Medicare is the federal health insurance program for people 65 and older, as well as some younger people with disabilities. It's one of the most important benefits available to older Americans — but it doesn't cover everything. Understanding what Medicare does and doesn't pay for can save families from financial surprises.
The Four Parts of Medicare
Part A: Hospital Insurance
Part A covers inpatient hospital stays, skilled nursing facility care (with limitations), hospice care, and some home health services. Most people don't pay a monthly premium for Part A because they or their spouse paid Medicare taxes during their working years. However, there are deductibles and coinsurance costs.
An important note about skilled nursing facilities: Medicare Part A can cover skilled nursing facility care after a qualifying hospital stay — but only for a limited time (up to 100 days, with full coverage only for the first 20). After that, you pay a daily coinsurance. After 100 days, Medicare pays nothing.
Part B: Medical Insurance
Part B covers doctor visits, outpatient care, preventive services, and medical equipment like walkers and wheelchairs. Most people pay a monthly premium for Part B, which increases with income. In 2024, the standard premium is around $174 per month.
Part B also covers many preventive services at no cost, including an annual wellness visit, flu shots, mammograms, and certain cancer screenings.
Part C: Medicare Advantage
Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans must cover everything Original Medicare covers, but often include extra benefits like dental, vision, hearing, and prescription drug coverage. Many have low or $0 monthly premiums, but usually have networks of providers you must use.
Choosing between Original Medicare and Medicare Advantage is an important decision that depends on your health needs, preferred doctors, and financial situation.
Part D: Prescription Drug Coverage
Part D plans help pay for prescription medications. These are sold by private insurance companies and vary significantly in what they cover (their "formulary") and what they cost. If you have Original Medicare, you can add a Part D plan. Many Medicare Advantage plans include Part D coverage.
Missing the enrollment window for Part D can result in a permanent late enrollment penalty, so it's important to enroll when first eligible.
Medigap / Medicare Supplement Insurance
Original Medicare has gaps — deductibles, coinsurance, and other costs that you pay out of pocket. Medigap policies, sold by private insurers, help fill those gaps. There are standardized Medigap plan types (labeled A through N), and they're different from Medicare Advantage. You cannot have both Medigap and Medicare Advantage.
What Medicare Does NOT Cover
This is one of the most important things families need to understand. Medicare does not cover:
- Long-term custodial care — The daily help with bathing, dressing, and eating in a nursing home or at home. This is the care that most families eventually need. Medicare only covers skilled care, not custodial care.
- Most dental care — Routine dental exams, cleanings, and dentures are generally not covered
- Most vision care — Routine eye exams and glasses are not covered (though some conditions are)
- Hearing aids — Not covered by Original Medicare
- Most care outside the U.S.
Important Enrollment Periods
Enrollment in Medicare has strict timing rules. Missing enrollment windows can result in permanent penalties or gaps in coverage. The main enrollment periods include:
- Initial Enrollment Period: a 7-month window around your 65th birthday
- General Enrollment Period: January 1 – March 31 each year
- Open Enrollment Period: October 15 – December 7 for changing plans
The SHIP program (State Health Insurance Assistance Program) in each state offers free, unbiased Medicare counseling. Find your state's SHIP at shiphelp.org.
This article provides general educational information. Medicare rules are complex and change over time. For personalized guidance, contact Medicare at 1-800-633-4227 or visit Medicare.gov. This website is not affiliated with Medicare or the Centers for Medicare & Medicaid Services.