Medicare covers hospital stays, doctor visits, and some preventive care, but not everything

Medicare is federal health insurance for people 65 and older, and some younger people with disabilities or end-stage renal disease. What it pays for depends on which part of Medicare you have — Part A covers hospital care, Part B covers outpatient doctor visits and tests, Part D covers prescription drugs, and Medigap or Medicare Advantage plans fill gaps in different ways. The most useful thing to know is that Medicare does not cover everything, and what it covers often comes with a cost to you.

This guide walks through what Medicare typically pays for, what it does not, and how to find out what your specific plan covers. The rules change, and your coverage depends on which plan you chose, so checking your plan documents or calling Medicare directly gives you the most current answer for your situation.

Key Takeaways

  • Medicare Part A covers hospital stays, skilled nursing facility care, and some home health services after a may have access to hospital stay.
  • Medicare Part B covers doctor visits, outpatient tests, and preventive care like screenings and vaccines, but you pay a monthly premium and a share of the cost.
  • Medicare does not cover dental, vision, hearing aids, or long-term custodial care in a nursing home or at home.
  • Medigap and Medicare Advantage plans cover some costs that Original Medicare does not, but they have different networks and out-of-pocket limits.
  • Your plan documents and the Medicare.gov website show exactly what is covered under your specific plan.

What Medicare Part A covers

Part A is hospital insurance. It covers inpatient hospital stays, care in a skilled nursing facility (a facility that provides medical care after a hospital stay, not a long-term nursing home), and some home health services if a doctor orders them after you leave the hospital. Part A also covers hospice care if you have a terminal illness.

You do not pay a monthly premium for Part A if you or your spouse paid Medicare taxes for at least 10 years. When you use Part A, you pay a deductible — a set amount you pay before Medicare starts paying — and then Medicare covers most of the cost. The deductible amount changes each year. If you stay in the hospital longer than a certain number of days, you also pay a daily coinsurance amount (a share of the cost per day).

Part A does not cover a hospital stay if you are admitted for observation rather than as an inpatient. This distinction matters because observation stays are treated differently for cost and for what comes after — for example, you may not be covered for a skilled nursing facility stay if your hospital stay was observation only. Ask the hospital to clarify your status when you arrive.

What Medicare Part B covers

Part B is medical insurance for outpatient care. It covers doctor visits, tests and imaging (like X-rays and ultrasounds), lab work, physical therapy, mental health counseling, and preventive services like cancer screenings, vaccines, and annual wellness visits. Part B also covers durable medical equipment — items like wheelchairs, walkers, oxygen equipment, and diabetic supplies — if a doctor orders them.

You pay a monthly premium for Part B, and the amount depends on your income. When you use Part B services, you typically pay a copay (a fixed amount per visit) or coinsurance (a percentage of the cost). For preventive services with no diagnosis code — like a screening colonoscopy or flu shot — you usually pay nothing. Once you meet your yearly deductible, Medicare pays its share and you pay yours.

Part B does not cover routine dental care, vision exams, eyeglasses, hearing exams, or hearing aids. It also does not cover most routine foot care, cosmetic surgery, or acupuncture (with rare exceptions for chronic lower back pain under specific conditions). If you need these services, you either pay out of pocket or look for coverage through a separate plan or program.

What Medicare Part D covers

Part D is prescription drug coverage. You choose a Part D plan from private insurance companies, and each plan has a different list of covered drugs, called a formulary. Most plans cover brand-name and generic drugs, but not all drugs are on every formulary. If your doctor prescribes a drug that is not on your plan's formulary, you can ask your doctor to prescribe a different drug that is covered, or you can ask the plan for an exception.

You pay a monthly premium for Part D. When you fill a prescription, you pay a copay or coinsurance depending on the drug and your plan. Part D has a coverage gap — a range of drug costs where you pay a higher percentage — though the gap has been shrinking in recent years. Once your total drug costs reach a certain amount, catastrophic coverage kicks in and you pay a small copay for the rest of the year.

Part D does not cover over-the-counter drugs, drugs used for cosmetic purposes, or most drugs not approved by the Food and Drug Administration. It also does not cover drugs that are covered under Part A or Part B (like drugs given during a hospital stay or in a doctor's office).

What Medicare does not cover

Medicare has significant gaps. It does not cover long-term care — ongoing help with daily activities like bathing, dressing, and eating — whether in a nursing home or at home. It does not cover custodial care in a nursing home (care that helps you with activities of daily living but is not medical care). If you need long-term care, you pay out of pocket, use Medicaid (if you meet income and asset limits), or have a long-term care insurance policy.

Medicare also does not cover dental care, routine vision exams, eyeglasses or contact lenses, hearing exams, or hearing aids. It does not cover routine foot care (though it covers foot care related to diabetes under certain conditions). It does not cover most routine physical exams or travel outside the United States (with rare exceptions). It does not cover experimental treatments or treatments deemed not medically necessary.

Some services are covered only under specific conditions. For example, Medicare covers mental health counseling, but only a certain number of visits per year. It covers physical therapy, but only if ordered by a doctor for a medical condition. It covers home health services, but only if you are homebound and a doctor orders the care. Always check your specific plan to understand the limits.

How Medigap and Medicare Advantage fill the gaps

If you have Original Medicare (Part A and Part B), you can buy a Medigap policy from a private insurance company. Medigap covers some of the costs that Original Medicare does not — like copays, coinsurance, and deductibles. Different Medigap plans (labeled A through N) cover different combinations of these costs. Medigap does not cover dental, vision, or hearing, but it does reduce your out-of-pocket costs for the services Medicare does cover.

Medicare Advantage (Part C) is an alternative to Original Medicare. It is offered by private insurance companies and must cover everything Original Medicare covers, but it often includes dental, vision, or hearing benefits that Original Medicare does not. Medicare Advantage plans have networks (you usually must see doctors in the network), and they have an annual out-of-pocket spending limit. If you reach that limit, the plan pays for the rest of your covered care for the year.

The trade-off is that Medicare Advantage plans require you to use their network, may require prior authorization before you see a specialist, and may not cover care outside your plan's service area. Medigap plans let you see any doctor who accepts Medicare, but they do not have an out-of-pocket limit and do not cover dental, vision, or hearing. Your choice depends on your doctors, your budget, and what services matter most to you.

How to find out what your plan covers

The fastest way is to look at your plan documents. If you have Original Medicare with Medigap, you have a Medigap policy document that lists what is covered. If you have Medicare Advantage, you have a plan document that lists covered services, your copays, and your network doctors. These documents are dense, but they are the source of truth for your coverage.

You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) to ask about a specific service. Have your Medicare number ready. If you have a Medicare Advantage plan, you can also call your plan's customer service number, which is on your insurance card. If you have a Medigap policy, call your Medigap insurance company.

Medicare.gov has a tool called "What's Covered" where you can search for a specific service or item and see whether Medicare covers it. The tool does not tell you your out-of-pocket cost, but it tells you whether the service is covered under Original Medicare. For your exact cost, you still need to check your plan documents or call your plan.

Frequently Asked Questions

Does Medicare cover physical therapy?

Yes, if a doctor orders it for a medical condition. Medicare Part B covers outpatient physical therapy, and Part A covers it during a hospital stay or skilled nursing facility stay. You pay a copay or coinsurance. Medicare limits the number of visits per year, though your doctor can request an exception if you need more.

Does Medicare cover mental health counseling?

Yes. Medicare Part B covers outpatient mental health visits with a psychiatrist, psychologist, social worker, or counselor. You pay a copay or coinsurance, usually the same as you would for a doctor visit. Medicare limits the number of visits per year, but your doctor can request more if medically necessary.

Does Medicare cover glasses or hearing aids?

Original Medicare does not cover eyeglasses, contact lenses, routine vision exams, hearing exams, or hearing aids. Some Medicare Advantage plans include vision or hearing benefits, so check your plan. You can also buy these items separately or through programs that offer discounts to Medicare beneficiaries.

What happens if I need care outside the United States?

Original Medicare does not cover care outside the U.S., except in rare cases (like emergency care in Canada or Mexico near the border). Medicare Advantage plans also typically do not cover care outside the U.S. If you travel internationally, consider travel health insurance or check whether your Medigap plan covers emergency care abroad.

Does Medicare cover preventive care?

Yes. Medicare Part B covers many preventive services at no cost to you, including cancer screenings, cardiovascular screenings, diabetes screenings, vaccines, and an annual wellness visit. You pay nothing for these services if they are done for prevention, not for diagnosis or treatment of a condition.