Medicare · Coverage
What Does Medicare Actually Cover (and Not Cover)?
The Short Answer
Medicare Part A covers hospital care and Part B covers outpatient and doctor services, but original Medicare does not cover routine dental, vision, hearing aids, or long-term custodial care. These gaps are significant: a private nursing-home room now exceeds $120,000 per year, and original Medicare has no annual out-of-pocket limit.
Medicare is a strong foundation, but it is not comprehensive, and the gaps surprise most people only after they have retired. Understanding what each part covers, and what falls entirely on you, is the difference between a plan that works and one that leaves a six-figure hole.
What do the four parts of Medicare cover?
Medicare is divided into four parts. Part A covers inpatient hospital stays, skilled nursing after a hospital stay, hospice, and some home health care, and is premium-free for most people. Part B covers doctor visits, outpatient care, preventive services, and medical equipment. Part D covers prescription drugs. Part C, or Medicare Advantage, is a private alternative that bundles A and B and often adds extras.1
| Part | Covers | 2026 cost |
|---|---|---|
| Part A | Hospital, skilled nursing, hospice | Premium-free for most; $1,736 deductible per benefit period |
| Part B | Doctor visits, outpatient, equipment | $202.90/month; $283 annual deductible, then 20% coinsurance |
| Part C | Bundled A+B+often D via private plans | Varies by plan |
| Part D | Prescription drugs | Varies; $2,000 annual out-of-pocket cap |
What does Medicare not cover?
The gaps in original Medicare are specific and expensive. Routine dental care, including cleanings, fillings, and dentures, is not covered. Routine vision care and eyeglasses are not covered. Hearing exams and hearing aids are not covered.2
The largest gap is long-term custodial care, help with daily activities like bathing and dressing, whether at home or in a facility. Medicare does not pay for extended custodial care, and these costs are substantial: a private nursing-home room now runs well over $120,000 per year. Care outside the United States is also generally not covered.
Free Tool
Estimate your lifetime retirement healthcare costs
How do I cover the gaps?
Two main approaches exist. A Medigap (Medicare Supplement) policy works alongside original Medicare to cover costs like the 20% coinsurance, which otherwise has no annual cap. A Medicare Advantage plan replaces original Medicare with a private plan that often adds dental, vision, and hearing, but restricts you to a network.1
Neither is universally better. The right choice depends on your health, your doctors, your prescriptions, your travel habits, and your tolerance for network restrictions versus the flexibility of original Medicare.
The coinsurance gap that catches people
Under original Medicare with no supplement, you pay 20% of most Part B costs with no annual maximum. For a major illness, that 20% can grow without limit. This single gap is the main reason many retirees add a Medigap policy.
Frequently asked questions
Does Medicare cover dental and vision?
Original Medicare does not cover routine dental or vision care, including cleanings, dentures, eye exams, or glasses. Some Medicare Advantage plans include these benefits, and standalone dental and vision policies are available separately.
Does Medicare pay for nursing homes or long-term care?
Generally no. Medicare covers only short-term skilled nursing after a qualifying hospital stay. It does not pay for extended custodial long-term care, which can exceed $120,000 per year for a private nursing-home room.
Is there a cap on out-of-pocket costs under Medicare?
Original Medicare has no annual out-of-pocket maximum for Part B services, which is why many people add a Medigap policy. Medicare Advantage plans do have an annual out-of-pocket limit, and Part D now caps drug costs at $2,000 per year.
Keep reading
Tool
Healthcare Cost Estimator
A personalized estimate of your retirement healthcare costs, gaps included.
Tool
Medicare Late Enrollment Penalty Calculator
Check whether you owe a Part B or Part D penalty, with 2026 premium numbers.
Article
When do I have to enroll in Medicare?
The 7-month window, the permanent 10% penalty, and the one way to delay safely.
Sources
- What Medicare Covers Medicare.gov. Coverage under Parts A, B, C, and D and the difference between original Medicare and Medicare Advantage.
- Items & Services Medicare Doesn't Cover Medicare.gov. Dental, vision, hearing aids, long-term custodial care, and overseas care are not covered.
- 2026 Medicare Parts A & B Premiums and Deductibles Centers for Medicare & Medicaid Services. 2026 Part A deductible of $1,736 and Part B premium of $202.90 and deductible of $283.