Most people who have Medicare, or who are helping a parent navigate it, do not fully know what it covers. That is not surprising. Medicare is genuinely complicated: multiple parts, different rules for different services, costs that vary by plan, and a stack of benefits that nobody tells you about unless you ask.
This guide breaks it down in plain language. Whether you are on Medicare yourself or you are helping someone you love figure out their coverage, here is what you need to know, including a few benefits that are almost always overlooked.
What Are the Four Parts of Medicare? Here Is What Each One Does
Medicare Part A is hospital insurance. It covers inpatient hospital stays, skilled nursing facility care after a hospital stay, hospice care, and some home health care. Most people do not pay a monthly premium for Part A if they or their spouse worked and paid Medicare taxes for at least ten years.
Medicare Part B is medical insurance. It covers doctor visits, outpatient care, preventive services, durable medical equipment, some home health services, and many telehealth visits. Part B has a monthly premium, and higher earners pay more.
Medicare Part C is Medicare Advantage. Instead of Original Medicare, you enroll in a private insurance plan that provides at least the same coverage, often with additional benefits like dental, vision, and hearing. The trade-off is that you are typically limited to a network of providers.
Medicare Part D covers prescription drugs. It is either a separate plan added to Original Medicare or included in a Medicare Advantage plan. Coverage and cost vary significantly by plan and by which medications you take.
What Does Medicare Part A Cover?
Medicare Part A covers hospital stays, but not without cost-sharing. In 2026, the deductible for each benefit period is $1,736. For stays longer than 60 days, daily coinsurance applies. After 90 days, you draw on lifetime reserve days, and you only get 60 of those total.
Skilled nursing facility care is covered after a qualifying hospital stay of at least three days. Medicare covers the full cost for the first 20 days, then a daily coinsurance for days 21 through 100. After 100 days, Medicare pays nothing. This is the most commonly misunderstood gap. Many patients and families assume Medicare covers long-term nursing home care. It does not. It covers short-term skilled rehabilitation. Long-term custodial care is not covered by Medicare at all.
Home health care is covered if a person is homebound and their doctor certifies a need for skilled nursing or therapy services. The care must be provided by a Medicare-certified agency and costs nothing under Part A or Part B.
Hospice care is fully covered for people with a terminal prognosis of six months or less. It is one of the most comprehensive benefits Medicare offers and one of the most underused.
What Does Medicare Part B Cover?
Medicare Part B covers doctor visits, specialist appointments, outpatient surgery, lab tests, imaging, mental health services, telehealth visits, and medically necessary equipment like wheelchairs, walkers, and CPAP machines.
Preventive services covered at no cost include annual wellness visits, flu and pneumonia vaccines, cardiovascular screenings, diabetes screenings, bone density scans, colorectal and lung cancer screenings, mammograms, cervical cancer screenings, and depression screenings.
Part B has a monthly premium. The standard amount in 2026 is $202.90, though higher earners pay more through an income-related surcharge. Once you meet your annual deductible, Part B pays 80 percent of most outpatient costs. The remaining 20 percent is yours to cover unless you have a supplemental plan.
What Does Medicare Part C Cover?
Medicare Part C, or Medicare Advantage, works differently than Parts A and B. Instead of billing Medicare directly, you choose a plan from a private insurer approved by Medicare. That plan has to cover everything Original Medicare covers. Most plans go further and add extras: dental cleanings, eyeglasses, hearing aids, gym memberships, and sometimes even meal delivery after a hospital stay.
The premium is often low. Many plans charge $0 a month beyond what you already pay for Part B. But low premiums come with a catch. Most Advantage plans use a network, similar to an HMO or PPO. See a doctor outside that network and you could pay full price, or the plan may not cover the visit at all.
There is also a real tradeoff around specialists and referrals. Some plans require a referral from your primary doctor before you can see a specialist. Original Medicare does not work that way. If you travel often, split time between two states, or want the freedom to see any doctor who accepts Medicare, that flexibility matters more than a plan with dental coverage.
What Does Medicare Part D Cover?
Medicare Part D pays for prescription drugs, and it is where a lot of people get caught off guard. Every plan has its own list of covered drugs, called a formulary, and formularies change every year. A drug that was covered in January can move to a different pricing tier by the following January.
Plans are sold by private insurers, and premiums vary widely. In 2026, the average premium is $34.50 a month, but that number means very little for any one person, since your actual cost depends on your plan, your drugs, and your income. Higher earners pay an additional surcharge on top of the base premium.
Most plans also have a deductible you pay before coverage kicks in, followed by a period where you and the plan split the cost, followed by a stage where your out-of-pocket costs drop sharply. This structure changed under recent law, and out-of-pocket drug costs are now capped each year, which was not always true. If you take an expensive medication, checking that cap matters more than checking the premium.
What Does Medicare Not Cover?
Across all four parts, some gaps show up again and again, and they catch people off guard because nobody explains them up front.
Medicare Part A does not cover long-term custodial care. Medicare covers short-term rehab in a skilled nursing facility after a qualifying hospital stay. It does not cover a permanent nursing home stay, and it does not cover help with daily activities like bathing or dressing if that is the only care someone needs. Families often find this out after a parent has already moved into a facility, when it is too late to plan around it.
Medicare Part B does not cover routine dental, vision, or hearing care. No cleanings, no eye exams for glasses, no hearing aids, and no routine foot care. Part B also excludes most cosmetic procedures, with the exception of reconstructive surgery after an accident or mastectomy, and most alternative medicine, including acupuncture for anything other than lower back pain. Care received outside the United States is not covered either, except in a narrow set of emergency situations.
Medicare Part C coverage depends on the plan, but the floor is set by Original Medicare. Every Medicare Advantage plan has to cover at least what Parts A and B cover, so the same core gaps apply unless a specific plan chooses to add a benefit back in. Many plans do add dental, vision, and hearing coverage, which is one of the main reasons people choose Part C over Original Medicare. But not every plan adds every benefit, and some plans that add coverage limit it to a small annual allowance, so it is worth checking exactly what is included before assuming a gap has been closed.
Medicare Part D still excludes most weight loss drugs used only for weight loss, along with fertility treatments, cosmetic drugs, and most over-the-counter medications. If your plan does not cover a medication you take, you pay full price for it unless you switch plans or your doctor requests an exception. One exception worth knowing: starting July 2026, a temporary program called the Medicare GLP-1 Bridge began covering certain GLP-1 drugs for weight loss at a $50 monthly copay for eligible members, separate from regular Part D rules. The program runs through the end of 2027, so this is worth checking directly if you or someone you are helping takes one of these medications.
None of these gaps mean Medicare is a bad program. It means the coverage has real edges, and knowing where those edges sit before you need care saves you from finding out the hard way.
How POD Health Can Help Medicare Patients Understand Their Coverage
Reading through the parts and gaps above is one thing. Figuring out what actually applies to your situation is another. Most people do not need a full breakdown of Medicare rules. They need to know whether a specific service is covered, what it will cost them, and who to call when something does not add up.
That is where a care coordinator matters more than a pamphlet. POD Health connects Medicare members with a dedicated coordinator who can check your specific coverage, explain what a service will actually cost before you commit to it, and help you avoid the gaps most people only discover after the fact. Many of these services, including telehealth visits, remote patient monitoring, chronic care management, diabetes management, nutrition counseling, podiatry, and behavioral health support, can be covered by Medicare depending on your specific plan and eligibility. The POD Health team can walk through what applies to your situation directly.
POD Health serves Medicare members across all five boroughs of New York City, including Staten Island, Brooklyn, Queens, the Bronx, and Manhattan, as well as Westchester County, Florida, and Colorado. Checking your eligibility costs nothing and takes a few minutes. Contact us, and we will tell you exactly what is covered and what is not.
