What Does Medicare Cover?
Key takeaways:
Medicare — whether original Medicare (Part A and/or Part B) or Medicare Advantage — covers a wide variety of medical services, from hospital stays and doctor visits to cancer screenings and X-rays.
Medicare Advantage plans may cover extra benefits that original Medicare doesn’t, such as dental, vision, and hearing care.
Original Medicare and Medicare Advantage plans don’t typically cover some services. These include long-term care, routine foot care, and cosmetic procedures.
Table of contents
Since its start six decades ago, Medicare has provided health insurance to adults ages 65 and older. It’s been more than 50 years since coverage was extended to younger people with long-term disabilities and end-stage renal disease. Medicare also covers people of any age diagnosed with amyotrophic lateral sclerosis (ALS), which is known as Lou Gehrig’s disease.
Today, more than 68 million people are enrolled in original Medicare and its private alternative, Medicare Advantage. And it’s important not to confuse Medicare with Medicaid, a joint federal-state health insurance program for people with low incomes.
Below, we explain what Medicare covers through each of its major parts.
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What is Medicare?
Medicare has two original components: Part A and Part B. Part C, better known as Medicare Advantage, is a private alternative to Parts A and B that was created in 1997 and originally called Medicare+Choice. Part D is optional prescription medication coverage that became available in 2006.
Medicare coverage at a glance
Part | Coverage | Premium in 2025 |
|---|---|---|
Part A | Hospital insurance for care and services received in an inpatient setting | $0 for most people, but others pay $285 or $518 per month, depending on how many quarters of Medicare taxes they paid |
Part B | Medical insurance for care and services received in an outpatient setting | $185 per month for most people, but those with higher incomes pay as much as $628.90 per month |
Part C | Medicare Advantage, a private alternative to Parts A and B | Varies; you must still pay your Part B premium, and “zero premium” plans mean no additional premium |
Part D | Optional prescription medication coverage | Varies; cost and coverage can be included in your Medicare Advantage plan |
What does Medicare Part A cover?
If you end up in the hospital or in need of care in a hospital setting, you’re covered by Part A. This insurance helps to pay for the services you need during inpatient care or intensive services that typically involve staying at a treatment facility overnight or receiving complex care at home. Part A typically covers:
Inpatient mental healthcare
Medications used during a covered hospital or skilled nursing facility stay
Skilled nursing facility stays after hospitalization
Home healthcare after a stay in a hospital or skilled nursing facility
Surgery such as knee replacement, blood transfusions, and other procedures performed in a hospital
What does Medicare Part B cover?
Part B covers preventive services and medically necessary care in outpatient settings. This includes doctor visits as well as ground ambulance services in certain situations. Many of the preventive services including cold, flu, and pneumonia vaccines are covered with no out-of-pocket costs.
Part B typically covers:
Colonoscopies, which screen for colon cancer, at a frequency that’s based on risk
Doctor services
Durable medical equipment such as a wheelchair, walker, or hospital bed that you need in your home
Emergency room visits for injury as well as sudden or quickly worsening illness (though Part A will typically provide coverage if you’re admitted to the hospital)
Lab tests that are not associated with a hospital visit, such as blood work or urine tests
Outpatient therapy such as mental healthcare, which can include an annual depression screening, family counseling, or psychiatric evaluation
Prosthetic devices like an artificial limb, external breast prostheses, or ostomy bag to compensate for the loss or function of a body part
Scans including X-rays, MRIs, and CTs
“Welcome to Medicare” preventive visit — known as the initial preventive physical exam — within the first 12 months you have Part B coverage
Medicare doesn’t cover long-term assisted living. Medicare won’t pay for lengthy assisted living room and board charges. But it will cover temporary skilled care in a nursing home.
Will Medicare pay for a wheelchair? If you have an eligible diagnosis, Medicare Part B and Medicare Advantage plans cover most of the cost of a manual or power wheelchair.
Medicare enrollees with high incomes may have higher premiums. The income-related monthly adjustment amount, known as IRMAA, is a surcharge for Medicare enrollees with high incomes. It increases your Part B premium and/or your Part D premium.
What does Medicare Advantage (Parts C) cover?
Medicare Advantage plans are private replacements for original Medicare whose coverage equals or exceeds the benefits of Parts A and B. Most Medicare Advantage plans include Part D prescription plans. You are required to pay your Part B premium with Medicare Advantage. Some so-called “zero-premium” plans still require you to pay your Part B premium. Other higher-cost plans require an additional Part B premium.
Some Medicare Advantage plans offer extra benefits that may include:
Hearing services, including coverage for hearing aids
Vision care, including coverage for eyeglasses that typically has a spending limit
Dental care, such as routine cleanings
Meal delivery
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Medicare Advantage plans have an out-of-pocket limit. Original Medicare doesn’t, but enrollees can purchase a Medigap insurance supplement plan to help cover out-of-pocket costs. People with Medicare Advantage plans aren’t eligible for Medigap coverage.
What does Medicare Part D cover?
Medicare Part D covers prescription medications, certain medical supplies, and most vaccines including shingles and respiratory syncytial virus (RSV). Part D formularies typically change year to year, so be sure your standalone Part D plan or the prescription coverage in your Medicare Advantage plan includes your medications.
There are several ways to get prescription medication coverage with Medicare:
Having original Medicare — Part A and/or Part B — and buying a standalone Part D plan
Having a Medicare Advantage plan that includes Part D
Having a Medicare Advantage plan that doesn’t include prescription coverage and buying a standalone Part D plan
What doesn’t Medicare typically cover?
Medicare doesn’t cover everything. If you’re not sure whether Medicare will cover a service or item, check with your healthcare professional in advance. You also can consult Medicare’s list of what is and isn’t covered. Medicare Advantage plans must equal — but can exceed — what’s offered by original Medicare.
What original Medicare doesn’t cover
Items and services not covered by original Medicare include:
Dental appliances, such as dentures
Dental care
Cosmetic procedures
Hearing aids
Long-term care
Routine foot care
Routine vision care
Weight-loss medications (unless you are prescribed a certain treatment because you have a medically accepted indication, such as stroke prevention)
White canes for blind individuals (though canes for mobility assistance are covered)
Another thing Medicare doesn’t fully cover is costs. You should expect to pay for premiums, deductibles, copays, and coinsurance.
For example, original Medicare enrollees pay a Part B premium, must meet an annual deductible for Part B care, and are responsible for 20% of the costs for most covered services. Medicare Advantage enrollees also must pay the Part B premium, but their cost-sharing may vary from what’s required by original Medicare.
A note on Medicare supplement insurance (Medigap)
Your cost-sharing responsibility with original Medicare can add up if you use a lot of services — and there’s no out-of-pocket maximum. If you find yourself facing high costs, you might consider buying a Medigap plan. There are 10 types of Medigap plans, and they are organized by letter names: A, B, C, D, F, G, K, L, M, and N. All plans with the same letter name have the same benefits; premiums are the only difference.
Premiums vary by plan and state, but averaged $217 per month nationwide in 2023. It’s important to note that you can be subject to medical underwriting — which can exclude you from Medigap coverage — if you have switched from Medicare Advantage to original Medicare or you’re beyond your one-time, Medigap open enrollment period.
Get help understanding your benefits
Making Medicare choices and understanding the program can be overwhelming. The State Health Insurance Assistance Program — known as SHIP — can help you weigh the options and make the best choice for your circumstances. SHIP counselors provide free, unbiased advice to people eligible for Medicare and their caregivers. You can get local help from a SHIP counselor in person or over the phone.
You also can find answers to your Medicare questions by visiting www.medicare.gov or calling 1-800-MEDICARE (1-800-633-4227).
Medicare also has a free handbook, Medicare & You, that outlines coverage for the current year. The publication is available in different languages and formats.
The bottom line
Medicare provides comprehensive insurance coverage for a wide range of hospital, outpatient, preventive, and emergency services for older adults and younger people with certain disabilities. Does Medicare cover everything? No. Your specific benefits depend on whether you have original Medicare or a Medicare Advantage plan. Part D plans cover prescription medications.
You can contact Medicare or a State Health Insurance Assistance Program counselor with questions.
Why trust our experts?
Freed, M., et al. (2024). Key facts about Medigap enrollment and premiums for Medicare beneficiaries. KFF.
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