The complete guide
What Medicare covers, what it never covers, and the grey areas
Short answer: Medicare covers medically necessary hospital care, doctor visits, outpatient services, equipment, prescriptions, and a long list of free preventive screenings. It does not cover long-term custodial care, most dental, routine vision and hearing, hearing aids, or care outside the United States. Between those two lists sits a grey zone, home health, nursing facility stays, therapy, where coverage turns on one distinction: whether the care requires a licensed professional. Here is the full map, with the rules that decide the hard cases.
Key takeaways
- Part A covers inpatient hospital, skilled nursing after a qualifying stay, hospice, and some home health.
- Part B covers doctors, outpatient care, equipment, lab work, and dozens of $0 preventive services.
- Never covered: long-term custodial care, most dental, routine vision and hearing exams, hearing aids, and care abroad.
- The grey areas turn on skilled versus custodial care, not on whether you are improving.
- Medicare Advantage plans must cover everything Original Medicare does, and may add dental, vision and hearing allowances.
Part A: hospital and facility care
Inpatient hospital stays (semi-private room, meals, nursing, drugs given as part of treatment), skilled nursing facility care for up to 100 days per benefit period after a qualifying three-day inpatient stay, hospice care, and some home health services. Costs run on a per-benefit-period ladder rather than a calendar year.
The trap in this section is observation status: nights spent in a hospital bed as an outpatient do not count toward the three-day requirement for nursing coverage, and are billed under Part B instead.
Part B: doctors, outpatient, and equipment
| Category | Examples |
|---|---|
| Professional services | Doctor visits, specialists, surgeon fees, second opinions, most therapy |
| Outpatient care | Emergency room, urgent care, outpatient surgery, dialysis, infused chemotherapy |
| Diagnostics | Lab work, X-rays, MRI and CT, EKGs |
| Equipment | Walkers, wheelchairs, oxygen, CPAP, hospital beds, glucose monitors |
| Mental health | Therapy and psychiatric care, including from licensed counselors and marriage and family therapists |
| Prevention | Dozens of screenings, counseling services, and all recommended vaccines |
You pay 20% of most Part B services after the $283 annual deductible in 2026, with no annual cap on Original Medicare unless you have Medigap or are in an Advantage plan.
What costs you nothing
A long list of preventive services carries no deductible and no coinsurance when your provider accepts assignment: the annual wellness visit, mammograms, colorectal and lung cancer screening, cardiovascular and diabetes screening, bone density, depression screening, smoking cessation counseling, and every vaccine recommended by federal advisers including shingles. The catch worth knowing is the coding: a screening that becomes diagnostic, because something was found or investigated, carries normal cost sharing. The full free list and the coding trap.
What Medicare never covers
| Not covered | What people do instead |
|---|---|
| Long-term custodial care (help with bathing, dressing, supervision) | Private pay, long-term care insurance, Medicaid, or VA benefits |
| Most dental care, including cleanings, fillings, dentures | Advantage plan allowances, standalone dental plans, dental schools |
| Routine vision exams and eyeglasses | Advantage allowances; Medicare does cover one pair after cataract surgery |
| Hearing exams for aids, and hearing aids | Advantage allowances, over-the-counter hearing aids, VA benefits |
| Care outside the United States | Medigap foreign travel emergency benefit, travel medical insurance |
| Cosmetic surgery, most acupuncture, concierge fees | Private pay |
Each of these has a dedicated article: long-term care, dental, vision, hearing aids, and coverage abroad.
The first row is the hardest truth in the program and deserves reading before it becomes urgent: what Medicare actually pays for long-term care. The rest are mapped in the gaps article, dental, vision, hearing aids, and abroad.
The grey areas, and the rule that decides them
Home health, nursing facility care, and therapy are covered when the care is skilled, meaning it requires licensed professionals, and not covered when it is custodial, meaning help with daily living. Two myths cause people to give up coverage they are entitled to. First, there is no improvement standard: under the Jimmo settlement, skilled care that maintains your condition or slows decline qualifies, so "you have plateaued" is not a lawful reason to end coverage. Second, therapy has no annual dollar cap; the old caps were repealed in 2018. If coverage is ending and you disagree, there is a fast appeal, and appeals are won regularly (how to appeal).
Filling the gaps
- The 20% with no ceiling is filled by a Medigap policy or capped by an Advantage plan’s out-of-pocket maximum.
- Prescriptions need Part D, separately, or built into an Advantage plan.
- Dental, vision, hearing come from Advantage allowances, standalone policies, or paying cash; value allowances at their printed caps.
- Long-term care is its own planning problem, and Medicare is not the answer to it.
- Check any specific service at Medicare’s coverage tool, which answers "is this covered" for thousands of items.
Questions people also ask
What does Medicare cover?
What does Medicare not cover?
Does Medicare cover home health care?
Do I have to be improving for Medicare to keep covering therapy?
Does Medicare cover dental and hearing aids?
Sources for this article
- Medicare.govMedicare coverage: the official item-by-item coverage lookup.
- Medicare.govMedicare.gov: what Parts A and B cover, and the limits on each.
- CMS.gov2026 premiums and deductibles: the deductibles and coinsurance that apply.
Figures checked against these sources on October 12, 2026. We update within days when CMS publishes new amounts.
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