What Does Medicare Cover?

Medicare pays for hospital care, doctor visits, tests, equipment and drugs, but in pieces. Hospital insurance (Part A) and Part B make up Original Medicare, and drug coverage (Part D) is a separate plan. Each part has its own costs, so a bill can come for care you thought was covered.

Medicare usually pays if

• Your doctor or nurse practitioner says you need the care.
• The doctor, hospital or supplier works with Medicare.
• The test, item or service is one Medicare covers. You can look it up at medicare.gov/coverage.

Not sure Medicare will pay? Ask anyway, because your doctor can tell you the cost before you go, Medicare.gov says. If you would rather not make the calls, a Pair Team advocate can help.

What do Parts A, B and D cover?

Part A, hospital insurance. It pays for care when you're admitted to a hospital, and for a short stay in a nursing facility after that. It also pays for hospice and some care at home. Most people pay $0 a month for it, because they or a spouse paid Medicare taxes for about 10 years. Rehab in a nursing facility is $0 for days 1 to 20 in 2026, then $217 a day up to day 100.

Part B, the part of Medicare that pays for doctor visits. It pays for doctors, nurse practitioners and therapists, care outside the hospital, lab tests, equipment like walkers, and many checkups and shots. It costs most people $202.90 a month in 2026, usually taken out of their Social Security check. Original Medicare has no yearly limit on what you pay, but extra insurance called Medigap can help pay your 20%.

Part D, drug coverage. You get it from a private drug plan that follows Medicare's rules, or inside a Medicare Advantage plan. See what Medicare pays for prescription drugs.

Medicare Advantage (Part C). It's a private plan approved by Medicare that covers Part A, Part B and usually drugs. You may need to use the plan's doctors and get approval first for some care. Plans have a yearly limit on what you pay. Most plans offer extras Original Medicare doesn't, like vision, hearing and dental, Medicare.gov says. You must keep paying the $202.90 a month for Part B. We don't sell plans, so to compare, use Medicare's Plan Finder, 1-800-MEDICARE or your State Health Insurance Assistance Program (SHIP). You can make changes during Open Enrollment, each fall from October 15 to December 7.

Which part pays for common needs

Lab tests are $0. Flu, COVID-19, pneumonia and hepatitis B shots are $0 under Part B. Shingles and respiratory syncytial virus (RSV) shots are $0 under Part D.

What does Original Medicare not cover?

Original Medicare does not cover these, so you pay the full cost unless you have other coverage:

• Most dental care, like cleanings, fillings, pulling teeth and dentures. It may pay for dental care tied to a few medical treatments, like a heart valve replacement. See Medicare and dental care.
• Hearing aids and exams to fit them. Part B does pay for a hearing exam your doctor orders to look for a medical problem. See Medicare and hearing aids.
• Routine eye exams for glasses, and most glasses. Part B pays for a yearly eye exam if you have diabetes, and one pair of glasses after cataract surgery. See Medicare and eye exams.
• Long-term care, meaning help with bathing, dressing or using the bathroom when that is the only care you need. That is true at home, in assisted living or in a nursing home. See paid help at home.

It also doesn't pay for cosmetic surgery, massage or a routine physical, though a yearly wellness visit is covered. It won't pay a doctor who opted out of Medicare except in an emergency, so ask if yours takes Medicare.

If you also have Medicaid

Medicaid may pay for care Medicare does not, like long-term care, if you qualify in your state. In California, Medicaid for people 65 and older covers incomes up to $1,836 a month for one person, from April 1, 2026. See Medicare and Medicaid in California. In New York, Medicaid for people 65 and older allows $1,856 a month in income and $33,038 in savings in 2026. See Medicare and Medicaid in New York.

How to check if Medicare covers something

1. Ask your doctor why you need it, if Medicare covers it and what you'll pay.
2. Look it up at medicare.gov/coverage to check the test, item or service.
3. Call your plan if you have Medicare Advantage. Ask if you need approval first, and if the doctor is in the network.
4. Call Medicare to ask about coverage: 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.
5. Get free help from your State Health Insurance Assistance Program (SHIP) at 1-877-839-2675. In California, call the Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222. In New York, call the Health Insurance Information, Counseling and Assistance Program (HIICAP) at 1-800-701-0501.
6. If Medicare says no, appeal. See how to appeal a Medicare denial.

What a Pair Team advocate does

People rarely call us with one question. A new walker comes with a bill that looks wrong, or a visit with no ride. This is what we do:

• Find out which part of Medicare should pay, and call your plan or the office with you.
• Check if you can get Extra Help, a Medicare Savings Program or Medicaid to lower your costs.
• Help you appeal when Medicare or your plan says no.
• Help with what usually comes with it: rides, food, utilities and housing.

An advocate is covered by Medicare if you qualify. It takes two minutes to find out.

Check if you qualify for a Pair Team advocate

Frequently asked questions

Is Medicare free?

Medicare isn't free for most people, though hospital insurance is $0 a month for most. Part B costs $202.90 a month in 2026, and drug plans have their own costs. If money is tight, a Medicare Savings Program can pay the $202.90.

Is there a limit on what I pay in a year?

Original Medicare has no yearly limit, unless you add Medigap or join a Medicare Advantage plan. Drug coverage has its own limit: $2,100 in 2026.

Does Medicare pay for a nursing home?

Medicare pays for a nursing home only for a short time, for skilled care like rehab after a 3-day hospital stay. It pays for up to 100 days in each benefit period. It does not pay for a long stay if you only need help with daily tasks, but Medicaid may if you qualify.

Does Medicare pay for a yearly physical?

Part B pays for a yearly wellness visit, not a routine physical, at $0 if your doctor accepts Medicare's price. At that visit, you and your doctor make a plan to keep you well.

Will Part B cost more in 2027?

Part B may cost more in 2027, because the federal agency that runs Medicare sets a new amount each fall. The 2026 amount is $202.90 a month, and the new one starts in January.

What is Medigap?

Medigap is extra insurance from a private company that helps pay your share in Original Medicare, like the 20%. It doesn't work with Medicare Advantage.

Sources

• Parts of Medicare, Medicare.gov
• Costs, Medicare.gov
• What Part A covers, Medicare.gov
• What's not covered?, Medicare.gov
• What's covered?, Medicare.gov
• Skilled nursing facility care, Medicare.gov
• Home health services, Medicare.gov
• Hospice care, Medicare.gov
• Long-term care, Medicare.gov
• Yearly "Wellness" visits, Medicare.gov
• Colonoscopies (screening), Medicare.gov
• Cardiovascular behavioral therapy, Medicare.gov
• Ambulatory Blood Pressure Monitoring (NCD 20.19), CMS
• Telehealth and Remote Monitoring (MLN901705), CMS
• Physical therapy services, Medicare.gov
• Telehealth, Medicare.gov
• Cognitive assessment and care plan services, Medicare.gov
• Opioid Use Disorder treatment services, Medicare.gov
• Alcohol misuse screenings and counseling, Medicare.gov
• Chronic care management services, Medicare.gov
• Community health integration services, Medicare.gov
• Ambulance services, Medicare.gov
• Insulin, Medicare.gov
• Blood sugar test strips, Medicare.gov
• Continuous glucose monitors, Medicare.gov
• Dental services, Medicare.gov
• Hearing and balance exams, Medicare.gov
• Eye exams (for diabetes), Medicare.gov
• Eyeglasses and contact lenses, Medicare.gov
• Prescription drugs (outpatient), Medicare.gov
• How much does Medicare drug coverage cost?, Medicare.gov
• 2026 Medicare Parts A and B Premiums and Deductibles, CMS
• State Health Insurance Assistance Programs