Medicare covers hospital stays, doctor visits, and some medical equipment, but not everything

Medicare pays for inpatient hospital care, doctor office visits, lab tests, imaging like X-rays and CT scans, and some medical equipment such as wheelchairs and oxygen. It also covers preventive services with no copay — screenings, vaccines, and annual wellness visits. But Medicare has strict rules about what qualifies as medically necessary, and it does not cover dental work, vision care, hearing aids, long-term custodial care, or most prescription drugs without a separate Part D plan.

What Medicare will or will not pay depends partly on which parts you have enrolled in. Part A covers hospital and skilled nursing. Part B covers outpatient doctor and lab services. Part D covers prescription drugs. Medigap and Medicare Advantage plans fill gaps in different ways. The specific dollar amounts you pay — copays, coinsurance, deductibles — vary by plan type and change each year.

Key Takeaways

  • Medicare Part A covers inpatient hospital stays and skilled nursing facility care after a hospital stay, but only for the first 100 days and with increasing copays after day 20.
  • Medicare Part B covers doctor office visits, lab work, imaging, and outpatient services, but you pay a monthly premium and a yearly deductible before coverage begins.
  • Medicare does not cover dental, vision, hearing aids, or long-term custodial care in a nursing home or at home, though some Medicare Advantage plans offer limited dental and vision benefits.
  • Prescription drug coverage requires a separate Part D plan, and you must enroll during your initial enrollment window or pay a late penalty if you join later.
  • Medigap plans pay some of your copays and coinsurance but do not add new services; Medicare Advantage plans bundle all coverage into one plan and often include dental and vision but limit your choice of doctors.

What Medicare Part A Covers

Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. If you are admitted to a hospital as an inpatient, Part A pays for your room, meals, nursing care, and most tests and procedures done during that stay. You pay a deductible for each benefit period (the amount changes yearly), and after 60 days you begin paying daily copays that increase the longer you stay.

Skilled nursing facility care is covered only after a hospital stay of at least three consecutive days, and only for up to 100 days per benefit period. Part A pays the full cost for days 1 through 20, then you pay a daily copay for days 21 through 100. After day 100, you pay all costs. Home health services — nursing, physical therapy, medical equipment — are covered if a doctor orders them and you are homebound, but only for a limited time and only if the care is skilled, not custodial.

Hospice care is covered when a doctor certifies you have six months or less to live and you choose comfort care over curative treatment. Part A pays for hospice services, medications related to your terminal condition, and some respite care. You may pay small copays for drugs and respite care, but the program covers most costs.

What Medicare Part B Covers

Part B covers doctor office visits, outpatient surgery, emergency room visits, lab tests, imaging, physical therapy, and durable medical equipment like wheelchairs, walkers, and oxygen. After you meet your yearly deductible, you typically pay 20 percent coinsurance for most services, and the provider bills Medicare for the remaining 80 percent. Some preventive services — annual wellness visits, cancer screenings, vaccines — are covered with no copay or coinsurance once you have met your deductible.

Part B does not cover routine dental cleanings, eyeglasses, hearing aids, or routine foot care. It also does not cover most outpatient prescription drugs, which are covered under Part D instead. If you need mental health services, Part B covers psychiatrist and therapist visits, but only up to a certain number per year unless your doctor documents medical necessity.

You must enroll in Part B when you first become may be able to access at 65, or during a later enrollment period. If you delay enrollment without a valid reason, you pay a permanent monthly penalty for as long as you have Medicare.

Prescription Drug Coverage Under Part D

Part D is a separate prescription drug plan you must choose and enroll in. It is not automatic, even if you have Part A and Part B. You pick a plan from private insurers, and the plan decides which drugs it covers and at what cost. Most plans have a yearly deductible, then you pay a copay or coinsurance per prescription. Once you spend a certain amount out of pocket, you enter the "donut hole" — a coverage gap where you pay more, though the gap has narrowed in recent years.

You must enroll in Part D when you first become may be able to access, or during the annual enrollment period (October 15 to December 7). If you go without Part D coverage for more than 63 days in a row, you pay a permanent monthly penalty when you do join, even if you join years later.

If you have limited income, you may be able to get help paying Part D premiums and copays through the Low-Income Subsidy program. You can also switch plans once a year during open enrollment if your current plan no longer meets your needs or costs have risen.

What Medicare Does Not Cover

Medicare does not cover dental work — cleanings, fillings, extractions, dentures, or implants. It does not cover routine eye exams, eyeglasses, or contact lenses. Hearing aids and hearing exams are not covered. Long-term custodial care in a nursing home or at home — help with bathing, dressing, meals, and housekeeping — is not covered by Original Medicare, though Medicaid may cover it if you meet income and asset limits.

Medicare also does not cover cosmetic surgery, weight loss surgery (unless medically necessary for a specific condition), most acupuncture, or most chiropractic care. Overseas medical care is not covered except in rare cases. Experimental treatments and drugs not yet approved by the FDA are not covered unless you are enrolled in a clinical trial.

If you need services Medicare does not cover, you can pay out of pocket, purchase a Medigap plan to cover some gaps, or enroll in a Medicare Advantage plan that may offer additional benefits like dental or vision. Some services may also be covered by Medicaid if you have low income, or by your former employer's retiree health plan if you are may be able to access.

How Medigap and Medicare Advantage Change What You Pay

Medigap (also called Supplement Insurance) is a policy sold by private insurers that pays some or all of your copays, coinsurance, and deductibles under Original Medicare. It does not add new services — it only reduces what you pay for services Medicare already covers. There are ten standardized Medigap plans (labeled A through N), each with a different combination of copay and coinsurance coverage. You still pay your Part B premium and your Part D premium if you have drug coverage.

Medicare Advantage (Part C) is an alternative to Original Medicare. It bundles Part A, Part B, and usually Part D into one plan run by a private insurer. You pay a monthly premium (often lower than Original Medicare plus Medigap), but you must use doctors and hospitals in the plan's network, and you may need prior approval for some services. Many Medicare Advantage plans include dental, vision, and hearing benefits that Original Medicare does not cover. However, you cannot use Medigap with Medicare Advantage.

Choosing between Original Medicare with Medigap and Medicare Advantage depends on your health, your doctors, and your budget. If you have a chronic condition and see many specialists, Original Medicare may give you more flexibility. If you want lower premiums and do not mind using a network, Medicare Advantage may cost less. You can switch between them during the annual open enrollment period.

How to Find Out What Your Specific Plan Covers

Your Medicare coverage details are in your Summary of Benefits, a document your plan sends you each year. It lists what services are covered, what you pay for each service, and any limits or restrictions. You can also call the customer service number on your Medicare card to ask about a specific service or drug before you receive it.

Medicare.gov has a tool called "Find Care Providers" where you can search for doctors, hospitals, and other providers in your plan's network. It also has a drug search tool where you can look up whether a specific prescription is covered under your Part D plan and what your copay will be. If you are considering a service you think Medicare might not cover, ask your doctor's office to check with Medicare before you proceed — they can often get a information in writing.

If Medicare denies a service or drug, you have the right to appeal. Your plan must tell you why it was denied and how to request a review. Many denials are overturned on appeal, especially if your doctor provides additional medical documentation.

Frequently Asked Questions

Does Medicare cover physical therapy?

Yes, Part B covers physical therapy ordered by a doctor, whether in an outpatient clinic, hospital, or your home. You pay 20 percent coinsurance after you meet your deductible. Medicare limits the number of visits per year unless your doctor documents that more are medically necessary.

Will Medicare pay for a nursing home?

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 custodial care — help with daily living — in a nursing home. Medicaid covers long-term custodial care if you have low income and few assets.

Does Medicare cover my blood pressure medication?

Only if you have Part D prescription drug coverage. Part B does not cover outpatient drugs. You choose a Part D plan, and each plan has its own list of covered drugs and copays. You can search your plan's formulary on Medicare.gov or call your plan to confirm your drug is covered.

What happens if I do not enroll in Part D when I am first may be able to access?

If you go without Part D coverage for more than 63 days in a row, you pay a permanent monthly penalty added to your Part D premium for as long as you have Medicare. The penalty is based on how long you went without coverage. You can avoid the penalty by enrolling during your initial enrollment period or if you have other creditable drug coverage.

Can I use my Medicare at any hospital or doctor?

With Original Medicare, yes — any provider that accepts Medicare can treat you. With Medicare Advantage, no — you must use doctors and hospitals in your plan's network, except in emergencies. Check your plan's provider directory before scheduling an appointment.