Medicare covers hospital stays, doctor visits, and some prescription drugs, 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, medical equipment, and preventive services. Part D covers prescription drugs. Part C, also called Medicare Advantage, is an alternative way to get Parts A and B coverage through a private insurance company, often bundled with Part D and sometimes dental or vision.

What Medicare does not cover is just as important to know: long-term care in a nursing home (unless it is skilled nursing for a specific medical reason after a hospital stay), most dental work, most vision care, hearing aids, or most routine foot care. You pay something toward almost every service — a deductible, a copay, or coinsurance — even after you are enrolled.

Key Takeaways

  • Part A covers hospital stays and some skilled nursing care; Part B covers doctor visits and outpatient services; Part D covers prescription drugs.
  • Medicare does not cover long-term nursing home care, dental work, vision care, or hearing aids.
  • You pay a deductible, copay, or percentage of the cost (coinsurance) for most services, even with Medicare.
  • Part C (Medicare Advantage) bundles Parts A and B through a private insurer and often includes prescription drug coverage and extra benefits like dental.

What Part A Covers

Part A pays for inpatient hospital care — that means you are admitted to the hospital and stay overnight. It covers your room, meals, nursing care, and most tests and procedures done while you are there. You pay a deductible for each hospital stay (the amount changes yearly), and after 60 days in the hospital, you start paying coinsurance — a daily amount that increases the longer you stay.

Part A also covers up to 100 days in a skilled nursing facility if you are admitted after a hospital stay of at least three days. Skilled nursing means a nurse or therapist provides the care — not just help with daily tasks. Medicare pays the full cost for days 1 through 20, then you pay coinsurance for days 21 through 100. After 100 days, you pay everything yourself.

Home health services are covered under Part A if a doctor orders them and you are homebound. A nurse, physical therapist, or occupational therapist can visit your home. Part A also covers hospice care if you have a terminal illness and choose comfort care instead of treatment to cure the disease.

What Part B Covers

Part B covers doctor visits — both routine checkups and visits for specific health problems. It pays for outpatient services, meaning you go to a clinic or office and come home the same day. This includes emergency room visits, urgent care, lab tests, X-rays, and imaging like CT scans or ultrasounds.

Part B also covers preventive services at no cost to you: annual wellness visits, cancer screenings (mammograms, colonoscopies, Pap tests), cardiovascular screenings, bone density tests, diabetes screenings, and vaccinations like flu shots and pneumonia vaccines. You do not pay a copay or coinsurance for these preventive visits if you see a doctor who accepts Medicare.

Medical equipment and supplies are covered under Part B: wheelchairs, walkers, oxygen, diabetic testing supplies, and similar items. Your doctor must order them, and you typically pay 20 percent of the cost after you meet your Part B deductible. Outpatient mental health services and substance abuse treatment are also covered.

What Part D Covers

Part D is prescription drug coverage. You choose a Part D plan from private insurers, and each plan has its own list of covered drugs, called a formulary. Most plans cover brand-name and generic drugs, but not all drugs are on every formulary.

You pay a monthly premium for Part D, a deductible (which varies by plan), and then a copay or coinsurance for each prescription. There is a coverage gap called the "donut hole" — once you and your plan have spent a certain amount on drugs in a year, you pay more out of pocket until you reach a catastrophic coverage threshold. After that, you pay a small copay for the rest of the year. The amounts change yearly.

If you do not sign up for Part D when you first become may be able to access and you go without coverage, you may pay a penalty if you join later. The penalty is added to your monthly premium for as long as you have Part D coverage.

What Part C (Medicare Advantage) Covers

Part C is an alternative to Original Medicare (Parts A and B). A private insurance company runs the plan and provides all your Part A and Part B coverage. Most Part C plans include Part D (prescription drug coverage) and often add benefits that Original Medicare does not: dental cleanings and exams, vision exams and glasses, hearing exams and hearing aids, fitness programs, or transportation to medical appointments.

The tradeoff is that Part C plans usually have a network — you must use doctors and hospitals in that network, or you pay more. Some plans are Health Maintenance Organizations (HMOs), which require you to pick a primary care doctor and get referrals to see specialists. Others are Preferred Provider Organizations (PPOs), which give you more flexibility to see any doctor but charge you more if you go out of network.

Part C plans have out-of-pocket maximums, which means once you have paid a certain amount in copays and coinsurance in a year, the plan pays 100 percent of covered services for the rest of that year. Original Medicare does not have an out-of-pocket maximum.

What Medicare Does Not Cover

Long-term care in a nursing home is not covered by Medicare, even if you need help with bathing, dressing, or eating. Medicare only pays for skilled nursing care after a hospital stay, and only for a limited time. If you need ongoing help at home or in a facility, you pay out of pocket or through Medicaid (a separate program for people with lower income).

Dental work — cleanings, fillings, root canals, dentures, extractions — is not covered by Original Medicare. Some Part C plans include dental benefits, but they usually cover only cleanings and exams, not major work. Vision care, including eye exams, glasses, and contact lenses, is not covered by Original Medicare, though some Part C plans offer it. Hearing aids are not covered by Original Medicare, though some Part C plans cover them in full or in part.

Routine foot care, weight loss programs, cosmetic surgery, and most acupuncture are not covered. If you travel outside the United States, Original Medicare does not cover care you receive abroad (some Part C plans offer limited coverage).

How Much You Pay: Deductibles, Copays, and Coinsurance

You pay something toward almost every Medicare service. The amounts change yearly and depend on which part of Medicare you use. Part A has a deductible for hospital stays and coinsurance for longer stays. Part B has an annual deductible, then you typically pay 20 percent coinsurance for most services after that. Part D has a monthly premium, a deductible, and copays or coinsurance per prescription.

If you have Original Medicare (Parts A and B) and want to limit your out-of-pocket costs, you can buy a Medigap policy (also called supplemental insurance) from a private insurer. Medigap helps pay the deductibles, copays, and coinsurance that Original Medicare does not cover. Medigap plans are standardized — Plan A, Plan B, Plan C, and so on — so the same plan letter covers the same benefits no matter which company sells it.

Part C plans have their own cost structure: a monthly premium (sometimes zero), copays for doctor visits and prescriptions, and an out-of-pocket maximum. Once you reach that maximum in a year, the plan pays 100 percent of covered services.

Frequently Asked Questions

Does Medicare cover preventive care like cancer screenings and vaccines?

Yes. Part B covers preventive services at no cost to you if you see a doctor who accepts Medicare: mammograms, colonoscopies, Pap tests, flu shots, pneumonia vaccines, and cardiovascular and diabetes screenings. You do not pay a copay or coinsurance for these services.

What happens if I need care while traveling outside the United States?

Original Medicare (Parts A and B) does not cover care outside the U.S., except in limited cases near the border. If you travel internationally, you pay out of pocket. Some Part C plans offer limited coverage abroad; check your plan's details before you travel.

Can I use any doctor with Medicare?

With Original Medicare (Parts A and B), you can see any doctor or hospital that accepts Medicare — you do not need a referral. With Part C (Medicare Advantage), you usually must use doctors and hospitals in your plan's network, or pay more. HMO plans require you to pick a primary care doctor.

Is there a limit to how much I have to pay out of pocket with Medicare?

Original Medicare has no out-of-pocket maximum — you could pay a lot if you have a serious illness. Part C plans have an out-of-pocket maximum; once you reach it, the plan pays 100 percent of covered services for the rest of the year. Medigap policies can also limit your costs by covering deductibles and coinsurance.

What is the donut hole in Part D?

The donut hole is a coverage gap in prescription drug plans. Once you and your plan have spent a certain amount on drugs in a year, you pay more out of pocket until you reach a catastrophic coverage threshold. After that, you pay a small copay for the rest of the year. The amounts change yearly.