Medicare pays for a wide range of health care services, from hospital stays and doctor visits to preventive screenings, mental health care, prescription drugs, and medical equipment. The program is split into distinct parts, each covering different categories of care with its own costs. Here’s a practical breakdown of what’s included, what’s not, and what you’ll still pay out of pocket.
Hospital Stays Under Part A
Part A is Medicare’s hospital insurance. When you’re admitted as an inpatient, it covers your semi-private room, meals, general nursing care, medications administered during your stay, and other hospital services tied to your treatment. You pay a deductible of $1,736 per benefit period (2026 figure) before coverage kicks in, but after that, the first 60 days of a hospital stay are fully covered with no daily cost to you.
Part A also covers care in a skilled nursing facility after a qualifying hospital stay, but only up to 100 days per benefit period. The first 20 days cost you nothing beyond the initial deductible. Days 21 through 100 carry a daily coinsurance of $217 in 2026. After day 100, Medicare stops paying entirely, which is one reason many people consider supplemental insurance.
Doctor Visits and Outpatient Care Under Part B
Part B covers the medical care you receive outside a hospital. This includes doctor visits, outpatient procedures, ambulance services, mental health care, and a limited set of outpatient prescription drugs. The standard monthly premium for Part B is $202.90 in 2026, and most people pay this amount directly or have it deducted from their Social Security check.
Part B divides its coverage into two broad categories: medically necessary services (anything that meets accepted standards to diagnose or treat a condition) and preventive services (care aimed at catching illness early or preventing it altogether). For most covered services, you pay 20% of the Medicare-approved amount after meeting your annual deductible.
Preventive Services at No Cost
One of Medicare’s strongest benefits is its lineup of preventive screenings and vaccines, which are covered at 100% when you see a provider who accepts Medicare assignment. That means no copay, no coinsurance, and no deductible for these services. The list is extensive:
- Cancer screenings: mammograms, colonoscopies, lung cancer screenings, prostate cancer screenings, cervical and vaginal cancer screenings, and several types of colorectal tests
- Cardiovascular screenings: cholesterol and lipid panels, plus behavioral counseling for heart disease risk
- Diabetes care: diabetes screenings, self-management training, and a diabetes prevention program
- Mental health: depression screenings, alcohol misuse screenings and counseling
- Vaccines: flu shots, COVID-19 vaccines, pneumococcal shots, and hepatitis B shots
- Other screenings: glaucoma tests, HIV screenings, hepatitis C screenings, bone density measurements, STI screenings, and obesity counseling
You also get a one-time “Welcome to Medicare” preventive visit when you first enroll and a yearly wellness visit every year after that. These visits are designed to create or update a personalized prevention plan with your doctor.
Mental Health Coverage
Medicare covers outpatient mental health care more broadly than many people realize. Part B pays for individual and group psychotherapy with psychiatrists, clinical psychologists, clinical social workers, nurse practitioners, physician assistants, marriage and family therapists, and mental health counselors. You typically pay 20% of the Medicare-approved amount for these sessions. Part B also covers treatment for substance use disorders, including medications used during inpatient stays to treat opioid use disorder.
Medical Equipment and Supplies
Part B covers durable medical equipment, commonly called DME, when a doctor prescribes it for use in your home. To qualify, the equipment must be durable enough for repeated use, medically necessary, and expected to last at least three years. The covered list includes wheelchairs and scooters, walkers, canes, crutches, hospital beds, oxygen equipment, CPAP machines for sleep apnea, nebulizers, patient lifts, suction pumps, and infusion pumps. Diabetes supplies are also covered: blood sugar monitors, test strips, lancets, and control solutions.
You generally pay 20% of the Medicare-approved amount for DME, and the equipment must be obtained from a Medicare-enrolled supplier to be covered.
Prescription Drugs Under Part D
Original Medicare (Parts A and B) covers very few prescription drugs on its own. For broader drug coverage, you need a Part D plan, which is sold by private insurance companies approved by Medicare. Each plan has its own formulary (list of covered drugs), and costs vary by plan.
A major change took effect in 2025: there is now a $2,000 annual cap on out-of-pocket spending for Part D prescription drugs. Once you hit that threshold in a given year, you pay nothing more for covered medications for the rest of the year. Before this cap existed, people with expensive prescriptions could face thousands more in costs, so this is a significant financial protection for anyone taking costly or multiple medications.
Home Health Services
Medicare covers home health care when you meet specific conditions. You must need part-time or intermittent skilled services, such as nursing care or physical therapy, and you must be considered “homebound.” That means leaving your home is either not recommended because of your condition, requires help from another person or assistive devices like a wheelchair or walker, or takes a major physical effort. If you qualify, Medicare covers the skilled nursing, therapy, and medical social services provided in your home. You pay nothing for covered home health services.
What Medicare Does Not Cover
The gaps in Medicare coverage catch many people off guard. The most notable exclusions are routine dental care, most vision services, and hearing aids. Medicare explicitly excludes services related to the care, treatment, filling, removal, or replacement of teeth. That includes routine cleanings, extractions (even impacted teeth), denture preparation, and related surgical procedures. The only dental exception is when a patient’s underlying medical condition requires hospitalization for the dental procedure.
Routine eye exams for glasses, eyeglasses themselves, contact lenses, and hearing aids are similarly excluded from Original Medicare. Many people turn to Medicare Advantage plans (Part C) to fill these gaps, since those plans often bundle dental, vision, and hearing benefits into their coverage. Standalone dental and vision insurance is another option.
Long-term custodial care is another major gap. Medicare pays for skilled nursing in a facility for up to 100 days after a hospital stay, but it does not cover ongoing help with daily activities like bathing, dressing, or eating when that’s the only care you need. This type of long-term care, whether in a nursing home or at home, falls outside Medicare’s scope entirely.
How the Parts Fit Together
Original Medicare consists of Part A (hospital) and Part B (medical). Most people get Part A premium-free if they or a spouse paid Medicare taxes for at least 10 years. Those who don’t qualify pay up to $565 per month for Part A in 2026. Part B requires a monthly premium from everyone.
From there, you have choices. You can stay with Original Medicare and add a Part D drug plan and a Medigap (supplemental) policy to help cover deductibles and coinsurance. Or you can choose a Medicare Advantage plan (Part C), which is an all-in-one alternative offered by private insurers that typically includes Parts A, B, and D together, often with added dental, vision, and hearing benefits. The trade-off with Advantage plans is that you usually need to use a network of providers and may need referrals for specialists.