What Medicare covers (and what it doesn't)

The short version

Part A: hospital insurance

Covers inpatient and facility-based care:

• Inpatient hospital stays (semi-private room, meals, nursing, drugs given during the stay)
• Skilled nursing facility care after a qualifying 3-day inpatient stay, up to 100 days
• Hospice care for terminal illness
• Some home health care
• Inpatient care in a religious non-medical health care institution

Note: hospital observation status is not inpatient. People sometimes spend two nights "under observation" and are surprised that Part A coverage rules don't kick in.

Part B: medical insurance

Covers outpatient and physician services:

• Doctor visits, specialist visits, and lab work
• Outpatient surgery and ER care that doesn't lead to admission
• Preventive services: annual wellness visit, screenings, vaccines (flu, COVID-19, pneumococcal)
• Durable medical equipment (wheelchairs, walkers, CPAP, oxygen)
• Mental health services, including outpatient counseling
• Limited Part B drugs (infusions and certain administered medications)
• Ambulance services when medically necessary

Part D: prescription drugs

Standalone Part D plans (PDPs) sit alongside Original Medicare. Each plan has its own formulary (covered drug list), tier system, and pharmacy network. The Inflation Reduction Act capped annual out-of-pocket spending on Part D drugs, which made the coverage materially better than it used to be.

Plans change formularies every January. A drug that was Tier 2 this year can be Tier 4, prior-authorized, or off-formulary next year. That's why we say to actually use the Annual Enrollment Period and re-check the formulary, not just auto-renew.

Part C: Medicare Advantage

A private plan that bundles Part A, Part B, and almost always Part D. Networks (HMO, PPO, or special needs plans), prior authorizations, and referrals apply. Many include extras: dental, vision, hearing, fitness, OTC allowances, and transportation. The tradeoff is the network and the prior-authorization process.

Compare Advantage and Medigap in detail

What Medicare does NOT cover

The list that catches people off guard:

• Routine dental care (cleanings, fillings, dentures)
• Routine vision (exams, glasses, contacts)
• Routine hearing exams and hearing aids
• Long-term custodial care in a nursing home or assisted living
• Most care received outside the U.S.
• Cosmetic surgery
• Acupuncture beyond limited indications for chronic low back pain
• Concierge or retainer fees charged by some practices

Frequently asked questions

Does Medicare cover dental, vision, and hearing?

Original Medicare does not cover routine dental, vision, or hearing care. Many Medicare Advantage plans include limited benefits for all three, often with annual allowances and network restrictions. Standalone dental and vision plans are also available separately.

Does Medicare cover long-term care?

No. Medicare covers short-term skilled nursing facility care after a qualifying hospital stay (up to 100 days) and limited home health, but it does not cover long-term custodial care in a nursing home or assisted living. Medicaid is the main public payer for long-term care.

Does Medicare cover prescription drugs?

Original Medicare only covers a narrow set of drugs administered in a clinical setting under Part B. For self-administered prescriptions you need either a Part D plan or a Medicare Advantage plan with drug coverage (MAPD). Standalone Part D pairs with Medigap or Original Medicare alone.

Does Medicare cover hospice?

Yes. Hospice care is covered under Part A for people with a terminal prognosis of six months or less, certified by a physician. It includes pain management, nursing, counseling, and short-term respite for caregivers. Hospice stays under Original Medicare even if you have a Medicare Advantage plan.

Does Medicare cover care outside the U.S.?

Original Medicare covers very little outside the U.S. Some Medigap plans (notably C, D, F, G, M, and N) include limited foreign travel emergency coverage. Many Medicare Advantage plans cover emergency care abroad but not routine care.