Medicare covers a broad range of health services for seniors, from hospital stays and doctor visits to preventive screenings, home health care, and prescription drugs. The program is divided into distinct parts, each handling different types of care, and understanding what falls under each part helps you avoid surprise costs and take full advantage of your benefits.
Part A: Hospital and Inpatient Care
Part A is hospital insurance. 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 because they or a spouse paid Medicare taxes during their working years.
The costs you do pay come through deductibles and coinsurance. In 2025, the inpatient hospital deductible is $1,676 per benefit period. For stays longer than 60 days, you pay $419 per day for days 61 through 90, and $838 per day if you dip into your lifetime reserve days. If you need skilled nursing facility care after a qualifying hospital stay, the first 20 days are fully covered, then you pay $209.50 per day for days 21 through 100.
Part B: Doctor Visits and Outpatient Services
Part B handles outpatient medical care. This includes doctor visits, lab tests, ambulance services, mental health and substance use treatment, durable medical equipment, and a limited set of outpatient prescription drugs. Coverage applies to two broad categories: medically necessary services (those that diagnose or treat a condition) and preventive services (those that catch illness early or prevent it entirely).
The standard Part B premium in 2025 is $185 per month, with an annual deductible of $257. After you meet that deductible, you typically pay 20% of the Medicare-approved amount for most services. One notable exception: if you use an insulin pump covered under Part B’s equipment benefit, your cost for a month’s supply of insulin is capped at $35, and the deductible doesn’t apply.
Preventive Screenings and Wellness Visits
Medicare covers a long list of preventive services at no cost to you, as long as your provider accepts Medicare assignment. This is one of the most valuable and underused parts of the program. Covered screenings include mammograms, colonoscopies, lung cancer screenings, cardiovascular disease screenings, diabetes screenings, glaucoma tests, prostate cancer screenings, bone density measurements, and screenings for hepatitis B, hepatitis C, and HIV. Depression screenings and alcohol misuse counseling are also covered.
Vaccinations are included too: flu shots, pneumonia shots, COVID-19 vaccines, and hepatitis B shots all come at no cost under Part B.
Two wellness visits deserve special attention. The first is a one-time “Welcome to Medicare” preventive visit, available within your first 12 months of Part B enrollment. After that, you’re eligible for a yearly wellness visit every 12 months. These visits are designed to create or update a personalized prevention plan, not to address specific complaints, but they’re an opportunity to flag health risks early.
Part D: Prescription Drug Coverage
Part D covers outpatient prescription drugs through private insurance plans that contract with Medicare. Every Part D plan maintains its own formulary, which is the list of drugs it covers. All plans are required to cover a wide range of medications that people with Medicare commonly take, including most drugs in certain protected classes like cancer treatments, HIV/AIDS medications, and antidepressants.
You enroll in a Part D plan separately from Original Medicare, and each plan has its own premiums, deductibles, and copay structure. Costs vary depending on the plan and which tier your medications fall into, so it’s worth comparing plans annually during open enrollment to make sure your specific drugs are covered at the best price.
Durable Medical Equipment
Part B covers medically necessary durable medical equipment prescribed by your doctor. The list is extensive and includes wheelchairs, scooters, walkers, canes, crutches, hospital beds, oxygen equipment and accessories, CPAP machines for sleep apnea, infusion pumps, and commode chairs. If you have diabetes, coverage extends to blood sugar monitors, test strips, lancets, and control solutions.
You typically pay 20% of the Medicare-approved amount after meeting your Part B deductible, and the equipment must be ordered by an enrolled provider and supplied by a Medicare-approved supplier.
Home Health Services
Medicare covers home health care when you meet specific criteria. You must need part-time or intermittent skilled care (nursing, physical therapy, speech therapy, or occupational therapy), you must be considered “homebound,” and a health care provider must assess you face-to-face and certify your need before services begin. Homebound means leaving your home is a major effort due to illness or injury, whether that requires a wheelchair, special transportation, or help from another person.
Covered services include skilled nursing care like wound care, injections, IV therapy, and monitoring of serious conditions. Physical therapy, occupational therapy, and speech therapy are covered if you meet certain conditions. Home health aides can help with bathing, grooming, walking, feeding, and changing bed linens, but only when you’re also receiving skilled care at the same time. Medical supplies and durable medical equipment for home use are included as well.
What Medicare won’t cover under home health: 24-hour care, meal delivery, housekeeping unrelated to your care plan, or personal care (bathing, dressing, using the bathroom) when that’s the only type of help you need. That line between skilled medical care and custodial assistance is where many seniors run into gaps.
What Original Medicare Does Not Cover
Some of the most common health expenses seniors face fall outside Original Medicare entirely. The major exclusions are:
- Dental care: routine cleanings, fillings, tooth extractions, and dentures
- Vision: eye exams for prescription glasses and the glasses themselves
- Hearing: hearing aids and the exams to fit them
- Long-term care: extended stays in nursing homes or assisted living facilities
- Routine physical exams: separate from the covered yearly wellness visit
- Cosmetic surgery
- Massage therapy
These gaps catch many seniors off guard, especially dental and long-term care costs, which can be substantial. If these services matter to you, a Medicare Advantage plan or separate insurance may help fill the holes.
Medicare Advantage (Part C)
Medicare Advantage plans are offered by private insurers approved by Medicare. They include everything Original Medicare covers (Parts A and B) and most plans bundle Part D drug coverage as well. The real draw for many seniors is the extra benefits that Original Medicare doesn’t offer: vision, hearing, and dental coverage are common additions. Some plans also include fitness programs, transportation to medical appointments, and over-the-counter health product allowances.
The tradeoff is that 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. Costs, coverage details, and network size vary widely from plan to plan, so comparing options in your area matters.
Medigap: Filling the Cost Gaps
If you stick with Original Medicare rather than choosing an Advantage plan, Medigap (Medicare Supplement Insurance) can help cover the out-of-pocket costs that Parts A and B leave behind. These are standardized private insurance policies labeled by letter (Plan G, Plan K, Plan N, and so on), each covering a specific combination of costs.
Depending on the plan you choose, Medigap can cover Part A coinsurance and hospital costs for up to an additional 365 days after Medicare benefits run out, Part B coinsurance or copayments, the Part A deductible, skilled nursing facility coinsurance, the first three pints of blood, Part B excess charges, and even foreign travel emergencies up to plan limits.
Plans K and L include annual out-of-pocket limits. In 2026, Plan K caps your costs at $8,000 and Plan L at $4,000. Once you hit those limits and have met your Part B deductible ($283 in 2026), your Medigap plan pays 100% of covered services for the rest of the year. High-deductible versions of Plans F and G are available in some states, requiring you to pay $2,950 in 2026 before the policy kicks in, but they come with lower monthly premiums.
Medigap plans do not cover prescription drugs, so you’d still need a separate Part D plan for medications. And you cannot use Medigap alongside a Medicare Advantage plan; it only works with Original Medicare.