Medicare pays for a wide range of medical services, from hospital stays and doctor visits to preventive screenings, mental health care, prescription drugs, and some home health services. The program is split into parts, each covering a different category of care, and what you’ll pay out of pocket depends on which part applies. Here’s a practical breakdown of what Medicare will and won’t cover.
Hospital Stays (Part A)
Part A covers inpatient hospital care, which includes a semi-private room, meals, general nursing, and any drugs administered as part of your treatment. If you need surgery, labs, or imaging while admitted, those fall under Part A as well. What it won’t cover: a private room (unless your doctor says it’s medically necessary), private-duty nursing, personal care items like razors or slippers, and separate charges for a TV or phone in your room.
Part A also covers care in a skilled nursing facility after a qualifying hospital stay. Medicare limits this to 100 days per benefit period. You pay nothing for the first 20 days. For days 21 through 100, you’re responsible for a daily coinsurance (currently $217 per day for 2026). After day 100, Medicare stops paying entirely, so longer stays require supplemental insurance or out-of-pocket payment.
Doctor Visits and Outpatient Care (Part B)
Part B is the outpatient side of Medicare. It covers two broad categories: medically necessary services and preventive services. On the medically necessary side, that includes doctor visits, ambulance services, durable medical equipment like wheelchairs or oxygen tanks, outpatient surgeries, diagnostic tests, and limited outpatient prescription drugs (typically ones administered in a clinic rather than picked up at a pharmacy).
In 2025, the standard Part B premium is $185 per month, and you’ll pay a $257 annual deductible before coverage kicks in. After meeting that deductible, you typically pay 20% of the Medicare-approved amount for most services. Higher-income enrollees pay more for their premium based on tax returns from two years prior.
Preventive Screenings and Vaccines
One of the most valuable and underused parts of Medicare is its preventive coverage. You pay nothing for most preventive services as long as your provider accepts Medicare assignment. The list is extensive:
- Cancer screenings: mammograms, colonoscopies, lung cancer screenings with low-dose CT, cervical and vaginal cancer screenings, prostate cancer screenings, and several types of colorectal tests including stool DNA tests and blood-based biomarker tests
- Cardiovascular screenings: cholesterol and lipid panels, plus behavioral therapy for heart disease prevention
- Diabetes: diabetes screenings, self-management training, medical nutrition therapy, and a Diabetes Prevention Program
- Vaccines: flu shots, COVID-19 vaccines, pneumococcal shots, and hepatitis B shots
- Other screenings: depression, HIV, hepatitis B and C, glaucoma, bone density, alcohol misuse, sexually transmitted infections, and abdominal aortic aneurysm
Medicare also covers a one-time “Welcome to Medicare” preventive visit when you first enroll and a yearly wellness visit after that. These visits are designed to create or update a personalized prevention plan with your doctor. The yearly wellness visit is not the same as a full physical exam, which Medicare generally does not cover. If your doctor orders additional tests or treats a condition during a wellness visit, those services may be billed separately with cost-sharing.
Mental Health Services
Part B covers outpatient mental health care, including visits with psychiatrists, psychologists, clinical social workers, marriage and family therapists, and licensed mental health counselors. It also covers intensive outpatient programs, which provide several hours of structured treatment per week without requiring an overnight stay. If you need inpatient psychiatric care, Part A covers that in the same way it covers other hospital admissions.
Prescription Drugs (Part D)
Medicare Part D is a separate plan you enroll in (either standalone or through a Medicare Advantage plan) that covers outpatient prescription drugs. Each plan has its own formulary, meaning the specific drugs covered and the cost tiers vary by plan.
The biggest recent change: starting in 2025, Part D includes a hard cap of $2,000 per year on out-of-pocket prescription drug costs. Once you hit that limit, you pay nothing more for covered drugs for the rest of the year. This is a significant shift for people who take expensive medications, as previously there was no firm ceiling and costs could spiral in the “catastrophic” coverage phase. Plans also offer the option to spread that $2,000 across monthly payments so you don’t face a large bill early in the year.
Weight Loss Medications
Medicare’s coverage of GLP-1 weight loss drugs like Wegovy and Zepbound has been a major question for enrollees. Historically, Medicare was prohibited from covering drugs prescribed solely for weight loss. That’s changing through a program called the Medicare GLP-1 Bridge, a short-term demonstration running from July 2026 through December 2027.
To qualify, your doctor must submit a prior authorization confirming you meet specific criteria. The thresholds depend on your BMI and any related health conditions:
- BMI of 35 or higher: eligible with no additional diagnosis required
- BMI of 30 or higher: eligible if you also have heart failure with preserved ejection fraction, uncontrolled high blood pressure (despite already taking two blood pressure medications), or moderate-to-severe chronic kidney disease
- BMI of 27 or higher: eligible if you also have pre-diabetes, a history of heart attack or stroke, or symptomatic peripheral artery disease
There’s an important distinction here. If your doctor prescribes a GLP-1 drug for a condition that’s already coverable under regular Part D, like Wegovy for cardiovascular risk reduction or Zepbound for obstructive sleep apnea in adults with obesity, that goes through your Part D plan’s normal coverage process, not the Bridge program. The Bridge is specifically for weight loss as the primary goal.
Home Health Care
Medicare covers home health services, but only when you meet a specific set of conditions. You must be homebound, meaning leaving your home either isn’t recommended due to your condition or requires considerable effort and assistance (a wheelchair, cane, special transportation, or another person’s help). You must need part-time or intermittent skilled care, such as nursing or physical therapy. A provider must assess you face-to-face and certify that you need these services, and the care must come from a Medicare-certified home health agency.
When you qualify, Medicare covers skilled nursing, physical and occupational therapy, speech therapy, medical social services, and some medical supplies. It does not cover 24-hour home care, meal delivery, homemaker services like cleaning or laundry, or personal care (bathing, dressing) when that’s the only care you need.
What Medicare Does Not Cover
The gaps in Original Medicare catch many people off guard. The most notable exclusions are dental, vision, and hearing. Medicare does not pay for routine dental cleanings, fillings, tooth extractions, dentures, or implants in most cases. It does not cover routine eye exams for glasses, eyeglasses, or contact lenses (though it covers eye exams for certain conditions like glaucoma). It does not cover hearing aids or exams for fitting them.
Other common exclusions include cosmetic surgery, long-term custodial care in a nursing home (when you don’t need skilled care), care received outside the United States, and routine foot care. Many people fill these gaps by enrolling in a Medicare Advantage plan, which often bundles dental, vision, and hearing benefits, or by purchasing a separate Medigap policy to help cover cost-sharing like the 20% coinsurance under Part B.
How the Parts Fit Together
Original Medicare (Parts A and B) covers hospital and outpatient care but leaves you responsible for premiums, deductibles, and coinsurance with no annual out-of-pocket maximum. Part D adds drug coverage with its own premium and the $2,000 yearly cap. You can add a Medigap supplemental policy to reduce cost-sharing under Original Medicare, or you can replace the whole structure with a Medicare Advantage plan (Part C), which bundles A, B, and usually D into one plan from a private insurer, often with added benefits and a single out-of-pocket limit.
Your coverage depends on which combination you choose. Comparing plans during open enrollment each fall, which runs from October 15 through December 7, is the best way to make sure you’re covered for the services you actually use.