Hospital stays, doctor visits, and preventive care are the main things Medicare Part A and Part B pay for, but they cover different pieces of your healthcare
Medicare Part A covers inpatient hospital care — when you stay overnight in a hospital bed. It also covers skilled nursing facility stays (short-term care after a hospital stay), hospice care, and some home health services. Medicare Part B covers outpatient services: doctor visits, lab tests, imaging like X-rays and ultrasounds, preventive screenings, and some equipment and supplies you use at home.
The two parts work together. Part A pays the hospital bill when you are admitted. Part B pays your doctor's fee for examining you in that hospital. Neither one covers everything — prescription drugs, dental care, vision care, and hearing aids are not included in either part — but knowing what each covers helps you understand what costs you will and will not see.
Key Takeaways
- Medicare Part A covers hospital stays, skilled nursing care after hospitalization, hospice, and some home health visits, with costs split between a deductible and copayments.
- Medicare Part B covers doctor office visits, outpatient procedures, lab work, imaging, preventive care, and durable medical equipment, with a monthly premium and copayments.
- Neither Part A nor Part B covers prescription drugs, dental work, vision care, hearing aids, or long-term custodial care in a nursing home.
- You typically pay a deductible before coverage starts each year, then copayments or coinsurance for each service, and these amounts differ between Part A and Part B.
What Medicare Part A Covers in Detail
Part A pays for a hospital stay when you are admitted as an inpatient — meaning you occupy a hospital bed overnight or longer. This includes all room and board, meals, nursing care, and most medications and supplies used during your stay. If you need surgery, Part A covers the operating room and surgical supplies. If you need blood transfusions, Part A covers the blood itself (though you may pay for the first pint).
After you leave the hospital, Part A covers up to 100 days in a skilled nursing facility if your doctor orders it and you meet Medicare's requirements. A skilled nursing facility is not a regular nursing home — it is a place where you receive medical care and rehabilitation, usually after a surgery or serious illness. Part A pays the full cost for the first 20 days. From day 21 to day 100, you pay a daily copayment (the amount changes each year).
Part A also covers hospice care when a doctor says you have six months or less to live. Hospice focuses on comfort rather than cure, and Part A covers the hospice services, medications related to your terminal condition, and equipment like hospital beds and wheelchairs. You pay nothing for hospice services themselves, though you may pay a small copayment for medications and supplies.
Part A covers some home health services — nursing visits, physical therapy, occupational therapy, and speech therapy — when you are homebound and your doctor orders the care. You pay nothing for these visits. Part A does not cover ongoing custodial care (help with bathing, dressing, or meals) unless it is part of a skilled service like physical therapy.
What Medicare Part B Covers in Detail
Part B covers visits to your doctor's office, whether for a routine checkup, a sick visit, or management of a chronic condition like diabetes or heart disease. It covers the doctor's time and the basic office visit, though you pay a copayment (usually $15 to $50 per visit, depending on your plan). Part B also covers visits to other healthcare providers like nurse practitioners, physician assistants, and mental health counselors.
Preventive services are a major Part B benefit. Part B covers an annual wellness visit at no cost to you — this is a chance to review your health, update your medications, and screen for problems. Part B also covers cancer screenings (mammograms, colonoscopies, Pap tests), cardiovascular screenings, bone density tests, diabetes screenings, and vaccines like flu shots and pneumonia vaccines, all at no copayment. These preventive services are designed to catch problems early.
Part B covers diagnostic and lab services: blood tests, urinalysis, EKGs, X-rays, ultrasounds, CT scans, and MRIs when your doctor orders them. You typically pay 20 percent of the cost after you meet your yearly deductible. Part B also covers outpatient procedures — surgeries and treatments done in a hospital outpatient department or an ambulatory surgery center where you do not stay overnight. You pay a copayment or coinsurance.
Part B covers durable medical equipment — items like wheelchairs, walkers, oxygen equipment, diabetic supplies, and continuous positive airway pressure (CPAP) machines — when your doctor prescribes them. You typically pay 20 percent of the approved cost after your deductible. Part B also covers some rehabilitation services like physical therapy and occupational therapy when medically necessary, though the number of visits may be limited.
What Part A and Part B Do Not Cover
Prescription drugs are not covered by Part A or Part B. That is what Medicare Part D is for — a separate prescription drug plan you can choose. Without Part D, you pay the full price of medications at the pharmacy.
Dental care, vision care, and hearing aids are not covered by Original Medicare (Part A and Part B). This includes routine dental cleanings, fillings, crowns, eyeglasses, contact lenses, eye exams for glasses, and hearing aids. Some Medicare Advantage plans (Part C) include dental or vision benefits, but Original Medicare does not.
Long-term custodial care in a nursing home is not covered by Part A or Part B. Part A covers skilled nursing care for up to 100 days after a hospital stay, but if you need ongoing help with daily living — bathing, dressing, meals, toileting — that is custodial care, and Medicare does not pay for it. Medicaid may cover nursing home care if you meet income and asset limits, but that is a different program.
Part A and Part B also do not cover routine foot care, most acupuncture, most chiropractic care, cosmetic surgery, or weight loss programs. Some of these services may be covered in specific medical situations — for example, acupuncture for chronic lower back pain — but you should check with Medicare before assuming coverage.
How You Pay Under Part A and Part B
For Part A, you pay a yearly deductible before Part A starts paying. In 2024, that deductible is $1,632 per benefit period (a benefit period begins when you enter the hospital and ends 60 days after you leave). After you meet the deductible, you pay nothing for the first 60 days of a hospital stay. From day 61 to day 90, you pay a daily copayment. If you stay longer than 90 days, you have a limited number of "lifetime reserve days" you can use, and you pay a higher daily copayment for those days.
For Part B, you pay a monthly premium (the standard amount in 2024 is $164.90, though it may be higher if your income is above a certain level). You also pay a yearly deductible (in 2024, it is $240). After you meet the deductible, you typically pay 20 percent of the approved cost for most services — doctor visits, lab work, imaging, and equipment. Some preventive services have no copayment or coinsurance.
These dollar amounts change each year. Medicare announces the new amounts in the fall for the following year. If you are on a fixed income, you may be able to get help paying your Part B premiums and cost-sharing through a program called Medicare Savings Programs, which is run by your state.
Part A and Part B Versus Medicare Advantage
Original Medicare — Part A and Part B together — is a fee-for-service plan run by the federal government. You can see any doctor or hospital that accepts Medicare, and Medicare pays its share of the cost. You are responsible for deductibles and copayments.
Medicare Advantage (Part C) is an alternative. It is a private insurance plan that must cover everything Part A and Part B cover, but it may have different costs, different networks of doctors, and additional benefits like dental or vision. If you choose Medicare Advantage, you still have Part A and Part B — the Advantage plan is the way you receive those benefits. Some people prefer Advantage plans because of lower copayments or extra benefits; others prefer Original Medicare because they can see any doctor.
You do not have to choose between Original Medicare and Advantage — you choose one or the other when you first become may be able to access for Medicare, or during the annual enrollment period (October 15 to December 7 each year).
Understanding Your Out-of-Pocket Costs
Your actual costs under Part A and Part B depend on how much healthcare you use. If you have a hospital stay, you will pay the Part A deductible plus copayments for days 61 to 90 (and beyond if you stay longer). If you see your doctor once a year for a wellness visit, you pay nothing because preventive visits are covered at no cost.
Many people buy a Medigap policy (also called supplemental insurance) to help pay the costs that Part A and Part B do not cover — deductibles, copayments, and coinsurance. Medigap is sold by private insurance companies and comes in standardized plans labeled A through N. A Medigap plan works alongside Original Medicare; it is not a replacement.
If your income is low, you may be able to get help through Medicare Savings Programs or Medicaid. Your state Medicaid office can tell you whether you may have access to. If you have limited resources, you may also be able to get help paying for prescriptions through the Low-Income Subsidy program, which is part of Part D.
Frequently Asked Questions
Does Medicare Part B cover my annual physical exam?
Yes. Part B covers one wellness visit per year at no cost to you. This is different from a traditional physical — it is focused on preventive care and reviewing your health status. If you need additional office visits for sick care or managing a chronic condition, those visits are covered but you pay a copayment.
If I have Part A and Part B, do I need to buy Part D for prescriptions?
You do not have to, but if you do not have prescription drug coverage and you do not have creditable coverage from another source (like an employer plan), you may pay a penalty if you join Part D later. It is usually cheaper to join Part D when you first become may be able to access for Medicare.
Does Part A cover a nursing home if I need long-term care?
Part A covers up to 100 days in a skilled nursing facility after a hospital stay, but only if you need skilled medical care or rehabilitation. If you need a nursing home for custodial care — help with daily living — Part A does not cover it. Medicaid may cover nursing home care if you meet income and asset limits.
What happens if I do not have Part B?
You can have Part A without Part B, but you will pay out of pocket for doctor visits, lab work, and imaging. If you delay joining Part B without a good reason, you may pay a higher premium when you do join. It is usually best to enroll in Part B when you first become may be able to access.
Can I use my Part A and Part B coverage at any hospital or doctor's office?
Yes, as long as the provider accepts Medicare. Most hospitals and doctors do, but you can check on Medicare.gov before scheduling an appointment. If you choose a Medicare Advantage plan instead of Original Medicare, you may have a network of preferred providers.