some preventive care, but not dental, vision, hearing aids, or long-term care

Original Medicare has two main parts. Part A covers inpatient hospital care, skilled nursing facility stays, hospice, and some home health services. Part B covers doctor visits, outpatient care, lab tests, imaging, and durable medical equipment like wheelchairs and oxygen. Together they pay a percentage of the cost — you pay the rest through deductibles, copayments, and coinsurance.

What Original Medicare does not cover matters as much as what it does. There is no annual limit on what Medicare pays for covered services, but there is no coverage for dental work, eyeglasses, hearing aids, or routine foot care. Long-term nursing home care, custodial care at home, and most prescription drugs are also not included in Parts A and B alone. Many people buy additional coverage — either a Medigap policy or a Medicare Advantage plan — to fill these gaps.

Key Takeaways

  • Part A covers hospital inpatient stays, skilled nursing care after hospitalization, hospice, and some home health visits, but you pay a deductible per hospital stay.
  • Part B covers doctor office visits, outpatient procedures, lab work, imaging, and medical equipment, and you pay a monthly premium plus 20% coinsurance after the deductible.
  • Original Medicare does not cover dental, vision, hearing aids, routine foot care, or prescription drugs without a separate Part D plan.
  • You can add Medigap coverage to reduce your out-of-pocket costs, or switch to a Medicare Advantage plan that may include dental and vision but usually has network restrictions.

What Part A Covers: Hospital and Skilled Nursing Care

Part A pays for inpatient hospital stays after you meet the annual deductible (the amount changes each year). Once you are admitted as an inpatient, Part A covers your room, meals, nursing care, and most hospital services. If you stay longer than 60 days in a single benefit period, your coinsurance amount increases. After 90 days, you enter a "lifetime reserve" of 60 additional days that you can use only once in your lifetime.

Part A also covers up to 100 days in a skilled nursing facility (SNF) if you were hospitalized for at least three days first and admitted within 30 days of leaving the hospital. The first 20 days are fully covered. Days 21 through 100 require a daily coinsurance payment. Part A covers skilled nursing care — wound care, physical therapy, medication management — but not custodial care, which is help with bathing, dressing, and eating without medical treatment.

Hospice care is covered under Part A when a doctor certifies you have six months or less to live. You pay nothing for hospice services, though you may pay a small copayment for drugs and inpatient respite care. Home health services — nursing visits, physical therapy, occupational therapy — are covered when ordered by a doctor and provided by a Medicare-certified agency, but only if you are homebound.

What Part B Covers: Doctor Visits and Outpatient Services

Part B covers doctor office visits, whether for a routine checkup or a specific problem. After you pay the annual deductible, Medicare pays 80% of the approved amount for most services, and you pay the remaining 20% as coinsurance. This means your out-of-pocket cost depends on what the doctor charges and what Medicare considers the "approved amount" — not always the same thing.

Outpatient hospital services, emergency room visits, and urgent care are covered under Part B. Lab work, X-rays, CT scans, and MRI imaging are covered when medically necessary. Part B also covers durable medical equipment — wheelchairs, walkers, oxygen equipment, diabetic supplies — at 80% after the deductible, though some equipment requires prior authorization from Medicare before you purchase it.

Mental health services, including therapy and psychiatric visits, are covered at the same 80% rate as other Part B services. Preventive services with no copayment or coinsurance include annual wellness visits, cancer screenings, cardiovascular screenings, and vaccinations. However, if your doctor finds a problem during a preventive visit and you need treatment, that treatment is subject to the deductible and coinsurance.

Preventive Services Covered at No Cost

Original Medicare covers certain preventive services with no deductible or coinsurance when provided by an in-network provider. These include an annual wellness visit, mammograms, colorectal cancer screening, prostate cancer screening, bone density testing, cardiovascular screening, and diabetes screening. Flu shots, pneumonia vaccines, and shingles vaccines are also covered with no cost to you.

Abdominal aortic aneurysm screening is covered once for men ages 65 to 75 who have smoked. Depression screening, obesity screening, and counseling for tobacco use cessation are covered. The key word is "preventive" — these services are covered only when there is no diagnosis or symptom. Once a condition is found, any follow-up care or treatment falls under Part B's regular deductible and coinsurance rules.

What Original Medicare Does Not Cover

Dental care is not covered by Original Medicare, including cleanings, fillings, root canals, and dentures. Vision care — eye exams for glasses or contacts, eyeglasses, and contact lenses — is not covered, though Part B does cover one pair of glasses or contact lenses after cataract surgery. Hearing aids and hearing exams for the purpose of fitting hearing aids are not covered, though diagnostic hearing tests ordered by a doctor for another medical reason may be.

Routine foot care, including nail trimming and callus removal, is not covered unless you have diabetes or a related circulatory condition. Cosmetic surgery is not covered unless it is reconstructive after an injury or illness. Acupuncture, chiropractic care, and most alternative therapies are not covered. Prescription drugs are not covered by Part A or Part B — you need Part D, a separate prescription drug plan, to have that coverage.

Long-term custodial care — help with daily living activities in a nursing home or at home — is not covered. Nursing home care beyond the 100-day skilled nursing benefit is your responsibility. Travel outside the United States is not covered, with rare exceptions for emergencies in Canada or Mexico near the U.S. border.

How Much You Pay: Deductibles, Coinsurance, and Premiums

Part A has an annual deductible per benefit period (a benefit period begins when you enter the hospital and ends 60 days after you leave). Once you meet the deductible, Part A covers 100% of approved charges for days 1 through 60 of a hospital stay. Days 61 through 90 require a daily coinsurance payment. The deductible and coinsurance amounts change each year.

Part B has a separate annual deductible. After you meet it, you pay 20% coinsurance on most services. You also pay a monthly premium for Part B, which is deducted from your Social Security check if you receive benefits. The premium is higher if you have higher income. Some people with low income may receive help paying Part B premiums through Medicaid or other programs.

If you see a provider who does not accept Medicare assignment — meaning they do not agree to accept Medicare's approved amount as full payment — you may owe more than the standard 20% coinsurance. This is called "balance billing." You can check whether a doctor accepts assignment before your visit by calling their office or searching Medicare's provider directory.

Medigap and Medicare Advantage: Filling the Gaps

Medigap (also called Supplement Insurance) is a private insurance policy that works alongside Original Medicare. It pays some or all of the deductibles, coinsurance, and copayments you would otherwise owe. There are ten standardized Medigap plans, labeled A through N. Each plan covers a different combination of out-of-pocket costs. Medigap does not cover dental, vision, or hearing aids — it only reduces what you pay for services Original Medicare already covers.

Medicare Advantage (Part C) is an alternative to Original Medicare. It is a private insurance plan that must cover everything Original Medicare covers, but it often includes dental, vision, and hearing benefits that Original Medicare does not. However, Medicare Advantage plans usually have network restrictions — you must see doctors in the plan's network or pay more. They also often require prior authorization for certain services and may have annual out-of-pocket limits.

You cannot have both Medigap and Medicare Advantage at the same time. If you have Original Medicare and want to add coverage for gaps, you choose either a Medigap policy or you switch to Medicare Advantage. The choice depends on your health, your doctors, and what coverage matters most to you.

Frequently Asked Questions

Does Original Medicare cover prescription drugs?

No. Part A and Part B do not cover prescription medications. You must enroll in Part D, a separate prescription drug plan, to have coverage for drugs. Part D is offered by private insurance companies approved by Medicare. If you do not enroll when you first become may be able to access, you may pay a penalty for late enrollment.

What happens if I see a doctor who does not accept Medicare?

If a doctor does not accept Medicare at all, Medicare will not pay anything toward their bill, and you pay the full amount. If a doctor accepts Medicare but does not accept assignment, Medicare pays its share, but the doctor can bill you for the difference between their charge and Medicare's approved amount. Always ask whether a provider accepts Medicare assignment before your visit.

Does Original Medicare cover eye exams and glasses?

No, except in one case: if you have cataract surgery covered by Medicare, Part B covers one pair of glasses or contact lenses after the surgery. Routine eye exams, glasses, and contact lenses for vision correction are not covered. You can purchase a separate vision plan or pay out of pocket.

Can I use Original Medicare outside the United States?

Original Medicare generally does not cover care outside the U.S. There are limited exceptions for emergencies in Canada or Mexico near the U.S. border. If you travel internationally, you may want to purchase travel health insurance. Some Medicare Advantage plans offer limited emergency coverage abroad.

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

Part A has one deductible per benefit period (each hospital stay starts a new benefit period). Part B has one deductible per calendar year. They are separate — meeting the Part A deductible does not count toward Part B, and vice versa. The amounts change each year and are set by Medicare.