Medicare pays for hospital care, doctor visits, prescription drugs, and preventive services, but not everything a senior needs

Medicare is federal health insurance for people 65 and older. It covers the costs of many medical services — hospital stays, doctor appointments, lab tests, imaging, and some prescription medications. But Medicare has limits. It does not cover dental work, vision care, hearing aids, long-term care in a nursing home, or most routine foot care. Understanding what Medicare pays for and what you pay out of your own pocket helps you plan for healthcare costs and know when to look for additional coverage.

Medicare has four main parts, each covering different services. Part A covers hospital stays and some follow-up care. Part B covers doctor visits and outpatient services. Part D covers prescription drugs. Part C, also called Medicare Advantage, is an alternative way to get Parts A and B through a private insurance company. Most seniors have Part A and Part B, and many add Part D for drug coverage. Some choose Medicare Advantage instead of traditional Medicare.

Key Takeaways

  • Medicare Part A covers hospital stays, skilled nursing care after hospitalization, hospice, and some home health services.
  • Medicare Part B covers doctor visits, outpatient care, lab tests, imaging, and some preventive services, and requires a monthly premium.
  • Medicare Part D covers prescription drugs through private insurance plans you choose, and the premium and coverage vary by plan.
  • Medicare does not cover dental, vision, hearing aids, long-term nursing home care, or most routine foot care, which is why many seniors buy supplemental or Medicare Advantage plans.
  • You pay deductibles, copayments, and coinsurance for most services, and costs vary depending on which parts of Medicare you have.

What Medicare Part A Covers

Part A covers inpatient hospital care — when you stay overnight in a hospital. This includes your room, meals, nursing care, and tests done during your stay. Part A also pays for skilled nursing facility care after you leave the hospital, but only if you were hospitalized for at least three days first and only for up to 100 days per benefit period. The facility must be a Medicare-approved skilled nursing facility, not a regular assisted living home.

Part A also covers hospice care for people with a terminal illness, and some home health services — like nursing visits or physical therapy at home — if your doctor orders them and you are homebound. Part A does not cover custodial care, which is help with daily activities like bathing or dressing when that is the only service you need. Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes for at least 10 years while working.

What Medicare Part B Covers

Part B covers doctor visits and outpatient care — services you receive without staying overnight. This includes office visits with your primary care doctor or specialists, emergency room visits, urgent care, and outpatient surgery. Part B also pays for diagnostic tests and imaging like blood work, X-rays, CT scans, and ultrasounds when your doctor orders them for diagnosis or treatment.

Part B covers preventive services at no cost to you — meaning you pay nothing out of pocket — including annual wellness visits, cancer screenings (mammograms, colonoscopies, Pap tests), cardiovascular screenings, bone density tests, and vaccines like flu and pneumonia shots. Part B also covers some durable medical equipment like wheelchairs, walkers, oxygen equipment, and diabetic supplies if your doctor prescribes them. You pay a monthly premium for Part B, and the amount changes each year.

What Medicare Part D Covers

Part D is prescription drug coverage through private insurance companies that contract with Medicare. You choose a Part D plan during your enrollment period, and the plan determines which drugs it covers, how much you pay, and which pharmacies you can use. Part D covers brand-name and generic medications, but not all drugs — your plan's formulary (the list of covered drugs) may exclude some medications or require your doctor to get approval first.

You pay a monthly premium for Part D, and the amount varies by plan and changes each year. You also pay a deductible before coverage begins, and then you pay a copayment or coinsurance for each prescription. If your prescription costs are very high, you may enter the "donut hole" — a coverage gap where you pay a larger share of the cost — though this gap has been shrinking in recent years. If you do not sign up for Part D when you first become may be able to access and you do not have other drug coverage, you may pay a penalty if you join later.

What Medicare Does Not Cover

Medicare does not pay for dental care — no cleanings, fillings, extractions, dentures, or root canals. It does not cover vision care — no eye exams for glasses or contacts, no eyeglasses, no contact lenses. Medicare does not cover hearing aids or hearing exams for the purpose of fitting hearing aids, though it does cover some diagnostic hearing tests ordered by your doctor.

Medicare does not cover long-term care in a nursing home — only skilled nursing care for a limited time after hospitalization. It does not cover custodial care at home or in a facility, which is help with bathing, dressing, toileting, and meals when that is the only service you need. Medicare does not cover most routine foot care, including toenail trimming and callus removal, unless you have diabetes or a related condition. It also does not cover cosmetic surgery, weight loss programs, or most alternative medicine like acupuncture or chiropractic care.

How Much You Pay Out of Pocket

Medicare requires you to share the cost of most services through deductibles (a set amount you pay before Medicare starts paying), copayments (a fixed amount per visit or service), and coinsurance (a percentage of the cost). Part A has a deductible for hospital stays and a separate deductible for skilled nursing care. Part B has an annual deductible, and then you typically pay 20 percent coinsurance for most services after that.

Your out-of-pocket costs can add up quickly, especially if you have chronic conditions that require frequent doctor visits or expensive medications. Many seniors buy Medigap (supplemental insurance) to cover some of these costs, or they choose Medicare Advantage (Part C), which is an alternative way to receive Medicare benefits through a private insurance company. Both options have their own costs and coverage rules, so comparing them based on your own health needs and budget is important.

When to Ask Your Doctor or Medicare

Ask your doctor whether a service or medication is covered by Medicare before you have it done or filled. Your doctor's office can often check your coverage, or you can call Medicare directly at 1-800-MEDICARE (1-800-633-4227). If Medicare denies coverage for something your doctor recommends, ask why — sometimes your doctor can request an exception or appeal the decision.

If you are considering a service that Medicare may not cover — like dental work, vision care, or hearing aids — ask your doctor whether it is medically necessary and whether there are any Medicare-covered alternatives. If you are thinking about buying supplemental coverage or switching to Medicare Advantage, compare plans during the annual enrollment period (October 15 to December 7 each year) so you understand what each plan covers and what you would pay.

Frequently Asked Questions

Does Medicare cover my medications?

Part D covers prescription drugs, but you must choose a Part D plan and the plan decides which drugs it covers. Not all medications are on every plan's formulary. Check your plan's list of covered drugs, or call the plan to ask whether your specific medications are covered before you fill a prescription.

Will Medicare pay for my hearing aids?

No. Medicare does not cover hearing aids or the cost of fitting them. It does cover diagnostic hearing tests if your doctor orders them for medical reasons. Some Medicare Advantage plans offer limited hearing aid coverage, so check your plan's details if you have Medicare Advantage.

What happens if I need dental work?

Medicare does not cover dental care. You can buy a standalone dental plan, visit a dental school for lower-cost care, or look for community health centers that offer sliding-scale fees based on income. Some states also have programs for seniors with limited income.

Does Medicare cover nursing home care?

Medicare covers skilled nursing facility care for up to 100 days per benefit period, but only after a hospital stay of at least three days. It does not cover long-term custodial care in a nursing home. Long-term care is usually paid for by Medicaid, private insurance, or out of pocket.

Can I change my coverage if my health needs change?

You can change your Part D plan or switch to or from Medicare Advantage during the annual enrollment period each fall. If you have a major life change — like losing other coverage or moving to a new state — you may be able to make changes outside the enrollment period. Call Medicare to ask about your options.