What services are covered by Original Medicare?

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Original Medicare includes Part A (Hospital Insurance) and Part B (Medical Insurance), which together cover most medically necessary health care services in hospitals, doctors' offices, and other approved facilities.

Medicare Part A (Hospital Insurance)

Part A helps cover inpatient care and short-term recovery services:

  • Inpatient hospital care: Semi-private rooms, meals, general nursing, and drugs/supplies used during a hospital stay (limited to 190 total days in a lifetime for freestanding psychiatric hospitals).
  • Skilled nursing facility (SNF) care: Short-term care following a qualifying 3-night inpatient hospital stay.
  • Hospice care: Comfort care for terminally ill patients with a life expectancy of 6 months or less.
  • Home health care: Part-time or intermittent skilled nursing and therapy services if you are homebound.

Medicare Part B (Medical Insurance)

Part B helps cover outpatient care, physician services, and preventive health:

  • Doctor and clinician services: Visits to primary care physicians, specialists, and surgeon fees for medically necessary procedures.
  • Outpatient hospital care: Treatments, diagnostic tests, and emergency room visits.
  • Preventive services: Annual wellness visits, flu shots, cancer screenings, and cardiovascular screenings.
  • Durable medical equipment (DME): Wheelchairs, walkers, hospital beds, and oxygen equipment.
  • Mental health services: Outpatient counseling and therapy.
  • Ambulance services: Emergency transportation when other transport is dangerous to your health.
  • Limited prescription drugs: Drugs usually administered by a doctor (such as certain injections, infusions, or insulin used with an external pump).

What Original Medicare Does Not Cover

Original Medicare does not cover many routine or long-term services, including:

  • Most prescription drugs (requires a separate Part D plan)
  • Routine dental care, cleanings, fillings, and dentures (with rare exceptions for specific medical treatments)
  • Routine eye exams, eyeglasses, and contact lenses (except post-cataract surgery)
  • Routine hearing exams and hearing aids
  • Long-term care / Custodial care (help with daily activities like bathing, dressing, or eating over an extended period)
  • Routine physical exams
  • Care received outside the United States (with rare exceptions)
  • Cosmetic surgery

You can review official guidelines or check specific treatments via the Medicare Provider Services Portal.

What is the downside of original Medicare?

Original Medicare lacks an annual limit on out-of-pocket spending, does not include prescription drug coverage, and requires separate supplemental insurance to cover coinsurance costs.

Key Drawbacks of Original Medicare

  • No Out-of-Pocket Maximum: Original Medicare (Parts A and B) does not cap your yearly spending. If you have a serious illness or need expensive medical care, you must pay 20% coinsurance for Part B services indefinitely.
  • No Prescription Drug Coverage: Original Medicare does not pay for outpatient prescription drugs. You must buy a separate, private stand-alone Part D plan to get pharmacy coverage.
  • No Routine Dental, Vision, or Hearing: The standard federal program does not cover routine dental care, eye exams, eyeglasses, or hearing aids.
  • Extra Costs for Supplemental Plans: To protect against high medical bills, most people must buy extra private insurance, known as Medigap, along with a drug plan. This means paying multiple separate monthly premiums.

You can review a full breakdown of these differences on the Official Medicare Comparison Tool.

What are the 6 things that original Medicare won't cover?

Original Medicare (Parts A and B) does not cover routine dental care, routine vision care, hearing aids, long-term custodial care, most outpatient prescription drugs, and medical care received outside the United States.

Uncovered Services and Items

  • Most dental care: Routine cleanings, fillings, tooth extractions, root canals, and dentures are excluded.
  • Routine vision care: Standard eye exams for prescribing glasses, eyeglasses, and contact lenses are not covered (though certain medical conditions like cataracts or glaucoma are).
  • Hearing aids: Routine hearing exams, fittings, and hearing aids are entirely out-of-pocket under Original Medicare.
  • Long-term care: Extended custodial care (help with daily personal activities like bathing or dressing in a nursing home or at home) is not covered.
  • Outpatient prescription drugs: Everyday medications you take at home require a separate Medicare Part D plan.
  • Care outside the U.S.: Medical treatment or emergencies while traveling abroad are generally not covered.

What free stuff can I get with Medicare?

Medicare covers many preventive services, screenings, and wellness visits at no out-of-pocket cost.

Preventive Visits

  • Welcome to Medicare Checkup: A one-time general review of your health and medical history during your first 12 months on Part B.
  • Annual Wellness Visit: A yearly meeting with your doctor to update your personalized prevention plan and check your vital signs and cognitive health.

Vaccines and Shots

  • Seasonal and Routine Immunizations: You pay $0 for key vaccines under Part B and Part D, including the COVID-19 Vaccine, flu shots, pneumonia shots, Hepatitis B shots, and the shingles vaccine.

Health Screenings

  • Cancer Screenings: Free annual mammograms (for women 40+), yearly prostate cancer screenings (for men 50+), and scheduled colonoscopies or blood-based biomarker tests.
  • Chronic Disease Tests: Annual screenings for cardiovascular heart disease, diabetes (if you are at risk), and glaucoma.
  • Infections and Mental Health: Free annual screenings for depression, HIV, and Hepatitis B or C.

Counseling and Therapy

  • Behavioral Counseling: Zero-cost face-to-face sessions for alcohol misuse screening, tobacco/smoking cessation, and obesity behavioral therapy.
  • Nutrition and Diabetes Education: Free medical nutrition therapy for individuals with diabetes or kidney disease, alongside diabetes self-management training.

Medicare Advantage Extras

  • Over-the-Counter (OTC) Allowances: Many private Medicare Advantage plans include a monthly or quarterly allowance card to buy everyday drugstore items like vitamins, toothpaste, and pain relievers.
  • Fitness Programs: Some plans and supplemental Medigap policies include free gym memberships and workout classes through programs like SilverSneakers.

Which of the following services are not covered by original Medicare?

Since you did not provide a specific list of options to choose from, here are the most common medical services and items not covered by Original Medicare (Part A and Part B):

  • ❌ Most dental care: Routine cleanings, fillings, extractions, root canals, and dentures.
  • ❌ Routine vision care: Eye exams for glasses or contact lenses, and the cost of eyeglasses or contacts themselves (except following cataract surgery).
  • ❌ Hearing care: Routine hearing tests, hearing aids, and exams for fitting hearing aids.
  • ❌ Outpatient prescription drugs: Most everyday medications are not covered under Part A or Part B and require a standalone Part D plan.
  • ❌ Long-term care: Custodial or nursing home care for assistance with daily living (like bathing or dressing).
  • ❌ Alternative medicine: Massage therapy, naturopathy, and most chiropractic services (Medicare only covers manual manipulation of the spine to correct a subluxation).
  • ❌ Routine physical exams: While Medicare covers an "Annual Wellness Visit" to create a prevention plan, it does not cover a traditional, comprehensive annual physical.
  • ❌ Medical care outside the United States: Except in very rare, specific emergency situations near land borders.
  • ❌ Cosmetic surgery: Any elective procedures that are not medically necessary.
  • ❌ Routine foot care: Standard podiatry such as nail-cutting or callus removal (unless related to a medical condition like diabetic nerve damage).

If you are answering a specific multiple-choice question, please reply with the choices provided, and I will gladly identify the correct option for you!

Original Medicare vs. Medicare Advantage: What's the Difference?

9 related questions found

Which is better to have original Medicare or Medicare Advantage?

Neither option is universally "better"; Original Medicare offers total freedom of choice, while Medicare Advantage provides lower initial costs and extra bundled perks.

You can learn more about how they compare directly through the official Medicare Guide or read an overview on NerdWallet.

Original Medicare (Parts A & B)

  • Provider Choice: See any doctor or hospital in the U.S. that accepts Medicare. You do not need referrals for specialists.
  • Approvals: No prior authorization is required for tests or treatments.
  • Costs: There is no yearly limit on your out-of-pocket spending unless you buy a separate Medigap (supplement) policy.
  • Extras: Does not include prescription drugs (Part D), routine dental, vision, or hearing care. You must buy separate plans for drugs.

Medicare Advantage (Part C)

  • Provider Choice: Restricted to local network providers like HMOs or PPOs. Seeing out-of-network doctors may cost more or require approval.
  • Approvals: Often requires prior authorization from the private insurer before getting care.
  • Costs: Includes a yearly out-of-pocket maximum (capped at $9,250 for in-network care in 2026). Monthly premiums can be very low.
  • Extras: Usually bundles prescription drug coverage (Part D) and adds extra benefits like dental, vision, hearing, and gym memberships.

Which one should you pick?

  • Choose Original Medicare if: You travel often, want to see any specialist without a referral, and can afford a Medigap plan to cover the out-of-pocket gaps.
  • Choose Medicare Advantage if: You want lower monthly premiums, need bundled prescription coverage, and want extra perks like dental or vision within a local network. For neutral guidance, you can also check out resources from the National Council on Aging.

What is the big mistake people make with Medicare?

The single biggest and most costly mistake people make with Medicare is missing enrollment deadlines, leading to permanent late-enrollment penalties and gaps in coverage.

Missing Enrollment Deadlines

  • Initial Enrollment Period (IEP): This window lasts for seven months. It starts three months before the month you turn 65, includes your birthday month, and ends three months after.
  • Late Penalties: Failing to sign up for Part B or Part D on time can trigger permanent monthly or yearly financial penalties added to your premiums.
  • Delayed Enrollment Confusion: Many people wrongly assume they can delay Medicare past age 65 just because they have health coverage like COBRA, a marketplace plan, or small-employer insurance.

Other Costly Medicare Mistakes

  • Ignoring Annual Changes: Sticking with automatic renewal without reading the Annual Notice of Change (ANOC) can result in unexpected costs, as drug lists and doctor networks shift every year.
  • Choosing Solely by Low Premiums: Picking a plan based only on a low monthly cost while ignoring total out-of-pocket expenses like deductibles, copays, and coinsurance.
  • Missing the Medigap Window: Forgetting to apply for a Medigap (Medicare Supplement) policy during your open enrollment window. After this six-month period, insurers can use medical underwriting to charge more or deny coverage.
  • Skipping Financial Assistance: Overlooking programs like Medicare Savings Programs or Part D Extra Help that assist with out-of-pocket medical and prescription expenses.

What bloodwork is not covered by Medicare?

Medicare does not cover bloodwork that lacks a documented medical necessity, such as routine wellness panels ordered during a standard annual physical exam.

Uncovered Blood Tests

  • Routine Wellness Panels: Comprehensive blood checks done out of general curiosity or routine monitoring without specific symptoms, risk factors, or a concrete diagnosis.
  • Self-Requested Tests: Direct-to-consumer lab orders, walk-in requests, or mail-order kits purchased without a doctor's formal prescription.
  • Employment or Licensing Tests: Screenings required by an employer, for insurance applications, or for legal/administrative certifications.
  • Experimental Markers: Investigational or alternative functional medicine blood tests not yet recognized by Medicare as safe and effective.
  • Over-Frequent Testing: Repeat bloodwork ordered more often than Medicare's established frequency limits allow for a specific condition.

Does Medicare pay 100% of your medical bills?

Original Medicare does not pay 100% of your medical bills.

Out-of-Pocket Costs

  • Deductibles: You must pay a yearly amount out-of-pocket before Medicare starts paying.
  • Coinsurance: For most doctor and outpatient services under Part B, Medicare pays 80% and you pay 20% of the approved amount.
  • Copayments: You may pay fixed amounts for certain services or prescription drugs (under Part D).
  • No Maximum Limit: Original Medicare has no yearly limit on out-of-pocket costs.

What is Not Covered

  • Prescription drugs: Original Medicare (Parts A and B) does not cover everyday retail medications.
  • Routine care: It excludes routine dental care, eyeglasses, hearing aids, and long-term (custodial) care.

How to Get More Coverage

  • Medigap: You can buy a private Medicare Supplement Insurance policy to help pay remaining costs like coinsurance and deductibles.
  • Medicare Advantage: You can join a private Part C plan that includes a yearly limit on your out-of-pocket spending. You can review official plan options directly through the Medicare Plan Finder tool.

Why are routine physicals not covered by Medicare?

Original Medicare does not cover routine annual physical exams because federal law and the original Social Security Act exclude routine physicals and restrict coverage to medically necessary care and specific preventive services.

Why Medicare Excludes Routine Physicals

  • Statutory Limits: Federal law dictates that Medicare pay for diagnosis and treatment of illness or injury, or specific authorized preventive services, rather than routine checkups.
  • Focus on Problem-Based Care: Historically, Medicare was built to cover problem-based medical visits and treatments rather than general physical maintenance.
  • Shift to Wellness Visits: Instead of a traditional hands-on physical, Medicare offers alternative preventive options.

What Medicare Covers Instead

  • Welcome to Medicare Visit: An Initial Preventive Physical Examination (IPPE) covered once during your first 12 months on Part B, which records your medical history and establishes vital baselines.
  • Annual Wellness Visits (AWV): Covered yearly after your first year on Part B, focusing on a health risk assessment, medical history review, and a personalized prevention plan.
  • Important Distinction: Neither the Welcome to Medicare visit nor the Annual Wellness Visit includes a traditional hands-on, head-to-toe physical exam or routine lab tests like blood work, unless they are ordered separately as medically necessary.