How much does medicare cover?

Medicare provides a strong foundation for health insurance coverage, but it does not cover everything. Understanding how much Medicare covers—and what costs you’re still responsible for—is key to effective planning.

🟩 Quick Definition 

Medicare covers many hospital, doctor and preventive services, but you still pay premiums, deductibles and coinsurance—and many services are excluded.

What Medicare Covers

Hospital Insurance (Part A)

• Covers inpatient hospital stays, skilled nursing facility care (under conditions), hospice care and some home health care.

• For example: For the first 60 days of a hospital stay you’ll pay the deductible, then Medicare covers the approved amount; after that you may pay daily coinsurance for days 61-90, and even more beyond that.

Medical Insurance (Part B)

• Covers medically necessary services: doctors’ visits, outpatient care, home health care, durable medical equipment, and certain preventive services.

• Medicare pays about 80% of the Medicare-approved amount for Part B services after you meet the deductible; you typically pay the remaining 20% coinsurance.

Medicare Advantage (Part C)

• These are private-insurance plans that bundle Part A and Part B coverage (and often Part D drug coverage) and may include extra benefits (vision, dental, wellness).

• They replace Original Medicare, but you’ll still owe the Part B premium, and costs (premiums, deductibles, out-of-pocket limits) vary by plan.

Prescription Drug Coverage (Part D)

• Helps cover outpatient prescription drugs. You pay a premium, deductible, and cost-sharing; plan terms vary.

• Starting in recent years, there is a set annual out-of-pocket cap for Part D drug coverage in many cases.

What Medicare Generally Does Not Cover

• Long-term care (custodial care) in most cases.

• Most dental care, dentures, routine vision or hearing care.

• Cosmetic surgery unless medically necessary.

• Most costs if you stay in a foreign country (exceptions apply).

• Full 100% of all covered services—the remaining coinsurance, deductibles and non-covered services are your responsibility.

Your Typical Costs

• Premiums: For Part B, the standard monthly premium is about $185 in 2025; higher-income beneficiaries may pay more.

• Deductibles & Coinsurance: For Part B in 2025 the annual deductible is about $257; after that you typically pay 20% of the Medicare-approved amount for most services.

• Hospital Stay Example: For Part A you pay the full deductible for days 1-60 of each benefit period; days 61-90 have daily coinsurance, and days beyond that may incur very high out-of-pocket cost unless you have additional insurance.

• Out-of-Pocket Maximum: With Original Medicare (Parts A & B) there is no annual out-of-pocket maximum for most services; with Medicare Advantage (Part C) the plan must set a yearly out-of-pocket limit (for example ~$9,350 for in-network services in 2025).

FAQs

Q1. Will Medicare cover all my medical costs?
No. Medicare covers many services, but you’re still responsible for premiums, deductibles and coinsurance. Also, many services (like long-term care, dental, most vision/hearing) aren’t covered.

Q2. How much will I pay out-of-pocket?
It depends on the services you use. For example, with Part B you pay the deductible then roughly 20% of approved costs. For hospital stays under Part A you pay the deductible and then daily coinsurance after 60 days.

Q3. Does Medicare have a cap on what I might pay in a year?
Original Medicare (Parts A & B) lacks a true annual cap on out-of-pocket costs for most services. However, if you’re enrolled in a Medicare Advantage (Part C) plan, those plans must have an annual out-of-pocket maximum.

Q4. Can I add coverage to protect myself from the costs Medicare doesn’t cover?
Yes. You can purchase a Medicare supplement (Medigap) policy, or choose a Medicare Advantage plan, or buy standalone coverage for things like long-term care or dental/vision.

Q5. What should I check when enrolling?
Check the premiums, deductibles, coinsurance, whether your doctors and hospitals are in-network (for Advantage plans), what extra benefits are included, and whether you’ll need supplemental coverage to fill gaps.

Final Thoughts

Medicare offers vital coverage for hospital and doctor services for eligible individuals—but it’s not comprehensive. Understanding what it covers, what you’ll still pay, and how to fill the gaps is essential for financial planning. Review your plan carefully, consider your health needs, and explore supplemental insurance if you want more complete protection.