Medicare covers hospital stays, doctor visits, preventive care, prescription drugs, and more, but the specifics depend on which part of Medicare you’re looking at. Original Medicare has two main components: Part A for hospital and inpatient care, and Part B for outpatient and medical services. Part D adds prescription drug coverage, and Medicare Advantage (Part C) bundles everything through a private insurer. Here’s what each part actually pays for and where the notable gaps are.
Part A: Hospital and Inpatient Care
Part A covers the big-ticket items when you’re admitted to a hospital. That includes a semi-private room, meals, general nursing care, drugs administered during your stay, and other hospital services tied to your inpatient treatment. Most people don’t pay a monthly premium for Part A if they or a spouse paid Medicare taxes for at least 10 years.
Part A also covers skilled nursing facility care, but only under specific conditions. You need a qualifying inpatient hospital stay of at least three consecutive days before Medicare will pay for skilled nursing. Even then, coverage is limited to 100 days per benefit period. The first 20 days are fully covered, but days 21 through 100 come with a daily copay that adds up quickly.
Home health services fall under Part A as well, covering part-time skilled nursing, physical therapy, and certain medical supplies when you’re homebound and need intermittent care. Full-time home care or help with daily activities like bathing and dressing is not covered.
Part B: Doctor Visits and Outpatient Services
Part B is the workhorse of day-to-day medical coverage. It pays for two broad categories: medically necessary services (anything that meets accepted standards for diagnosing or treating a condition) and preventive services (care aimed at catching illness early or preventing it altogether). In practical terms, that means doctor appointments, outpatient procedures, lab tests, ambulance services, durable medical equipment like wheelchairs and walkers, mental health care, and limited outpatient prescription drugs.
Part B comes with a monthly premium. In 2025, the standard premium is $185 per month, rising to $202.90 in 2026. There’s also an annual deductible ($257 in 2025, $283 in 2026). After you meet the deductible, you typically pay 20% of the Medicare-approved amount for most services. Higher-income enrollees pay more through income-related surcharges.
One newer benefit worth knowing: if you use an insulin pump covered under Part B’s durable medical equipment benefit, your cost for a month’s supply of insulin for the pump is capped at $35, and the Part B deductible doesn’t apply.
Preventive Services at No Cost
Medicare covers a long list of preventive services at zero cost to you, as long as your provider accepts Medicare assignment. No copay, no coinsurance, no deductible. This is one of the most underused parts of the program.
The covered screenings and services include:
- Annual wellness visits and a one-time “Welcome to Medicare” preventive visit
- Mammograms, colonoscopies, and other colorectal cancer screenings
- Cardiovascular disease screenings and behavioral therapy
- Diabetes screenings, self-management training, and a Diabetes Prevention Program
- Depression screenings
- Lung cancer screenings
- Glaucoma tests and prostate cancer screenings
- HIV, hepatitis B, and hepatitis C screenings
- Sexually transmitted infection screenings and counseling
- Alcohol misuse and tobacco cessation counseling
- Obesity behavioral therapy and medical nutrition therapy
- Bone density measurements
Vaccines are also covered at no cost, including flu shots, pneumococcal shots, COVID-19 vaccines, and hepatitis B shots. These are separate from the vaccines covered under Part D.
Part D: Prescription Drug Coverage
Part D covers outpatient prescription drugs through private insurance plans that contract with Medicare. You can get Part D as a standalone plan alongside Original Medicare or as part of a Medicare Advantage plan that includes drug coverage.
The biggest recent change is the $2,000 annual out-of-pocket cap that took effect in 2025. Once your total out-of-pocket spending on covered Part D drugs hits $2,000 in a calendar year, you pay nothing more for the rest of that year. Before this cap, people taking expensive medications could face costs well into the thousands. Plans also offer the option to spread your out-of-pocket costs across the year in monthly installments rather than paying large amounts upfront at the pharmacy.
Mental Health Coverage
Medicare covers both inpatient and outpatient mental health care. Part A pays for psychiatric hospital stays, while Part B covers outpatient visits with psychiatrists, psychologists, clinical social workers, marriage and family therapists, and mental health counselors. You pay the same 20% coinsurance for outpatient mental health visits as you would for other Part B services. Substance use disorder treatment, including counseling and certain medications, is also covered.
Hospice Care
Part A covers hospice care when a doctor certifies that a patient is terminally ill with a life expectancy of six months or less. To qualify, you must accept palliative (comfort-focused) care instead of curative treatment for your terminal illness and sign a statement choosing hospice. Medicare then covers nursing care, pain management, medical equipment, counseling, and short-term respite care for caregivers.
Hospice coverage doesn’t expire after six months. If you’re still terminally ill, a hospice doctor can recertify you after a face-to-face visit, and coverage continues. Medicare still pays for treatment of conditions unrelated to your terminal diagnosis during this time.
What Medicare Does Not Cover
The gaps in Original Medicare catch many people off guard. The three biggest exclusions are dental care, vision, and hearing aids. Medicare does not cover routine dental cleanings, fillings, extractions, or dentures. It does not cover eye exams for prescription glasses or the glasses themselves. And it does not cover hearing aids or the fitting exams that go with them.
There are narrow exceptions on the dental side. Medicare may pay for dental services that are directly tied to certain medical procedures, such as a heart valve replacement, organ transplant, cancer treatment, or dialysis for end-stage renal disease. But routine dental care remains entirely out of pocket unless you have a Medicare Advantage plan or separate dental insurance.
Other notable exclusions: long-term custodial care (nursing home stays where you don’t need skilled medical care), cosmetic surgery, acupuncture for most conditions, and care received outside the United States in almost all situations.
Coverage Outside the United States
Original Medicare generally does not pay for health care you receive abroad, with three narrow exceptions. Medicare may cover emergency care at a foreign hospital if you’re in the U.S. when the emergency happens and the foreign hospital is closer than any U.S. hospital that can treat you. It may also cover emergencies that occur while you’re traveling through Canada on the most direct route between Alaska and another state. And it can cover care at a foreign hospital that’s simply closer to your home than the nearest qualifying U.S. hospital.
Outside those situations, you’re on your own. Most Medigap supplemental plans (C, D, F, G, M, and N, among others) do include foreign travel emergency coverage. These plans typically pay 80% of emergency care costs abroad after a $250 annual deductible, with a $50,000 lifetime limit, as long as the emergency occurs within the first 60 days of your trip.
Medicare Advantage vs. Original Medicare
Medicare Advantage plans (Part C) are offered by private insurers as an alternative to Original Medicare. They must cover everything Parts A and B cover, but many also bundle in prescription drugs, dental, vision, hearing, and fitness benefits. The trade-off is that you typically need to use in-network providers and may need referrals to see specialists.
If you stick with Original Medicare, you can add a standalone Part D plan for drug coverage and a Medigap (Medicare Supplement) policy to help cover the 20% coinsurance, deductibles, and other cost-sharing that Original Medicare leaves behind. Medigap plans don’t add new benefits like dental or vision, but they reduce your out-of-pocket exposure for covered services. You cannot have both a Medigap policy and a Medicare Advantage plan at the same time.