What Does Medicare Cover? A Plain-English Guide

Medicare Part A — Hospital Insurance

Medicare Part A covers inpatient hospital care, skilled nursing facility care (after a qualifying hospital stay), hospice care, and some home health care. Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes for at least 10 years. However, Part A has a deductible ($1,632 per benefit period in 2024) and coinsurance for extended hospital stays.

• Inpatient hospital stays
• Skilled nursing facility care (up to 100 days after qualifying hospital stay)
• Hospice care
• Home health care (limited)

Medicare Part B — Medical Insurance

Medicare Part B covers outpatient medical services including doctor visits, preventive care, lab tests, X-rays, durable medical equipment, and some home health services. Part B has a monthly premium ($174.70 in 2024 for most enrollees), an annual deductible ($240 in 2024), and 20% coinsurance after the deductible. There is no out-of-pocket maximum with Original Medicare alone.

• Doctor visits and specialist care
• Preventive services (annual wellness visits, screenings)
• Outpatient surgery and procedures
• Lab tests and X-rays
• Durable medical equipment (wheelchairs, walkers)
• Mental health services

Medicare Part C — Medicare Advantage

Medicare Part C (Medicare Advantage) is an alternative way to receive your Medicare benefits through a private insurance company. These plans must cover everything Original Medicare covers, and most include prescription drug coverage (Part D). Many plans also include dental, vision, and hearing benefits. See our Medicare Advantage vs Supplement guide for a full comparison.

Medicare Part D — Prescription Drug Coverage

Medicare Part D covers prescription drugs. It is offered through private insurance companies approved by Medicare. You pay a monthly premium, annual deductible, and copays or coinsurance for your medications. If you do not enroll in Part D when first eligible and do not have other creditable drug coverage, you may face a permanent late enrollment penalty.

What Medicare Does NOT Cover

Understanding Medicare's gaps is just as important as knowing what it covers. Medicare does not cover:

• Routine dental care (cleanings, fillings, dentures)
• Routine vision care (eye exams, glasses, contacts)
• Hearing aids
• Long-term care (nursing home custodial care)
• Most care outside the United States
• Cosmetic surgery

Filling the Gaps with Supplemental Coverage

Medicare Supplement (Medigap) plans cover the cost-sharing gaps in Original Medicare — deductibles, copays, and coinsurance. Dental, vision, and hearing coverage can be added through supplemental insurance plans. AG Insurance helps West Virginia seniors build a complete coverage package that addresses all of Medicare's gaps.