What Does Medicare Cover? A Quick Overview
Medicare is the federal health insurance program for people aged 65 and older, certain younger individuals with disabilities, and people with End-Stage Renal Disease. But what does Medicare actually cover?
The short answer: Medicare covers a wide range of hospital care, doctor visits, preventive services, and prescription drugs through its four parts. However, it does not cover everything. Dental, vision, hearing aids, and long-term care are significant gaps that surprise many new beneficiaries.
“Understanding what Medicare covers, and what it doesn’t, is the single most important step in planning your healthcare in retirement,” says Karl Bruns-Kyler, founder of The Big 65 and a Medicare specialist with over 20 years of experience. “Too many people assume Medicare works like their employer insurance. It doesn’t, and the gaps can be costly if you’re not prepared.” Learn more about employer insurance and Medicare.
This guide breaks down Medicare coverage for 2026 across all four parts, explains what’s not covered, and shows you how to fill the gaps with supplemental coverage. New to Medicare? Start with our Understanding Medicare overview.
The Four Parts of Medicare Explained
Medicare is divided into four distinct parts, each covering different services. Here is a quick comparison:
| Medicare Part | What It Covers | 2026 Monthly Premium |
|---|---|---|
| Part A (Hospital Insurance) | Inpatient hospital, skilled nursing, hospice, home health | $0 for most people |
| Part B (Medical Insurance) | Doctor visits, outpatient care, preventive services, durable medical equipment | $202.90 (standard) |
| Part C (Medicare Advantage) | Everything in Parts A and B, often plus dental, vision, hearing, and Part D | Varies by plan (plus Part B premium) |
| Part D (Prescription Drugs) | Outpatient prescription medications | Varies by plan (~$35/mo average) |
Let’s look at each part in detail.
What Does Medicare Part A Cover?
Medicare Part A is Hospital Insurance. It covers medically necessary inpatient care when you are admitted to a hospital or certain other facilities. Most people qualify for premium-free Part A because they (or a spouse) paid Medicare taxes for at least 10 years (40 quarters).
Part A Covered Services
- Inpatient hospital stays — semi-private room, meals, nursing care, medications administered during your stay, lab tests, surgeries, and intensive care
- Skilled nursing facility (SNF) care — up to 100 days per benefit period following a qualifying 3-day hospital stay (days 1-20 at no cost; days 21-100 with a $217/day coinsurance in 2026)
- Home health care — part-time skilled nursing, physical therapy, occupational therapy, and speech-language pathology when you are homebound and need medically necessary care
- Hospice care — comfort care for terminally ill patients with a life expectancy of 6 months or less, including medications for symptom control, medical equipment, and respite care
- Inpatient psychiatric care — up to 190 days in a psychiatric hospital over your lifetime
- Blood transfusions — after the first 3 pints per calendar year
2026 Part A Costs at a Glance
| Cost Type | 2026 Amount |
|---|---|
| Part A Premium (most people) | $0 |
| Part A Premium (without 40 quarters) | Up to $565/month |
| Hospital Deductible (per benefit period) | $1,736 |
| Days 1-60 Coinsurance | $0 (after deductible) |
| Days 61-90 Coinsurance | $434/day |
| Lifetime Reserve Days (91-150) | $868/day |
| Skilled Nursing Facility (Days 21-100) | $217/day |
Important: There is no annual out-of-pocket maximum with Original Medicare Part A. A single long hospital stay could cost you thousands. This is one of the main reasons many beneficiaries add supplemental coverage like a Medigap plan to protect themselves financially.
For a full breakdown of all Medicare expenses, see our complete guide to Medicare costs in 2026.
What Does Medicare Part B Cover?
Medicare Part B is Medical Insurance. It covers medically necessary outpatient services and preventive care. Unlike Part A, everyone pays a monthly premium for Part B.
Part B Covered Services
- Doctor and specialist visits — office visits, consultations, and second opinions
- Outpatient procedures — surgeries, diagnostic tests (X-rays, MRIs, CT scans, blood work), and outpatient hospital services
- Preventive services — annual wellness visits, flu shots, pneumonia vaccines, COVID-19 vaccines, screenings for cancer (mammograms, colonoscopies, prostate), cardiovascular disease, diabetes, depression, and more
- Durable medical equipment (DME) — wheelchairs, walkers, hospital beds, oxygen equipment, CPAP machines
- Mental health services — outpatient therapy, counseling, psychiatric evaluations
- Ambulance services — when medically necessary ground or air transportation
- Clinical laboratory services — blood tests, urinalysis, and other lab work (typically at no cost to you)
- Home health services — when not covered under Part A
- Limited outpatient prescription drugs — certain drugs administered by a provider (like chemotherapy infusions or injectable osteoporosis drugs)
2026 Part B Costs
| Cost Type | 2026 Amount |
|---|---|
| Standard Monthly Premium | $202.90 |
| Annual Deductible | $283 |
| Coinsurance (after deductible) | 20% of Medicare-approved amount |
Note: Higher-income beneficiaries may pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of the standard premium. If your modified adjusted gross income from 2024 exceeded $109,000 (individual) or $218,000 (joint), your Part B premium may range from $284.10 to $689.90 per month.
“The 20% coinsurance with no annual out-of-pocket maximum is what catches people off guard,” explains Karl Bruns-Kyler. “If you need an expensive surgery or ongoing treatment, that 20% adds up fast. That’s exactly why Medicare Supplement Plan G is so popular. It covers that 20% coinsurance so you can budget your healthcare costs with confidence.”
What Does Medicare Part C (Medicare Advantage) Cover?
Medicare Advantage plans (Part C) are an alternative to Original Medicare. These plans are offered by private insurance companies approved by Medicare and must cover everything that Original Medicare covers. Most plans also include additional benefits. You may also want to read about potential drawbacks of Medicare Advantage.
What Medicare Advantage Typically Includes
- All Part A and Part B covered services — at minimum, everything Original Medicare covers
- Prescription drug coverage — most MA plans include Part D
- Dental coverage — routine cleanings, exams, and sometimes major dental work
- Vision coverage — routine eye exams and an eyewear allowance
- Hearing coverage — hearing exams and sometimes hearing aid benefits
- Fitness programs — gym memberships through programs like SilverSneakers
- Out-of-pocket maximum — a yearly cap on your spending (a major advantage over Original Medicare, which has no cap)
Important Medicare Advantage Trade-offs
While Medicare Advantage plans can offer attractive extra benefits, they come with limitations you should understand:
- Network restrictions — most plans require you to use in-network doctors and hospitals (HMO plans) or pay more for out-of-network care (PPO plans)
- Prior authorization — some services and procedures require approval from your plan before you receive care
- Geographic limitations — coverage is typically limited to a specific service area
- Referral requirements — HMO plans usually require referrals from a primary care physician to see specialists
To understand the full picture, read our detailed comparison: Medicare Advantage vs. Medigap: Which Is Right for You?
What Does Medicare Part D Cover?
Medicare Part D provides outpatient prescription drug coverage. Original Medicare (Parts A and B) has very limited drug coverage, so Part D fills an essential gap.
Part D Covered Medications
- Brand-name and generic prescription drugs — each plan maintains a formulary (list of covered drugs) organized into tiers
- Specialty medications — high-cost drugs for complex conditions (typically Tier 4 or 5)
- Vaccines — most commercially available vaccines not covered under Part B (like shingles vaccine)
- Insulin — capped at $35 per month per covered insulin prescription as of 2026
- Weight loss medications — coverage for drugs like Ozempic and Wegovy varies by plan and diagnosis. Learn more about whether Medicare covers Ozempic
2026 Part D Cost Protection
A major improvement for 2026: the annual out-of-pocket cap for Part D drugs is $2,100. Once you reach this limit, you pay nothing for covered Part D prescriptions for the rest of the year. This is a significant change from previous years when beneficiaries in the “catastrophic” coverage phase still owed 5% of drug costs, which could add up to thousands for expensive medications.
For complete details on formularies, coverage phases, and how to choose the right plan, see our Medicare Part D 2026 guide.
What Medicare Does NOT Cover
This is where many new Medicare beneficiaries are surprised. Original Medicare has significant coverage gaps that you need to plan for:
Major Services Not Covered by Original Medicare
- Routine dental care — cleanings, fillings, extractions, dentures, and most dental procedures are NOT covered. Medicare only covers limited dental services that are part of a covered hospital procedure (for example, jaw reconstruction after an accident). For a full breakdown, see our guide: Does Medicare Cover Dental? Complete 2026 Guide.
- Routine vision care — eye exams for glasses or contacts and eyeglasses/contact lenses are NOT covered. Medicare does cover eye exams for medical conditions like glaucoma and macular degeneration, and it covers cataract surgery with standard intraocular lenses. For a full breakdown, see our complete guide to Medicare eye exam and vision coverage.
- Hearing aids — hearing aids and fitting exams for hearing aids are NOT covered under Original Medicare. Diagnostic hearing exams ordered by a doctor are covered under Part B. For a full breakdown, see our hearing aid coverage guide.
- Long-term care (custodial care) — nursing home care when you don’t require skilled medical care, assisted living, and in-home personal care (bathing, dressing, eating assistance) are NOT covered. Medicaid, not Medicare, is the primary payer for long-term nursing home care for those who qualify.
- Routine foot care — cutting or removal of corns and calluses, trimming of nails (unless medically necessary due to conditions like diabetes)
- Cosmetic surgery — procedures done solely for cosmetic reasons
- Acupuncture — except for chronic low back pain (limited coverage)
- Most chiropractic services — only manual manipulation of the spine to correct subluxation is covered
- Overseas healthcare — Medicare generally does not cover healthcare received outside the United States (limited exceptions for emergencies near the Canadian or Mexican border)
“The dental, vision, and hearing gaps are the ones I get asked about most,” says Karl Bruns-Kyler. “People who had employer insurance are used to those being included. When they see Original Medicare doesn’t cover a routine cleaning or a pair of glasses, it’s a real eye-opener. That’s where Medicare Advantage or standalone dental and vision plans come in.”
How to Fill Medicare Coverage Gaps
You have several options to get coverage beyond what Original Medicare provides:
Option 1: Medicare Supplement Insurance (Medigap)
Medigap plans are sold by private insurance companies and help pay for costs that Original Medicare doesn’t fully cover, including deductibles, coinsurance, and copayments. Popular plans include:
- Plan G — the most popular Medigap plan in 2026. Covers the Part A deductible, Part B coinsurance (the 20%), skilled nursing coinsurance, and Part B excess charges. You pay only the Part B deductible ($283 in 2026).
- Plan F — the most comprehensive plan, covering everything Plan G covers plus the Part B deductible. Available only to those who became eligible for Medicare before January 1, 2020.
- Plan N — a cost-effective option with lower premiums. Covers most of what Plan G covers but requires small copays for some office visits ($20) and emergency room visits ($50) and does not cover Part B excess charges.
Important: Medigap plans do NOT cover dental, vision, hearing, or prescription drugs. You would need to add a standalone Part D plan and separate dental/vision policies.
Not sure if you need a supplement? Read our guide: Do I Need a Medicare Supplement?
Option 2: Medicare Advantage (Part C)
Medicare Advantage plans bundle hospital, medical, drug, and often dental/vision/hearing coverage into a single plan. Many plans have $0 premiums (beyond your Part B premium). They provide an out-of-pocket maximum that Original Medicare lacks.
The trade-off is network restrictions, prior authorization requirements, and potentially higher costs for major medical events compared to a Medigap plan.
Option 3: Standalone Plans for Specific Gaps
- Dental insurance plans — standalone dental policies (DPPO or DHMO) for routine and major dental care — see our Medicare dental coverage guide for details
- Vision insurance plans — cover routine eye exams, glasses, and contact lenses
- Hearing aid coverage options — standalone hearing aid benefit programs or Medicare Advantage plans with hearing benefits
2026 Medicare Coverage Changes Worth Knowing
Several important changes took effect for the 2026 Medicare coverage year:
- $2,100 Part D out-of-pocket cap — for the first time, Part D enrollees have a hard annual limit on their out-of-pocket drug spending. Once you reach $2,100, you pay $0 for the rest of the year.
- Medicare Drug Price Negotiation — the Inflation Reduction Act continues to reduce prices on select high-cost drugs. Negotiated prices on the first 10 drugs took effect in 2026, with more drugs being added in future years.
- $35 insulin cap — the monthly cost of covered insulin is capped at $35 per prescription under Part D plans.
- Free recommended vaccines — all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are covered at $0 cost-sharing under Part D, including the shingles vaccine.
- Updated premiums and deductibles — Part B premium rose to $202.90/month, Part B deductible to $283/year, and Part A hospital deductible to $1,736 per benefit period.
- Advanced Primary Care Management — Medicare now pays for coordinated care management services where your doctor tailors care to your needs with 24/7 access to your care team.
For a complete overview of turning-65 enrollment timing, see our complete Medicare enrollment guide for turning 65.
Get Expert Medicare Guidance
Navigating Medicare coverage can feel overwhelming, but you don’t have to figure it out alone. The Big 65, founded by Karl Bruns-Kyler with over 20 years of Medicare expertise and licenses in 33 states, provides independent, one-on-one guidance to help you understand your coverage options and choose the right plan.
Whether you’re turning 65 and new to Medicare, reviewing your options during the Annual Enrollment Period, or trying to fill coverage gaps, we can help you explore your options and find the right fit for your health needs and budget. Ready to get started? See our step-by-step guide to applying for Medicare.