What Original Medicare Does and Does Not Cover
When you enroll in Medicare, you have three basic options. You can sign up for:
- Original Medicare, which includes Part A and Part B (you would have to enroll in a Part D plan separately)
- A Medicare Advantage (Part C) plan, which includes Part A and Part B, and usually Part D
- Original Medicare plus a Medicare Supplement plan (you would have to enroll in a Part D plan separately)
Medicare Advantage and Medicare Supplement plans offer additional coverage not included under Original Medicare. But understanding whether Original Medicare alone is enough for you starts with understanding what it does and does not cover.
Does Original Medicare provide enough coverage for your needs?
Below is a chart of items and services that Medicare does and does not cover. (You can use the Medicare coverage search on Medicare.gov to check for additional items and services not listed here.)
What does Original Medicare (Part A and Part B) cover? | |
Item or service: | Covered under: |
Inpatient care in a hospital | Part A |
Skilled nursing facility care (on a short-term basis only) | Part A |
Hospice care | Part A |
Home health care | Part A and Part B Note: This is limited to part-time or intermittent skilled services for homebound individuals |
Doctor office visits (primary care and specialists) | Part B |
Test and laboratory services | Part B |
Ambulance and emergency services | Part B |
Outpatient care | Part B |
Durable medical equipment (wheelchairs, walkers, hospital beds, and more) | Part B |
Preventive services (screenings, certain shots or vaccines, yearly “Wellness” visits) | Part B |
Mental health services | Part B |
Routine physical exams | Not covered |
Part D prescription drugs (including many recommended shots or vaccines) | Not covered Note: Part B covers a limited number of outpatient prescription drugs (usually, drugs you wouldn’t typically administer yourself) |
Most dental care | Not covered |
Dentures | Not covered |
Eye exams and prescription eyeglasses | Not covered |
Hearing aids and hearing aid fitting exams | Not covered |
Long-term care | Not covered |
Custodial care (help with bathing, dressing, using the bathroom, and eating) at home or in a nursing home | Not covered |
Nursing home care | Not covered Note: Most nursing home care is custodial care, which Original Medicare does not cover if it's the only care you need. |
Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care) | Not covered |
Cosmetic surgery | Not covered |
Massage therapy | Not covered |
Covered items or services you get from providers who do not accept Medicare (known as “opt-out providers”), except in the case of an emergency or urgent need | Not covered |
Gym memberships or fitness classes | Not covered |
Weight management programs | Not covered |
Medicare Advantage Plans Cover More
Many people find that Original Medicare does not offer enough coverage and choose to enroll in a Medicare Advantage plan. Medicare Advantage plans cover everything Original Medicare covers, plus more.
For example, Tufts Health Plan offers plans with vision, dental, and hearing aid coverage. Plus, plans are available with Part D prescription drug coverage included.
Other benefits of a Medicare Advantage plan include:
- Lower or $0 deductibles
- Limits on out-of-pocket spending (Medicare has no limit)
- Lower monthly premiums than Medicare Supplement plans
Need help choosing the best plan for your situation? This interview with one of our local Medicare Experts walks you through your three basic options.