Medicare 101: What Services Does Medicare Cover?

About Tori Thurmond

Tori Thurmond combines her creative writing background with her marketing experience in her role as the Content Specialist at Brookdale. When she's not writing, she's probably spending time with her two cats or knitting.

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Medicare can be a great resource for a wide range of healthcare coverage. Unlike Medicaid, which is income-based, Medicare provides health insurance coverage for anyone who is age 65 or older (subject to certain coverage exclusions), or who has a severe disability, no matter what their income is.

Medicare typically undergoes several changes each year, and it’s important to stay informed as to how these changes might affect you. For example, the Inflation Reduction Act provided the health secretary the authority to negotiate the prices of certain costly or common medications on behalf of Medicare recipients, with such adjusted pricing set to take effect in 2026.

With all of the yearly changes and different aspects to be aware of, choosing a Medicare plan can be confusing. Medicare is broken into four parts: Part A, Part B, Part C and Part D. Each “Part” or plan covers different benefits, and there are certain services that Medicare may not cover at all.

You can only change your Medicare coverage during one period per year, referred to as the Open Enrollment Period, so it’s important to choose the right plans for the services you need. This article is aimed to help explain what generally is and isn’t covered by Medicare so that you can consider the right plans for you.

Original Medicare

“Original Medicare” is directly issued by the U.S. government. There are two parts included in Original Medicare: Part A and Part B. Each part covers different types of healthcare services.

Part A: Hospital Insurance

The first part of Original Medicare, Part A, typically covers services like inpatient hospital stays, stays in a skilled nursing facility, hospice care, and some home health services. As with other types of insurance, there are limitations, deductibles and co-insurance or other out-of-pocket costs that may also apply depending on your particular plan. Part A is generally available without a premium for people who have worked and paid Social Security taxes for at least 10 years. If you have not worked and paid taxes for 10 years, there typically will be a monthly premium for Part A coverage.

If you or your loved one is considering assisted living or a nursing home, keep in mind that custodial care services such as help with day-to-day tasks are not covered by Medicare Part A.

Part B: Medical Insurance

Most medically necessary equipment, doctors’ services, mental healthcare, hospital outpatient services, and some therapy and preventative care are covered by Part B, which is the second part of Original Medicare. Depending on your plan, Part B may also cover some home health and ambulance services. A monthly premium is usually required to receive Part B. As with other types of insurance, there are limitations, deductibles and co-insurance or other out-of-pocket costs that may apply depending on the specifics of your plan.

Private Medicare

Unlike Original Medicare, Part C and Part D Medicare plans are provided by private insurance companies that have contracts with the U.S. government, rather than from the U.S. government itself. Part C is generally considered to be an alternative to Part A and Part B.

Part C: Medicare Advantage

The plans offered under Part C are also known as Medicare Advantage Plans. They are Medicare-approved private insurance plans that provide coverage similar to Medicare Part A and Part B. Some Medicare Advantage Plans can also offer other services that aren’t covered by Original Medicare, such as dental, vision and hearing.

A Medicare Advantage Plan can sometimes have less expensive out-of-pocket costs than what you might pay under Original Medicare, depending on your needs, but there may be some limitations or restrictions, and some Medicare Advantage Plans may have higher out-of-pocket costs than Original Medicare. The Medicare Advantage Plan will set the premiums, the deductibles, the copayments and any coinsurance amounts, so you may want to consider what those out-of-pocket costs may be when evaluating which Medicare plan is best for you.

Part D: Outpatient Prescription Drug Insurance

Medicare Part D is an optional part of Medicare that generally covers prescription drugs.

If you decide to get Part D, you’ll need to choose a plan that works with your Medicare existing benefits. Many Medicare Advantage Plans offer Part D coverage included in the bundle. If you have Original Medicare only, you can choose a stand-alone Part D plan to add drug coverage to your Original Medicare coverage.

What Original Medicare Doesn’t Cover

As you consider which Medicare plan may be right for you, you should be aware of potential additional costs with Medicare Part A and Part B:

Deductibles

Part A has a $1,632 deductible to be paid for inpatient hospital stays in 2024.
Part B plans have a $240 deductible for the year of 2024.

Coinsurance payments

Not including the deductible, inpatient hospital stays that are covered by Medicare Part A but last longer than 60 days may have additional coinsurance costs.

Part B copayments

After the Part B deductible is met, Medicare Part B usually covers 80 percent of the cost of the services that you receive when you are in the hospital (to the extent the costs are approved by Medicare) and you are generally responsible for 20 percent of the cost of the services.

Parts A and B (Original Medicare) typically do not cover the following:

Non-skilled Long-term care such as nursing homes or assisted living
Personal care (help with daily tasks)
Most dental services
Eye exams for prescription glasses purposes
Dentures
Most cosmetic surgery
Hearing aids and exams related to them

If you’re still not sure whether the service you need is covered by Medicare, you may want to try using this tool to help you figure out where to start.

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