What Does Medicare Cover (and Not Cover)? A Complete 2026 Guide

How Medicare Coverage Is Organized

Medicare is a federal health insurance program for people 65 and older, as well as certain younger individuals with disabilities or specific conditions. The program is divided into four parts, and each part covers a different category of healthcare services. Understanding how the parts fit together is the first step toward knowing what you are (and are not) covered for.

For a detailed breakdown of all four parts in one place, see our guide to Medicare Parts A, B, C, and D explained simply.

What Does Medicare Part A Cover?

Medicare Part A is hospital insurance. It covers medically necessary inpatient care when you are formally admitted to a hospital. Part A also covers several other categories of care that follow a hospital stay or relate to end-of-life services.

Here is what Part A covers in 2026:

• Inpatient hospital stays including semi-private room, meals, nursing care, medications administered during your stay, and lab tests

• Skilled nursing facility (SNF) care for up to 100 days per benefit period following a qualifying 3-day hospital stay

• Home health care including skilled nursing, physical therapy, and occupational therapy when you are homebound

• Hospice care for terminally ill patients with a life expectancy of 6 months or less, including pain management, counseling, and respite care

• Blood after the first 3 pints per calendar year

Part A Costs in 2026

Most people pay $0 in premiums for Part A if they (or their spouse) paid Medicare taxes for at least 40 quarters. However, Part A still has significant cost-sharing:

For a full breakdown of all Medicare costs this year, see our Medicare costs in 2026 guide.

What Does Medicare Part B Cover?

Medicare Part B is medical insurance. It covers medically necessary outpatient services, doctor visits, and preventive care. Part B is where the majority of your day-to-day healthcare interactions are covered.

Part B covers:

• Doctor and specialist visits including primary care, cardiologists, oncologists, and other specialists

• Outpatient surgery and procedures performed in ambulatory surgical centers or hospital outpatient departments

• Preventive services including annual wellness visits, cancer screenings (mammograms, colonoscopies), flu shots, and cardiovascular screenings

• Durable medical equipment (DME) including wheelchairs, walkers, oxygen equipment, CPAP machines, and glucose monitors

• Ambulance services when medically necessary

• Mental health services including therapy, psychiatric visits, and substance abuse treatment

• Lab tests, X-rays, MRI/CT scans, and diagnostic imaging

• Home health care when ordered by a doctor

• Certain vaccines including flu, pneumonia, hepatitis B, and COVID-19

Part B Costs in 2026

After you pay the Part B deductible, Medicare typically pays 80% of the approved amount and you pay the remaining 20% coinsurance with no cap on what that 20% can add up to. This is one of the biggest reasons people add supplemental coverage.

Higher-income beneficiaries pay more through IRMAA surcharges. For details on how income affects your premiums, see our IRMAA guide.

What Is NOT Covered by Original Medicare?

Original Medicare (Parts A and B combined) has notable gaps. These are services that Medicare simply does not pay for, regardless of medical necessity:

• Routine dental care (cleanings, fillings, dentures, extractions)

• Routine vision care (eye exams for glasses, eyeglasses, contact lenses)

• Routine hearing care (hearing aids, hearing exams for fitting)

• Long-term care (nursing home custodial care, assisted living)

• Cosmetic surgery (unless medically necessary, such as reconstruction after mastectomy)

• Prescription drugs (covered separately under Part D)

• Care outside the United States (with limited exceptions)

• Acupuncture (except for chronic low back pain)

For a deeper look at how to fill these gaps, read our guide on dental, vision, and hearing coverage options.

What Does Medicare Part C (Medicare Advantage) Cover?

Medicare Advantage (Part C) is an alternative way to receive your Medicare benefits. These plans are offered by private insurance companies approved by Medicare. Every Medicare Advantage plan must cover everything Original Medicare covers, but most plans also include additional benefits.

Common extra benefits in Medicare Advantage plans include:

• Prescription drug coverage (Part D built into the plan)

• Routine dental (cleanings, X-rays, sometimes major dental)

• Routine vision (eye exams, glasses allowance)

• Routine hearing (hearing exams, hearing aid allowance)

• Fitness programs (gym memberships like SilverSneakers)

• Transportation to medical appointments

• Over-the-counter allowances for health-related items

• Telehealth services

The tradeoff is that Medicare Advantage plans use provider networks (HMO or PPO), which means you may be limited in which doctors and hospitals you can see. The maximum out-of-pocket limit for Medicare Advantage plans in 2026 is $9,250.

To understand the differences between Medicare Advantage and Original Medicare with a supplement, read our Medicare Supplement vs. Medicare Advantage comparison.

What Does Medicare Part D Cover?

Medicare Part D is prescription drug coverage. It is offered through private insurance companies as either a standalone plan (paired with Original Medicare) or built into a Medicare Advantage plan.

Part D covers:

• Brand-name and generic prescription drugs (varies by plan formulary)

• Specialty medications including biologics and cancer drugs

• Vaccines covered under Part D (shingles, Tdap, RSV)

• Insulin capped at $35 per month

In 2026, the maximum Part D deductible is $615, and the out-of-pocket cap is $2,100 per year. Once you reach $2,100 in total drug spending, your plan pays 100% for the rest of the year. You can also spread your costs monthly through the Medicare Prescription Payment Plan.

For details on how Part D is changing, see our guide on Medicare Part D changes in 2026.

💡 Eddie's Pro Tip

I tell everyone the same thing: do not assume you are covered. Before any procedure, surgery, or new treatment, call your plan and ask three questions. (1) Is this service covered under my plan? (2) Does my doctor or facility need to be in-network? (3) Do I need prior authorization? Those three questions can save you thousands of dollars in surprise bills. Original Medicare is straightforward, but if you have a Medicare Advantage plan, network rules and prior auth requirements vary widely between plans.

How to Fill the Gaps in Medicare Coverage

Original Medicare leaves you responsible for 20% coinsurance on Part B services with no annual cap, plus the Part A deductible every time you are admitted to the hospital. Over the course of a year, especially if you face a serious illness, those costs can add up to tens of thousands of dollars.

There are two primary ways to fill these gaps:

Option 1: Medicare Supplement (Medigap)

A Medicare Supplement plan (also called Medigap) works alongside Original Medicare to cover your cost-sharing. The most popular plan, Plan G, covers the Part A deductible, all Part B coinsurance, skilled nursing coinsurance, and foreign travel emergencies. Your only remaining cost is the annual Part B deductible of $283.

Option 2: Medicare Advantage

A Medicare Advantage plan replaces Original Medicare entirely and bundles hospital, medical, and usually drug coverage into one plan with a built-in out-of-pocket maximum. Many plans also add dental, vision, and hearing benefits at no extra premium.

For a detailed comparison of these two approaches, see our Supplement vs. Advantage guide.

Common Coverage Questions

Does Medicare Cover Nursing Homes?

Original Medicare does not cover long-term custodial care in a nursing home. However, Part A does cover up to 100 days in a skilled nursing facility following a qualifying 3-day hospital stay. After day 20, you pay $217 per day in coinsurance (2026). For long-term nursing home care, you would need to look into Medicaid, long-term care insurance, or private pay.

Does Medicare Cover Hearing Aids?

Original Medicare does not cover hearing aids or routine hearing exams. Part B does cover diagnostic hearing tests if your doctor orders them for medical treatment. Many Medicare Advantage plans include hearing aid benefits with annual allowances ranging from $500 to $3,000 depending on the plan.

Does Medicare Cover Hospice?

Medicare Part A covers hospice care if your doctor certifies a life expectancy of 6 months or less and you agree to comfort care rather than curative treatment. Hospice coverage includes pain management, nursing care, medical equipment, counseling for the patient and family, and short-term respite care.

Does Medicare Cover Vaccines?

Yes. Medicare covers vaccines across both Part B and Part D. Part B covers flu, pneumococcal, hepatitis B, COVID-19, and RSV vaccines at no cost. Part D covers additional vaccines like shingles (Shingrix) and Tdap at $0 cost-sharing under the Inflation Reduction Act.

Does Medicare Cover Home Health Care?

Medicare covers home health services including skilled nursing, physical therapy, speech therapy, and occupational therapy when you are homebound and under a doctor's plan of care. Medicare does not cover 24-hour home care, meal delivery, or help with daily activities like bathing and dressing.

Does Medicare Cover Medical Equipment?

Medicare Part B covers durable medical equipment (DME) when prescribed by your doctor for home use. This includes wheelchairs, walkers, hospital beds, oxygen equipment, CPAP machines, blood sugar monitors, and insulin pumps. You pay 20% coinsurance after the Part B deductible, and the supplier must be Medicare-enrolled.

Does Medicare Cover Pre-Existing Conditions?

Yes. Original Medicare covers pre-existing conditions without any waiting periods or exclusions. Whether you have diabetes, heart disease, cancer, or any other condition, Medicare will cover medically necessary treatment from day one. Medicare Advantage plans also cannot deny enrollment based on pre-existing conditions (except for end-stage renal disease in certain situations).

Frequently Asked Questions