Medicare covers a broad range of medical services, from hospital stays and doctor visits to preventive screenings, mental health care, and medical equipment. The program is divided into distinct parts, each handling different categories of care, and understanding what falls under each part helps you anticipate both your coverage and your costs.
Hospital and Inpatient Care (Part A)
Part A is the hospital insurance side of Medicare. It covers inpatient care in hospitals and critical access hospitals, skilled nursing facility stays, hospice care, and some home health services. Most people don’t pay a monthly premium for Part A if they or a spouse paid Medicare taxes for at least 10 years. If you don’t qualify for premium-free Part A, the monthly cost in 2025 ranges from $285 to $518 depending on your work history.
Hospital stays come with a per-benefit-period deductible of $1,676 in 2025. That covers the first 60 days of a hospitalization. After that, you pay $419 per day for days 61 through 90, and $838 per day if you dip into your lifetime reserve days. For skilled nursing facility care, the first 20 days are fully covered after your deductible. Days 21 through 100 carry a daily coinsurance of $209.50. After day 100, Medicare stops covering skilled nursing entirely.
Hospice care for people with a terminal illness is also covered under Part A, including pain management, symptom control, and support services. You can receive hospice care at home or in an inpatient facility.
Doctor Visits and Outpatient Care (Part B)
Part B handles the outpatient side: doctor visits, lab tests, outpatient surgeries, and medically necessary services or supplies used to diagnose or treat a condition. The standard monthly premium for Part B is $185 in 2025, with an annual deductible of $257. After meeting that deductible, you typically pay 20% of the Medicare-approved amount for most services.
Part B also covers mental health care on an outpatient basis. That includes psychiatric evaluations and ongoing therapy visits. You pay your standard 20% coinsurance for mental health visits, though services received in a hospital outpatient department may carry an additional copayment.
Preventive Services at No Cost
One of the most valuable pieces of Medicare is its lineup of preventive services, which are covered at no out-of-pocket cost when you see a provider who accepts Medicare. These are designed to catch problems early or prevent them altogether.
Cancer screenings include mammograms, colorectal cancer screening, lung cancer screening, cervical and prostate cancer screening, and pap tests with pelvic exams. Cardiovascular checks cover cholesterol and lipid level testing, behavioral counseling for heart disease, and a one-time ultrasound screening for abdominal aortic aneurysms in qualifying individuals.
Vaccines are also covered without cost-sharing. Medicare pays for flu shots, pneumonia vaccines, hepatitis B vaccines, and COVID-19 vaccines including their administration. These preventive benefits alone can save hundreds of dollars a year, especially for older adults who need annual flu and pneumonia protection.
Home Health Services
Medicare covers home health care, but eligibility is specific. You must be considered “homebound,” meaning leaving your home isn’t recommended due to your condition or requires considerable effort, such as needing a wheelchair, walker, crutches, special transportation, or help from another person. Short, infrequent outings for medical treatment or things like religious services won’t disqualify you.
Once eligible, covered services include part-time skilled nursing care (wound care, injections, IV therapy, monitoring of serious illness), physical therapy, occupational therapy, speech-language pathology, and medical social services. A home health aide can help with bathing, grooming, walking, feeding, and changing bed linens, but only if you’re simultaneously receiving skilled nursing or therapy services. Medicare also covers durable medical equipment and medical supplies for home use as part of home health care.
Medical Equipment and Supplies
Part B covers durable medical equipment, commonly called DME, when your doctor prescribes it for use in your home. To qualify, the equipment must be durable enough for repeated use, medically necessary, primarily useful to someone who is sick or injured, and expected to last at least three years.
Covered items include wheelchairs and motorized scooters, walkers, oxygen equipment and accessories (including humidifiers), and glucose monitoring supplies like blood sugar monitors, test strips, lancets, and control solutions. You pay 20% of the Medicare-approved amount after meeting your Part B deductible, and the equipment must come from a Medicare-enrolled supplier.
Prescription Drug Coverage (Part D)
Original Medicare (Parts A and B) does not cover most prescription drugs you pick up at a pharmacy. For that, you need a separate Part D plan. These are offered by private insurance companies approved by Medicare, and each plan maintains its own formulary, which is the list of drugs it covers.
Formularies organize medications into tiers, with generic drugs typically on lower, cheaper tiers and brand-name or specialty drugs on higher, more expensive ones. The specific drugs covered and what you pay for them vary from plan to plan, so it’s worth checking whether your medications are on a plan’s formulary before enrolling. Part D plans charge their own monthly premiums in addition to what you pay for Part B.
What Original Medicare Does Not Cover
Several major categories of care fall outside Original Medicare entirely. The most notable gaps are:
- Dental care: Routine cleanings, fillings, tooth extractions, and dentures are not covered in most cases.
- Vision: Eye exams for prescription glasses and the glasses themselves are excluded.
- Hearing: Hearing aids and the exams required to fit them are not covered.
- Long-term care: Custodial care in a nursing home, where you need help with daily activities but not skilled medical care, is not a Medicare benefit.
- Cosmetic surgery: Procedures that aren’t medically necessary are excluded.
- Routine physical exams: Standard annual physicals are not covered, though Medicare does cover a separate “wellness visit” focused on preventive planning.
- Massage therapy and concierge medicine: Neither is a covered benefit.
These exclusions catch many people off guard, especially dental and long-term care. A single dental procedure can cost thousands out of pocket, and long-term nursing home care can run well over $90,000 a year without separate insurance.
How Medicare Advantage Plans Differ
Medicare Advantage (Part C) is an alternative way to receive your Medicare benefits. These plans are run by private insurers approved by Medicare, and they must cover everything Original Medicare covers. The key difference is that most Medicare Advantage plans bundle in extra benefits that Original Medicare does not provide, including vision, hearing, and dental coverage.
Many plans also include prescription drug coverage, eliminating the need for a separate Part D plan. Some offer additional perks like fitness programs, transportation to medical appointments, or allowances for over-the-counter health products. The tradeoff is that Medicare Advantage plans typically use provider networks, meaning you may need to see doctors and use hospitals within the plan’s network to get full coverage. Original Medicare lets you see any provider nationwide that accepts Medicare.