What Original Medicare Covers — and What It Does Not

Original Medicare is the federal core of the program. Knowing what it pays for, and what it does not, is the foundation of any coverage comparison.

Original Medicare has two parts: Part A pays for inpatient hospital, skilled nursing facility, hospice, and limited home health care; Part B pays for doctor visits, outpatient care, preventive services, durable medical equipment, and most outpatient mental health. It does not pay for routine dental, vision, hearing aids, long-term custodial care, or most care outside the United States. It also does not include prescription drug coverage — that requires a separate Part D plan. Knowing exactly what is in and what is out is what makes every other Medicare decision easier.

Original Medicare is the foundation of a house. Strong, well-defined, federally regulated. The rooms not on the blueprint — dental, vision, hearing, long-term care, prescriptions — are additions you build separately.

The short answer

Original Medicare is Parts A and B together. Part A is hospital insurance: inpatient hospital stays, skilled nursing facility care after a qualifying hospital stay, hospice care, and limited home health care. Part B is medical insurance: doctor visits, outpatient care, preventive services, lab tests, durable medical equipment, ambulance services, and most outpatient mental health care. Together they cover most medically necessary services that licensed providers deliver in standard healthcare settings. They do not cover routine dental, vision, hearing aids, long-term custodial care, or most overseas care. Prescription drug coverage requires a separate Part D plan. The covered list is broad; the excluded list is specific and worth knowing before you assume.

What Part A covers

Part A is the inpatient side of Medicare. It pays for:

• Inpatient hospital care. Semi-private room, meals, general nursing, drugs administered during the stay, and other services Medicare considers medically necessary while you are formally admitted as an inpatient.
• Skilled nursing facility care. Up to 100 days per benefit period when you need short-term skilled care after a qualifying inpatient hospital stay of at least three days. The first 20 days have no copay; days 21–100 have a daily coinsurance.
• Hospice care. End-of-life care at home or in a facility for people with a terminal illness who meet eligibility criteria.
• Limited home health care. Skilled care delivered at home — for example, intermittent skilled nursing or physical therapy after a hospital stay.

Part A has a deductible per benefit period ($1,736 for 2026), and daily coinsurance amounts apply after specific day thresholds in a hospital or skilled nursing stay.

Most people do not pay a monthly Part A premium because they (or a spouse) paid Medicare taxes during their working years. People without enough quarters of Medicare-covered employment can buy into Part A.

What Part B covers

Part B is the outpatient and medical side. It pays for:

• Doctor visits and specialist consultations. Primary care, specialists, second opinions, and most office-based encounters that Medicare considers medically necessary.
• Outpatient hospital services. Emergency room visits (without admission), outpatient surgery, observation status, outpatient imaging, and outpatient procedures.
• Preventive services. Annual wellness visit, screenings (cancer, cardiovascular, diabetes, depression, alcohol misuse), vaccines (flu, pneumococcal, COVID-19, hepatitis B, RSV for eligible groups), counseling for tobacco use, and more. Many preventive services are covered at no cost share when delivered by a participating provider.
• Laboratory tests. Blood tests, urinalysis, screening labs, diagnostic labs when medically necessary.
• Durable medical equipment (DME). Wheelchairs, walkers, hospital beds, oxygen equipment, CPAP machines, and certain other devices when prescribed for use at home.
• Outpatient mental health care. Therapy, psychiatric evaluations, and counseling with Medicare-participating mental health professionals.
• Outpatient physical, occupational, and speech therapy.
• Ambulance services. When other transportation would endanger health.
• Some home health. Coordinated with Part A coverage where applicable.
• Limited outpatient prescription drugs. Specifically, certain injected or infused drugs administered in an outpatient setting (oncology infusions, certain biologics, certain insulins used with traditional pumps). Most retail prescription drugs are not Part B — they are Part D.

Part B has an annual deductible ($283 for 2026). After the deductible, you pay 20% of Medicare-approved charges for most services, with no annual out-of-pocket maximum on Original Medicare by itself.

What Original Medicare does not cover

Some categories of care are routinely excluded from Original Medicare (Medicare.gov — What’s not covered):

• Routine dental care. Cleanings, fillings, extractions, dentures, and most dental procedures. (Some dental work directly related to a covered medical procedure may be paid under specific circumstances; most routine dental is not.)
• Routine vision care. Eye exams for glasses, glasses themselves, contact lenses. (Cataract surgery and certain medically necessary eye services are covered.)
• Hearing aids and routine hearing exams. (Some diagnostic hearing services are covered when ordered by a physician for medical reasons.)
• Long-term custodial care. Help with bathing, dressing, eating, and other activities of daily living when that is the primary need, whether at home, in assisted living, or in a nursing facility. Medicare covers short-term skilled care, not custodial care.
• Most overseas care. Original Medicare generally does not pay for healthcare received outside the United States, with narrow exceptions. Travelers usually rely on travel-medical insurance or, for some, Medigap policies that include limited foreign travel emergency coverage.
• Cosmetic procedures.
• Acupuncture in most situations. (Acupuncture for chronic low back pain is covered with limits.)
• Routine foot care. (Diabetic foot care and certain medical podiatry services are covered.)
• Concierge or “membership” practice fees. The fee charged by a concierge practice for non-covered services is not reimbursable.

What this means for the comparison

When people compare Original Medicare against Medicare Advantage, the Medicare Advantage “extras” — dental, vision, hearing, fitness, OTC — show up because those services are not in Original Medicare. The honest comparison is not “this plan has more benefits than Medicare.” Every Medicare Advantage plan must, at minimum, cover everything Original Medicare covers. The extras are added on top.

The trade-off is structural. Original Medicare delivers Part A and Part B benefits with broad provider access and minimal year-to-year change, and leaves dental/vision/hearing out. Medicare Advantage delivers Part A and Part B benefits inside a network with plan-specific rules, and adds extras of varying scope. Both paths leave long-term custodial care out — that requires separate planning regardless of which path you take.

How this applies to you

If you are choosing your first Medicare coverage. Know what is and is not in Part A and Part B before any plan-specific conversation. The plan-specific extras (or lack thereof) are layered on top of this foundation; the foundation is what the layer rests on.

If you have specific care concerns. Routine dental, vision, hearing, and long-term care planning are concerns on both paths — they are excluded by Original Medicare, partially covered with limits on most MA plans, and a separate financial-planning conversation either way.

If you travel internationally. Original Medicare’s overseas exclusion is real. Medigap Plan G and Plan N policies include limited foreign travel emergency coverage. Most travelers add a separate travel medical insurance policy for trips abroad regardless of which Medicare path they are on.

If you are helping a parent plan for the future. Long-term care needs (custodial care, memory care, extended assisted living) are not paid by Medicare on either path. Medicaid in some states covers long-term custodial care for those who qualify financially; long-term care insurance is a separate market; family resources cover the rest. This is the conversation that often surprises families later.

What this is not

It is not a complete list of every covered or excluded item. Medicare’s coverage rules run to thousands of pages. The article above captures the major categories and the most common surprises. Specific situations — covered diagnoses, billing codes, medical necessity decisions, and similar — depend on the service and the provider.

It is not legal, tax, or financial advice. Long-term care planning, in particular, deserves the help of a financial planner or elder-care attorney.

It is not a substitute for the Medicare & You handbook, which is the most complete consumer overview Medicare publishes (Medicare & You 2026).

Foundation first. The additions come after — and knowing which are on the blueprint matters.

• The Two Medicare Paths and What Each One Asks of You
• What Medigap Does, and Why the Timing Matters
• Original Medicare Is Not a Network — companion piece on provider access
• How to Compare Coverage Choices Without Getting Pulled Off Track