What Does Medicare Cover and What Does It Not Cover?
Medicare covers a lot — but the gaps can cost you thousands. Here's a complete breakdown of what's in and what's out.
General information, not professional advice — see terms of use.
Medicare has four main parts:
Part A (Hospital Insurance): Inpatient hospital stays, skilled nursing facility care (limited), hospice, and some home health. Most people pay no Part A premium with 40+ work quarters. 2025 deductible: $1,676 per benefit period.
Part B (Medical Insurance): Doctor visits, outpatient care, preventive services (free in-network), medical equipment. 2025 standard premium: $185/month. You pay 20% coinsurance after deductible — with no out-of-pocket maximum in original Medicare.
Part C (Medicare Advantage): Private plans that replace Parts A and B. Often includes dental, vision, hearing, and drug coverage.
Part D (Prescription Drug Coverage): Standalone drug plans. 2025 out-of-pocket drug cap: $2,000.
What Medicare does NOT cover:
- Long-term care / nursing home custodial care
- Routine dental, vision, and hearing
- Hearing aids
- Most care outside the US
- Cosmetic surgery
Follow-up questions
What is Medigap and do I need it?
Medigap (Medicare Supplement) is private insurance covering gaps in original Medicare — primarily the 20% coinsurance and deductibles. Without it, a catastrophic illness could cost you tens of thousands. Plan G is the most comprehensive for those who became eligible after 2020.
When should I sign up for Medicare?
Your 7-month Initial Enrollment Period begins 3 months before you turn 65. Enrolling late results in permanent premium penalties: 10% higher Part B premium for each 12-month period you delayed.
Does Medicare cover nursing home care?
Medicare covers skilled nursing facility care only after a qualifying 3-day hospital stay, only for the medical condition treated, and only for up to 100 days. After day 20, there's a significant daily copay. Medicare provides NO coverage for ongoing custodial care (help with daily activities).
More medicare answers
This page is general information, not professional advice, and it may not reflect the latest rules where you live. For your own situation, talk to a qualified adviser. Spotted an error? Email per@upperia.se and we will fix it.