Medicare Part A covers hospital stays, skilled nursing, hospice, and home health care

Medicare Part A is hospital insurance. It pays for inpatient hospital stays (when you are admitted and stay overnight), care in a skilled nursing facility after a hospital stay, hospice care for terminal illness, and some home health services. 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.

Part A has a deductible — the amount you pay out of pocket before Medicare starts paying. For hospital stays in 2024, that deductible is per benefit period, not per year, which means it resets after you have been out of the hospital for 60 days. After you meet the deductible, Medicare covers all approved hospital costs for the first 60 days. Days 61 through 90 require a daily copay from you. Beyond 90 days, you pay more, though you have a limited number of "lifetime reserve days" that can extend coverage.

Part A does not cover doctor visits, outpatient care, prescription drugs, or long-term custodial care in a nursing home (care that is not skilled medical care). That is where Part B comes in.

Medicare Part B covers doctor visits, outpatient services, and preventive care

Medicare Part B is medical insurance. It pays for doctor office visits, outpatient hospital services, diagnostic tests, physical therapy, mental health care, and preventive services like screenings and vaccinations. Part B is optional, but most people enroll because the cost of going without it is high.

Part B requires a monthly premium, which varies by income. In 2024, the standard premium is around $165 per month for most people, but higher earners pay more. You also pay a yearly deductible (around $240 in 2024) before Part B coverage begins. After you meet the deductible, you typically pay 20 percent of the cost of covered services, and Medicare pays 80 percent.

Part B does not cover routine dental, vision, or hearing care. It also does not cover prescription drugs — that is covered under Part D, which is separate. If you want more comprehensive coverage than Part A and B alone provide, you can choose a Medigap policy or a Medicare Advantage plan instead of Part B.

Key Takeaways

  • Part A covers hospital stays, skilled nursing care, and hospice; Part B covers doctor visits, outpatient care, and preventive services.
  • Part A has no monthly premium for most people; Part B requires a monthly premium that increases with income.
  • Both Part A and Part B have deductibles and cost-sharing, meaning you pay some costs out of pocket.
  • Part A alone does not cover doctor visits, and Part B alone does not cover hospital stays — you typically need both for full coverage.
  • Neither Part A nor Part B covers prescription drugs, dental, vision, or hearing care.

How Part A and Part B work together

Most people who have Medicare have both Part A and Part B, because together they cover the major medical services you are likely to need. Part A handles the big-ticket events — hospital admissions — while Part B handles the ongoing care: your regular doctor, lab work, imaging, and preventive visits.

When you are hospitalized, Part A pays the hospital bill (after your deductible). When you see your doctor during or after that hospital stay, Part B pays the doctor's bill (after your deductible). The two work in parallel, not one after the other. You will receive separate bills and separate explanations of benefits from each part.

If you choose not to enroll in Part B when you first become may be able to access at 65, you can enroll later, but you may face a permanent penalty on your monthly premium. The exception is if you are still working and covered by your employer's health plan — in that case, you can delay Part B without penalty.

What you pay out of pocket with each part

Part A costs vary by the length of your hospital stay. You pay the deductible for the first hospital stay in a benefit period. If you are readmitted within 60 days, you do not pay another deductible — you are still in the same benefit period. After 60 days out of the hospital, a new benefit period begins, and you would owe a new deductible if you are hospitalized again.

Part B costs are more predictable: a monthly premium, an annual deductible, and then 20 percent coinsurance on most services. Some preventive services (like annual wellness visits and certain screenings) have no cost-sharing — Medicare covers them in full after you meet your deductible.

Neither part has an out-of-pocket maximum, which means your costs can add up if you have a serious illness or injury. Many people buy a Medigap policy to cover some of these gaps, or they choose a Medicare Advantage plan, which does have an out-of-pocket maximum but requires using doctors in the plan's network.

When you might choose Medicare Advantage instead

Medicare Advantage (Part C) is an alternative to Part A and Part B. It is offered by private insurance companies and must cover everything Part A and Part B cover, but it often includes prescription drug coverage, dental, vision, and hearing benefits that original Medicare does not. However, Medicare Advantage plans typically have networks — you must use doctors and hospitals in the plan's list, except in emergencies.

If you travel frequently or want to see any doctor who accepts Medicare, original Medicare (Part A and Part B) gives you more freedom. If you want lower out-of-pocket costs and do not mind a network, Medicare Advantage may be cheaper. The choice depends on your health, your budget, and how much flexibility you need.

Enrollment and timing

You become may be able to access for Medicare at 65. You can enroll during your Initial Enrollment Period, which is the three months before the month you turn 65, the month itself, and the three months after. If you enroll during this window, your coverage starts on the first day of your birth month (or the first of the following month if you enroll after your birth month).

If you miss your Initial Enrollment Period and do not have other health coverage, you can enroll during the General Enrollment Period (January 1 through March 31 each year), but your coverage will not start until July 1, and you may owe a permanent penalty on your Part B premium. The penalty is 10 percent of the standard premium for each full year you were may be able to access but did not enroll.

Frequently Asked Questions

Do I have to take Part B if I have Part A?

No, Part B is optional. However, if you delay enrolling in Part B beyond your Initial Enrollment Period and do not have other may have access to coverage, you will face a permanent premium penalty. If you are still working and covered by your employer's health plan, you can delay Part B without penalty.

What happens if I only have Part A and not Part B?

Part A alone covers hospital stays and some follow-up care, but not doctor office visits or outpatient services. You would pay the full cost of any doctor visit out of pocket. Most people find this risky and enroll in Part B as well.

Can I switch from Part B to Medicare Advantage?

Yes. You can switch during the Annual Enrollment Period (October 15 through December 7 each year) or during the Medicare Advantage Open Enrollment Period (January 1 through March 31). If you switch to Medicare Advantage, you are still enrolled in Part A, but Part B is covered under the Medicare Advantage plan.

Do Part A and Part B cover prescription drugs?

No. Prescription drug coverage is Part D, which you enroll in separately. If you do not enroll in Part D when you first become may be able to access, you may face a permanent penalty on your Part D premium later.

What is the difference between the deductible and the copay?

The deductible is the amount you pay before Medicare starts paying anything. The copay (or coinsurance) is what you pay for each service after you have met the deductible. With Part A, you pay the deductible once per benefit period, then copays for days 61 and beyond. With Part B, you pay the deductible once per year, then 20 percent coinsurance on most services.