What All Does Medicare Cover?

What Medicare Covers at a Glance

Medicare covers hospital stays, skilled nursing facility care, hospice, some home health services, doctor visits, outpatient care, preventive services, and most medically necessary procedures. It also helps pay for prescription drugs through standalone plans or Medicare Advantage. The exact coverage depends on the part of Medicare you have and whether a service is considered medically necessary.

Part A: Hospital and Inpatient Coverage

Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. It pays for semi-private rooms, meals, general nursing, drugs given during inpatient treatment, and other hospital services. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes long enough, but there are deductibles and coinsurance for each benefit period.

Part B: Medical and Outpatient Coverage

Part B covers services and supplies needed to diagnose or treat a medical condition, including doctor visits, outpatient therapy, durable medical equipment, ambulance services, and preventive care such as screenings and vaccines. It also covers second opinions before surgery and some clinical research. You pay a monthly premium, an annual deductible, and typically 20% of the Medicare-approved amount for covered services.

Prescription Drug Coverage

Medicare Part D plans, sold by private insurers, cover most outpatient prescription drugs. Each plan has its own formulary, or list of covered drugs, organized into tiers that affect cost. Part D plans have deductibles, copays, or coinsurance, and they may include coverage during the coverage gap, though the gap has been narrowing under current law. People enrolled in Medicare Advantage plans often receive drug coverage bundled into their plan.

Medicare Advantage and Additional Benefits

Medicare Advantage, or Part C, bundles Parts A and B and usually Part D into one plan from a private insurer. Many Advantage plans also offer extra benefits not found in Original Medicare, such as vision, dental, hearing, fitness programs, and transportation to medical appointments. Coverage and costs vary widely by plan and by region.

What Medicare Does Not Cover

Medicare does not cover long-term custodial care, most dental care, routine vision or hearing exams, cosmetic surgery, acupuncture, or private-duty nursing. It also does not pay for care received outside the United States except in limited circumstances. Medigap policies can help fill some of these gaps, but they do not add new types of coverage beyond what Medicare already provides.