What Does Medicare Cover?

Medicare covers a wide range of hospital, medical, preventive, and prescription drug services, but exactly what is covered depends on which parts of Medicare you have and how you receive your coverage.

Original Medicare includes Medicare Part A and Medicare Part B.

Part A primarily helps cover inpatient hospital care and certain other facility-based services. Part B helps cover doctor services, outpatient care, preventive services, durable medical equipment, and other medically necessary care.

Prescription drug coverage is generally provided through Medicare Part D or through a Medicare Advantage plan that includes drug coverage.

Medicare does not cover every healthcare service, so understanding what is—and is not—covered is an important part of planning for Medicare.

Key Takeaways

Original Medicare includes Part A and Part B.
Part A primarily covers inpatient hospital care and certain facility-based services.
Part B primarily covers medically necessary doctor and outpatient services and many preventive services.
Original Medicare does not generally include prescription drug coverage, so many beneficiaries add Medicare Part D.
Medicare Advantage plans provide Part A and Part B benefits through private Medicare-approved plans and usually include Part D.
Original Medicare generally does not cover routine dental care, routine vision exams for glasses, hearing aids, or non-medical long-term care.
Coverage for a specific service can depend on whether Medicare considers the service medically necessary and whether other Medicare coverage requirements are met.

What Does Medicare Part A Cover?

Medicare Part A is often called hospital insurance.

Part A generally helps cover:

Inpatient hospital care
Care in a critical access hospital
Skilled nursing facility care when Medicare requirements are met
Hospice care
Certain home health services

Part A does not mean that every service you receive in a hospital is automatically covered without cost.

Your costs can depend on the service, how long you receive care, whether Medicare's coverage requirements are met, and whether you have additional insurance.

Learn more: Medicare Part A

What Does Medicare Part B Cover?

Medicare Part B is often called medical insurance.

Part B helps cover medically necessary services and many preventive services.

Examples can include:

Doctor and other healthcare provider services
Outpatient care
Certain home health services
Durable medical equipment
Ambulance services when Medicare requirements are met
Diagnostic tests
Mental health services
Certain therapy services
Many preventive screenings
Certain vaccines
The “Welcome to Medicare” preventive visit
Yearly Medicare “Wellness” visits

For many Part B services, you may pay a deductible and coinsurance.

Some preventive services may have no out-of-pocket cost when Medicare's requirements are met and the provider accepts assignment.

Learn more: Medicare Part B

Does Medicare Cover Preventive Care?

Medicare Part B covers many preventive and screening services.

Depending on your eligibility and risk factors, covered preventive services can include certain:

Cancer screenings
Diabetes screenings
Cardiovascular screenings
Depression screenings
Vaccines
Tobacco-use counseling
Obesity behavioral therapy
Glaucoma screenings
“Welcome to Medicare” preventive visits
Yearly “Wellness” visits

A Medicare yearly “Wellness” visit is not the same as a traditional routine physical.

Coverage and cost-sharing can vary depending on the service and whether additional diagnostic services are performed during the same visit.

Does Medicare Cover Prescription Drugs?

Original Medicare Part A and Part B do not provide comprehensive outpatient prescription drug coverage.

Medicare Part D helps cover prescription drugs.

You can generally get Medicare drug coverage in one of two ways:

Join a stand-alone Medicare Part D plan while using Original Medicare, or
Enroll in a Medicare Advantage plan that includes prescription drug coverage.

Part B does cover certain drugs in specific situations, such as some medications administered in a doctor’s office or certain drugs used with covered durable medical equipment.

However, most people who want broad outpatient prescription drug coverage need Part D or another source of creditable drug coverage.

Learn more: Medicare Part D

What Does Medicare Advantage Cover?

Medicare Advantage, also called Medicare Part C, is an alternative way to receive your Medicare Part A and Part B benefits.

Medicare Advantage plans are offered by private insurance companies approved by Medicare.

Plans provide Medicare-covered Part A and Part B services through the plan. Most Medicare Advantage plans also include Part D prescription drug coverage.

Many plans offer additional benefits that Original Medicare does not generally cover, which may include:

Routine dental benefits
Routine vision benefits
Hearing benefits
Fitness or wellness benefits

Benefits, provider networks, costs, and rules vary by plan.

Some Medicare Advantage plans require you to use network providers or receive prior authorization for certain services.

Learn more: What Is Medicare Advantage?

Does Medicare Cover Dental Care?

Original Medicare does not generally cover routine dental care.

Services that are usually not covered include:

Routine dental cleanings
Fillings
Dentures
Most routine tooth extractions
Dental implants

However, Medicare may cover certain dental services when they are directly related to specific Medicare-covered medical treatments.

Examples can include certain dental services needed in connection with procedures such as organ transplants, heart valve treatment, cancer treatment, or dialysis.

Some Medicare Advantage plans offer additional dental benefits. Coverage, provider networks, annual limits, and cost-sharing vary by plan.

Does Medicare Cover Vision Care?

Original Medicare generally does not cover routine eye exams for eyeglasses or contact lenses.

It may cover certain medically necessary eye services and screenings when Medicare's requirements are met.

For example, Medicare Part B may cover certain glaucoma screenings for people considered at high risk and may cover treatment for certain eye diseases.

Part B also covers one pair of standard-frame eyeglasses or one set of contact lenses after each covered cataract surgery in which an intraocular lens is implanted.

Some Medicare Advantage plans offer additional routine vision benefits.

Does Medicare Cover Hearing Aids?

Original Medicare does not cover hearing aids or exams solely for fitting hearing aids.

Part B can cover certain diagnostic hearing and balance exams when they are medically necessary and Medicare's requirements are met.

Some Medicare Advantage plans provide additional hearing benefits that may include hearing exams or an allowance toward hearing aids.

Benefits vary by plan.

Does Medicare Cover Long-Term Care?

Medicare does not generally pay for non-medical long-term care, sometimes called custodial care or long-term services and supports.

Long-term care can include help with everyday activities such as:

Bathing
Dressing
Eating
Using the bathroom
Transportation
Other personal-care needs

This is different from Medicare-covered skilled nursing facility care.

Medicare may cover skilled nursing facility care for a limited period when specific Medicare requirements are met, but it does not provide general coverage for long-term custodial care in a nursing home, assisted living facility, or at home.

What Doesn't Original Medicare Usually Cover?

Original Medicare does not cover everything.

Common services or items that are generally not covered include:

Routine dental care
Dentures
Routine eye exams for prescription glasses
Most eyeglasses and contact lenses
Hearing aids
Exams solely for fitting hearing aids
Non-medical long-term care
Routine physical exams
Cosmetic surgery in most circumstances
Massage therapy
Concierge or membership-based medical fees

There can be exceptions when a service is medically necessary and meets specific Medicare coverage requirements.

If you are unsure whether a particular test, item, procedure, or service is covered, check with Medicare and your healthcare provider before receiving the service.

How Does Medicare Decide Whether Something Is Covered?

Whether Original Medicare covers a particular service can depend on several factors.

Medicare says coverage decisions can be based on:

Federal and state laws
National Medicare coverage decisions
Local Medicare coverage decisions
Whether a service is considered medically necessary
Whether Medicare's specific coverage requirements are met

That means two services that appear similar may not always be covered in exactly the same way.

Before receiving expensive treatment, equipment, or services, ask your healthcare provider whether Medicare is expected to cover it and what you may be responsible for paying.

Does Medicare Pay 100% of Covered Services?

Usually not.

Even when Medicare covers a service, you may still have out-of-pocket costs.

Depending on the service and the coverage you have, you may be responsible for:

Premiums
Deductibles
Copayments
Coinsurance

With Original Medicare, beneficiaries may choose to purchase Medicare Supplement Insurance, also called Medigap, to help pay certain out-of-pocket costs.

Medicare Advantage plans have their own cost-sharing structures and include an annual limit on out-of-pocket costs for covered Part A and Part B services.

Understanding whether a service is covered is only one part of the question. It is also important to understand what your share of the cost may be.

Frequently Asked Questions

Does Medicare cover hospital stays?

Medicare Part A generally helps cover inpatient hospital care when Medicare's requirements are met.

Your costs depend on factors such as the length of your stay, the applicable benefit period, and whether you have additional coverage.

Does Medicare cover doctor visits?

Medicare Part B generally covers medically necessary doctor and other healthcare provider services.

After the Part B deductible is met, you may be responsible for coinsurance for many covered services.

Does Medicare cover preventive care?

Yes.

Medicare Part B covers many preventive and screening services. Some may have no out-of-pocket cost when Medicare's requirements are met and the provider accepts assignment.

Does Original Medicare cover prescription drugs?

Original Medicare does not provide comprehensive outpatient prescription drug coverage.

Most beneficiaries who want prescription drug coverage use a separate Medicare Part D plan or a Medicare Advantage plan that includes drug coverage.

Does Medicare cover dental implants?

Original Medicare generally does not cover dental implants.

Certain dental services can be covered when they are directly connected to specific Medicare-covered medical treatment, but routine restorative dental care is generally excluded.

Does Medicare cover eyeglasses?

Original Medicare generally does not cover routine eyeglasses.

Part B does cover one pair of standard-frame eyeglasses or one set of contact lenses after each covered cataract surgery that implants an intraocular lens.

Does Medicare cover hearing aids?

Original Medicare does not cover hearing aids or exams solely for fitting hearing aids.

Some Medicare Advantage plans offer additional hearing benefits.

Does Medicare cover nursing home care?

Medicare does not generally cover long-term custodial nursing home care.

Medicare Part A may cover limited skilled nursing facility care when specific Medicare requirements are met.

The Bottom Line

Medicare covers a significant amount of healthcare, but it does not cover everything.

Original Medicare consists of Part A and Part B.

Part A primarily helps cover inpatient hospital and certain facility-based care. Part B helps cover medically necessary doctor services, outpatient care, durable medical equipment, and many preventive services.

Prescription drug coverage usually requires Part D or a Medicare Advantage plan that includes drug coverage.

Routine dental care, routine vision services, hearing aids, and non-medical long-term care are among the most important gaps to understand when planning your Medicare coverage.

Before assuming a specific treatment or service is covered, verify the details with Medicare and your healthcare provider.

Need Personalized Medicare Help?

General Medicare education can help you understand the basics, but the coverage that works for you can depend on your doctors, medications, healthcare needs, budget, and other insurance.

If you would like personalized assistance, you can request a no-obligation conversation with one licensed Medicare professional.

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