Medicare: What's Covered and What Isn't

Part A is hospital insurance — it covers inpatient hospital stays, skilled nursing facility care (short-term, after a qualifying hospital stay), hospice, and some home health care. Most people pay no premium for Part A because they or a spouse paid Medicare taxes while working. It does not cover long-term custodial care or doctor visits, which fall under other parts.

Part B is medical insurance — it covers doctor visits, outpatient care, preventive services, lab tests, and durable medical equipment. It has a monthly premium (higher for high earners, via IRMAA) and an annual deductible, after which you typically pay 20% of the Medicare-approved amount with no out-of-pocket maximum. That 20%-with-no-cap exposure is why many people add a Medigap or Advantage plan.

Original Medicare (Parts A and B) generally does not cover routine dental, vision, or hearing care, including cleanings, dentures, eyeglasses, or hearing aids. Many Medicare Advantage plans bundle some of these benefits, and standalone dental or vision plans can fill the gap. This is one of the most common surprises for new enrollees.

No — Medicare does not pay for most long-term custodial care (help with daily activities like bathing and dressing) in a nursing home or at home. It covers only limited, short-term skilled care after a hospital stay. Long-term care is paid out of pocket, through long-term care insurance, or by Medicaid after you've spent down assets. Planning for this gap is essential.

Your Initial Enrollment Period is a seven-month window around your 65th birthday (the three months before, your birth month, and the three months after). Enrolling on time matters: missing it without qualifying coverage can trigger lifelong late-enrollment penalties for Part B and Part D. If you're still working with employer coverage, special rules may let you delay — verify your situation before your 65th birthday.

Original Medicare (Parts A and B, usually paired with a Part D drug plan and often a Medigap supplement) lets you see any provider that accepts Medicare nationwide, with predictable costs when you add Medigap. Medicare Advantage (Part C) bundles A, B, and usually D through a private plan with a network, often adds extras like dental, and caps out-of-pocket costs — but limits you to its network. The right choice depends on your providers, travel, and budget.

Only through Part D (a standalone drug plan added to Original Medicare) or a Medicare Advantage plan that includes drug coverage. Original Medicare Parts A and B do not cover most outpatient prescription drugs. Skipping Part D when you first qualify — without other creditable drug coverage — can trigger a lifelong late-enrollment penalty, so enroll on time even if you take few medications.

IRMAA (the Income-Related Monthly Adjustment Amount) is a surcharge added to your Part B and Part D premiums if your income is above certain thresholds, based on your tax return from two years earlier. Higher earners pay more; most people are not affected. Because it uses a two-year lookback, a high-income year can raise your Medicare premiums two years later — plan ahead around income events like Roth conversions.