Medicare Part A covers hospital care, Part B covers doctor visits and outpatient services

Medicare Part A pays for inpatient hospital stays, skilled nursing facility care after hospitalization, hospice care, and home health services. Medicare Part B pays for doctor office visits, preventive care, lab tests, imaging, and outpatient procedures. Most people age 65 and older receive both automatically, though you can decline Part B if you have other coverage.

Part A is hospital insurance. Part B is medical insurance. Together they form the foundation of Original Medicare — the traditional fee-for-service program run by the federal government. Understanding what each covers helps you know what costs you will face and whether you need additional coverage.

Key Takeaways

  • Part A covers hospital stays, skilled nursing care after hospitalization, and hospice; Part B covers doctor visits, preventive services, and outpatient care.
  • Most people automatically receive Part A at age 65 if they have paid Medicare taxes for at least 10 years; Part B enrollment requires a separate decision.
  • Part A has a deductible per hospital stay and daily copayments after 60 days; Part B has a monthly premium, annual deductible, and 20% coinsurance.
  • If you delay Part B enrollment without other may have access to coverage, you may face a permanent penalty on your premium.
  • Neither Part A nor Part B covers dental, vision, hearing aids, or long-term custodial care in a nursing home.

What Medicare Part A Covers

Part A covers a hospital stay from the moment you are admitted as an inpatient until you are discharged. It pays for your room, meals, nursing care, medications given in the hospital, and most tests and procedures done during that stay. It does not cover a doctor's office visit or an emergency room visit unless you are admitted to the hospital afterward.

Part A also covers up to 100 days in a skilled nursing facility if you need rehabilitation after a hospital stay of at least three days. It pays for nursing care, therapy, and meals during that stay. It does not cover custodial care — help with bathing, dressing, or eating — if that is the only service you need. Part A covers home health services when ordered by a doctor, including nursing visits, physical therapy, and medical equipment. It covers hospice care for people with a terminal illness, including pain management and comfort care.

What Medicare Part B Covers

Part B covers visits to your doctor's office, including routine checkups, sick visits, and specialist consultations. It pays for preventive services at no cost to you, including annual wellness visits, cancer screenings, vaccinations, and cardiovascular screenings. It covers lab work and imaging ordered by your doctor, such as blood tests, X-rays, and ultrasounds done in an outpatient setting.

Part B pays for outpatient procedures and surgeries, mental health counseling, physical and occupational therapy, and durable medical equipment like wheelchairs, oxygen, and diabetic supplies. It covers ambulance services when medically necessary. It does not cover routine dental care, eye exams for glasses or contacts, hearing aids, or cosmetic procedures.

How Part A and Part B Costs Work

Part A is funded through payroll taxes you paid during your working years. Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes for at least 10 years. If you did not work long enough, you can still receive Part A by paying a monthly premium, which varies by how many years of work history you have.

Part B requires a monthly premium that is deducted from your Social Security check. The standard premium amount changes each year. You also pay an annual deductible before Part B starts paying, and then you pay 20% of the cost of most services after that. Part A has a deductible per hospital stay and daily copayments if your stay extends beyond 60 days.

If your income is higher, you may pay an additional amount on top of the standard Part B premium, called an Income-Related Monthly Adjustment Amount (IRMAA). This is calculated based on your tax return from two years prior.

When You Automatically Receive Part A and Part B

You automatically receive Part A the month you turn 65 if you are a U.S. citizen or permanent resident and have lived in the country for at least five years. You do not need to do anything — it starts on its own. Part B is different: you must actively choose to enroll, or you can decline it if you have other coverage.

If you are still working and have health insurance through your employer, you can delay Part B enrollment without penalty as long as your employer coverage continues. Once you leave that job or lose the coverage, you have eight months to enroll in Part B without facing a late enrollment penalty. If you miss that window, your Part B premium increases by 10% for each year you delayed, and that increase is permanent.

What Part A and Part B Do Not Cover

Neither part covers routine dental care, dentures, or dental implants. Neither covers routine eye exams, glasses, or contact lenses. Neither covers hearing aids or hearing exams. Neither covers long-term custodial care in a nursing home — the kind of care where you need help with daily living but not skilled medical care.

Neither part covers most prescription drugs. You need a separate prescription drug plan (Part D) for that coverage. Neither part covers vision care beyond what is medically necessary, such as cataract surgery. Neither covers most alternative therapies, acupuncture, or chiropractic care except in limited circumstances.

Original Medicare Versus Medicare Advantage

Part A and Part B together make up Original Medicare, the traditional program. You can use any doctor or hospital that accepts Medicare. You pay out-of-pocket costs as described above, and you may want to buy a Medigap policy to cover some of those costs.

Alternatively, you can choose a Medicare Advantage plan (Part C), which is a private insurance alternative to Original Medicare. Medicare Advantage plans must cover everything Part A and Part B cover, but they often have lower out-of-pocket costs and may include dental or vision benefits. The trade-off is that you usually must use doctors and hospitals in the plan's network, and you may need prior approval for certain services.

Frequently Asked Questions

Do I have to take Part B when I turn 65?

No. If you have health insurance through an employer or your spouse's employer, you can delay Part B without penalty. You have eight months after you leave that job or lose the coverage to enroll. If you do not have other coverage and do not enroll in Part B when you first become may be able to access, you will pay a higher premium permanently.

What happens if I go to the emergency room but am not admitted to the hospital?

Part A does not cover an emergency room visit unless you are admitted to the hospital. If you are treated and released, Part B covers the emergency room visit, and you pay your Part B deductible and 20% coinsurance. If you are admitted, Part A covers the hospital stay, and the emergency room visit is included as part of that stay.

Does Part B cover my doctor's office visit if I have not met my deductible?

No. You must pay your full Part B deductible before Part B starts paying. Once you meet the deductible, Part B pays 80% of the cost and you pay 20%. Preventive services are covered at no cost even before you meet your deductible.

Can I use any doctor with Part A and Part B?

Yes, as long as the doctor accepts Medicare. Most doctors do. You do not need to choose a primary care doctor or get referrals. If you choose a Medicare Advantage plan instead of Original Medicare, you will usually need to use doctors in that plan's network.

What should I do if I am still working at 65?

If you have health insurance through your job, you can delay Part B enrollment without penalty. Enroll in Part A if you want it, but you can decline Part B. When you leave your job or lose the coverage, contact Social Security within eight months to enroll in Part B without a penalty.