Part A covers hospital stays, skilled nursing, hospice, and some home health care
Medicare Part A is hospital insurance. It pays for inpatient hospital care — meaning you stay overnight — plus skilled nursing facilities, hospice services, and limited home health visits. You do not pay a monthly premium for Part A if you or your spouse paid Medicare taxes for at least 10 years while working. Most people age 65 and older have Part A automatically.
Part A covers the full cost of your hospital room, meals, nursing care, and standard medical supplies while you are admitted. It also covers up to 100 days in a skilled nursing facility after a hospital stay of at least three days, though you pay a daily amount after day 20. Hospice care — end-of-life comfort care — is covered in full, and home health visits by nurses or therapists are covered if a doctor orders them and you are homebound.
What Part A does not cover: doctor visits, outpatient care, prescription drugs, physical therapy outside the home, or long-term custodial care in a nursing home. If you need ongoing help with daily tasks but do not need skilled medical care, Part A will not pay for it.
Part B covers doctor visits, outpatient care, tests, and some equipment
Medicare Part B is medical insurance. It pays for doctor office visits, emergency room care, outpatient surgery, lab tests, X-rays, and durable medical equipment like wheelchairs and oxygen. Part B also covers preventive services — annual wellness visits, cancer screenings, vaccinations — at no cost to you beyond your premium.
You pay a monthly premium for Part B, which changes each year based on your income. In 2024, the standard premium is $164.90 per month, but higher earners pay more. You also pay a yearly deductible before Part B starts paying, and then you typically pay 20 percent of the cost of covered services after that.
Part B does not cover routine dental, vision, or hearing care. It does not cover prescription drugs outside a hospital or skilled nursing facility. It does not cover long-term care, custodial care in a nursing home, or most physical therapy unless ordered by a doctor as part of treatment for an injury or illness.
Key Takeaways
- Part A covers hospital stays, skilled nursing facilities, hospice, and some home health care, with no monthly premium for most people.
- Part B covers doctor visits, outpatient care, tests, and preventive services, and requires a monthly premium that varies by income.
- Together, Part A and Part B do not cover dental, vision, hearing, prescription drugs, or long-term custodial care.
- You pay a deductible and coinsurance under Part B, and a daily amount after day 20 in a skilled nursing facility under Part A.
- Many people add Part D (prescription drug coverage) or a Medigap or Medicare Advantage plan to cover gaps left by Part A and Part B alone.
How much you pay out of pocket under Part A and Part B
Part A has an inpatient hospital deductible — the amount you pay before Part A starts paying — that changes each year. In 2024, it is $1,556 per benefit period. A benefit period starts when you enter the hospital and ends after you have been out for 60 days in a row. If you go back to the hospital after that 60-day break, a new benefit period begins and you pay the deductible again.
After you meet the Part A deductible, you pay nothing for days 1 through 60 of a hospital stay. Days 61 through 90 cost you a daily amount (in 2024, $389 per day). If you stay longer than 90 days, you have 60 "lifetime reserve days" you can use, and those cost you more per day. After your lifetime reserve days are gone, you pay the full cost.
Part B has its own yearly deductible (in 2024, $240) and then you pay 20 percent of the cost of most services. Your doctor's office or the lab will bill Medicare first, and Medicare pays its share, then sends you a bill for your 20 percent. Some preventive services — like annual wellness visits and cancer screenings — have no deductible and no coinsurance, so you pay nothing.
What happens if you delay signing up for Part A or Part B
Part A is automatic at 65 if you are already getting Social Security. If you are not yet taking Social Security, you must sign up for Part A during your initial enrollment period — the three months before the month you turn 65, the month you turn 65, and the three months after. If you miss this window and do not have other coverage, you pay a penalty for each year you were may be able to access but did not sign up.
Part B enrollment works the same way: you have a seven-month initial enrollment period centered on your 65th birthday. If you miss it and do not have other coverage, you pay a 10 percent penalty on your Part B premium for each year you delayed. The penalty is permanent — it stays on your premium for life. The only exception is if you were covered by an employer health plan when you turned 65; in that case, you have eight months after that coverage ends to sign up without penalty.
How Part A and Part B work together with other coverage
Part A and Part B together cover many things, but they leave gaps. Most people add one of three types of additional coverage: Part D (prescription drug coverage), a Medigap policy (also called supplemental insurance), or a Medicare Advantage plan (Part C).
A Medigap policy is sold by private insurance companies and pays some or all of the costs that Part A and Part B do not — like deductibles, coinsurance, and copays. It does not cover dental, vision, or hearing. A Medicare Advantage plan is an alternative to Part A and Part B; it is run by a private insurance company and usually includes prescription drug coverage, but it has a network of doctors and hospitals you must use, and it may have higher out-of-pocket costs for certain services.
Part D is prescription drug coverage. It is separate from Part A and Part B and is sold by private insurance companies. You can add Part D to Original Medicare (Part A and Part B) or it may be included in a Medicare Advantage plan. If you do not sign up for Part D when you first become may be able to access, you pay a penalty for each month you go without it.
Preventive services covered at no cost under Part B
Medicare Part B covers certain preventive services with no deductible and no coinsurance — you pay nothing. These include an annual wellness visit with your doctor, colorectal cancer screening, breast cancer screening (mammogram), prostate cancer screening, cardiovascular screening, diabetes screening, bone density screening, and vaccinations like flu, pneumonia, and shingles.
To receive these services at no cost, you must use an in-network provider — a doctor or facility that accepts Medicare. If you go to an out-of-network provider, you may pay more. Your doctor's office can tell you whether they are in-network and whether a specific service is covered as preventive care.
Frequently Asked Questions
Do I have to take Part B when I turn 65?
No, but if you delay and do not have other health coverage, you will pay a permanent 10 percent penalty on your Part B premium. If you are still working and covered by your employer's health plan, you can delay Part B without penalty, but you must sign up within eight months after that coverage ends.
What is the difference between Original Medicare and Medicare Advantage?
Original Medicare is Part A and Part B run by the federal government. Medicare Advantage (Part C) is an alternative run by private insurance companies; it usually includes prescription drug coverage and may have lower premiums, but you must use doctors and hospitals in the plan's network. Both cover the same basic services, but the out-of-pocket costs and rules are different.
Does Part B cover my doctor's office visit?
Yes, Part B covers office visits to your doctor. You pay 20 percent of the cost after you meet your yearly deductible. If your doctor is in-network with Medicare, they bill Medicare directly and you pay your share. If your doctor is out-of-network, you may pay more.
Can I use Part A and Part B at any hospital or doctor's office?
Part A works at any hospital or skilled nursing facility in the United States that accepts Medicare, which is nearly all of them. Part B works with any doctor or provider that accepts Medicare, but some do not. Before your visit, ask your doctor's office whether they accept Medicare to avoid surprise bills.
What should I do if I cannot afford my Part A and Part B costs?
If your income is low, you may may have access to for Medicaid, which can help pay your Medicare premiums and out-of-pocket costs. You can also look into a Medigap policy, which covers many of the costs Part A and Part B do not. Contact your state Medicaid office or a local Area Agency on Aging to learn what programs may be available to you.