Which services are not covered under Medicare Part A?
Medicare Part A does not cover outpatient care, most prescription drugs, routine dental, vision, hearing care, or long-term custodial care.
Everyday Items and Comforts
- Private rooms: A private hospital room is not covered unless your doctor says it is medically necessary.
- Personal items: Razors, slipper socks, and television or phone rentals in a hospital room are not covered.
- Private-duty nurses: Extra nursing care just for you is not covered.
Long-Term and At-Home Care
- Custodial care: Help with daily life like bathing, dressing, or eating is not covered if it is the only care you need.
- Long-term nursing homes: Staying in a nursing home for basic, ongoing care (non-skilled care) is not covered.
- At-home extras: 24-hour home care, grocery delivery, and cleaning services are not covered by Part A.
Medical and Outpatient Services
- Outpatient care: Doctor office visits, tests, and outpatient surgeries belong under Medicare Part B, not Part A.
- Prescription drugs: Outpatient medications you take at home are not covered by Part A (you need Part D for this).
- Routine extras: Most dental work, routine eye exams for glasses, hearing aids, and routine foot care are excluded.
You can check more details directly through the Official Medicare Coverage Tool.
What does Medicare Part A pay 100% for?
Medicare Part A pays 100% of approved costs for specific services, but only after you pay the Part A deductible ($1,736 per benefit period in 2026), and for specific durations or types of care.
Services Covered 100% (After Deductible or Specific Conditions)
- Inpatient Hospital Care: Days 1 through 60 of a hospital stay are covered 100% by Medicare once you meet the $1,736 inpatient deductible.
- Skilled Nursing Facility (SNF) Care: Days 1 through 20 of a qualifying SNF stay are covered 100%. (Note: You do not need to pay a separate hospital deductible for this if it follows a qualifying 3-day inpatient hospital stay).
- Home Health Care: Eligible part-time or intermittent skilled home health care services are covered 100% with a $0 copay (though you may owe 20% for durable medical equipment like wheelchairs).
- Hospice Care: Certified hospice care for terminal illness is covered 100%, though you may pay a small copay (up to $5) for prescription drugs and 5% coinsurance for inpatient respite care.
What is NOT Covered 100%
- Extended Stays: After day 60 in a hospital or day 20 in a skilled nursing facility, you must pay daily coinsurance amounts ($434/day for hospital days 61–90; $217/day for SNF days 21–100).
- Outpatient Care: Doctor visits, tests, and outpatient surgeries are covered under Medicare Part B, not Part A.
What is not true regarding Medicare Part A?
Medicare Part A does not cover outpatient care or outpatient hospital charges, which fall under Medicare Part B.
What Medicare Part A Actually Covers
- Inpatient hospital care: Stays in a hospital.
- Skilled nursing facility care: Limited care after a qualifying hospital stay.
- Hospice care: Care for terminally ill individuals.
- Home health care: Part-time or intermittent skilled nursing and home health aide services.
Key Facts About Medicare Part A
- Cost: It is premium-free for most people who worked and paid Medicare taxes for at least 10 years.
- Role: It acts as hospital insurance, whereas Part B covers medical insurance, doctor visits, and outpatient services.
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.
What services fall under Medicare Part A?
Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.
You can learn more details directly from the official Medicare Part A Coverage Guide.
Main Services Covered
- Inpatient Hospital Care: Covers semi-private rooms, meals, general nursing, and drugs or supplies used during a formal overnight stay in a hospital. It does not cover observation stays or emergency room visits unless you are officially admitted.
- Skilled Nursing Facility (SNF) Care: Covers care in a certified facility after a qualifying 3-night hospital stay, including physical therapy, bed, and meals for a limited time.
- Hospice Care: Covers symptom management, pain relief drugs, medical equipment, and support services for terminally ill individuals.
- Home Health Services: Covers part-time, intermittent skilled nursing care or therapy if you are homebound and need medical treatment.
What is Not Covered
- Outpatient care: Doctor visits outside of a hospital admission fall under Medicare Part B.
- Long-term custodial care: Extended help with daily personal tasks (like bathing or dressing) when you do not need skilled medical care.
Medicare Part A B C D Explained (and made simple!)
9 related questions found
What is excluded from Medicare Part A?
Medicare Part A does not cover outpatient care, long-term custodial nursing home care, or personal comfort items like private TVs and telephones during a hospital stay.
🏡 Long-Term & Custodial Care
- Custodial care: Help with daily living activities (bathing, dressing, eating) when it is the only care needed.
- Long-term nursing home stays: Residential care for chronic conditions or permanent placement.
- (Note: Part A covers short-term skilled nursing care up to 100 days only after a qualifying 3-day inpatient hospital stay).
🏥 Hospital Conveniences & Outpatient Services
- Private rooms: Unless medically necessary and ordered by a doctor.
- Personal items: Razors, socks, or similar convenience items.
- Convenience electronics: Personal phones or televisions in your hospital room.
- Outpatient care: Standard doctor visits, diagnostic tests, or surgeries where you are not formally admitted as an inpatient (covered under Part B instead).
🦷 Routine & Other Exclusions
- Routine dental, vision, and hearing: Dental cleanings, dentures, eye exams for glasses, and hearing aids.
- Outpatient prescription drugs: Drugs you take at home (covered under Part D or Part B).
- Non-emergency care abroad: Medical care received outside the United States.
Is it better to have Medicare A and B or Medicare Advantage?
Neither option is universally "better"; Original Medicare (Parts A and B) and Medicare Advantage (Part C) serve different needs depending on your budget, health, and preference for doctors. You can review your official choices on the Medicare Coverage Options Page.
Original Medicare (Parts A & B)
- How it works: Run directly by the federal government. Covers hospital care (Part A) and doctor visits (Part B).
- Doctor choice: Go to any doctor or hospital in the U.S. that accepts Medicare without needing referrals.
- Costs: No yearly limit on out-of-pocket costs unless you buy a separate Medigap (supplement) policy. You also need separate Part D for prescription drugs.
- Best for: People who travel often within the U.S., want absolute freedom in choosing specialists, or prefer predictable coinsurance paired with a Medigap plan.
Medicare Advantage (Part C)
- How it works: Offered by private insurance companies approved by Medicare. Combines Part A, Part B, and usually Part D (prescription drugs) into one plan.
- Extra benefits: Often includes routine dental, vision, hearing, and gym memberships.
- Costs: Features a mandatory yearly out-of-pocket maximum limit, but you must use specific provider networks (HMO or PPO) and may need prior approval for treatments.
- Best for: People who want lower upfront or bundled monthly costs, desire extra perks like dental/vision, and stay within a local hospital or doctor network.
Who doesn't have to pay for Medicare Part A?
You do not have to pay a monthly premium for Medicare Part A if you or your spouse worked and paid Medicare taxes for at least 10 years (or 40 quarters of work).
Who Qualifies for Premium-Free Part A?
- Workers: Individuals age 65 or older who worked and paid FICA Medicare taxes for at least 40 quarters.
- Spouses: A current, former, or deceased spouse who meets the 10-year (40-quarter) work and tax requirement.
- Government Employees: State, federal, or local government employees who paid Medicare payroll taxes for the required 10-year period.
- Individuals with Disabilities: People under age 65 who receive Social Security or Railroad Retirement Board (RRB) disability benefits for 24 months, or those diagnosed with ALS (Lou Gehrig's disease), qualify automatically without a waiting period.
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 are the five things that Medicare will not cover in 2026?
Original Medicare (Parts A and B) does not cover routine dental care, routine vision care, hearing aids, long-term custodial care, and health care received overseas.
Major Uncovered Services in 2026
- Most dental care: Original Medicare does not pay for routine cleanings, checkups, fillings, tooth extractions, root canals, or dentures.
- Routine vision care: Regular eye exams, eyeglasses, and contact lenses are excluded, though treatments for medical eye conditions like cataracts or glaucoma are covered.
- Hearing aids: Original Medicare does not cover hearing aids or routine exams used to fit them.
- Long-term care: Extended nursing home care or custodial care (help with daily personal activities like bathing or dressing) is not covered outside of limited short-term skilled nursing rehabilitation.
- Overseas coverage: Medical care received outside of the United States and its territories is generally excluded, with rare exceptions like emergencies on cruise ships close to a U.S. port.