Review cost and coverage

When reviewing Medicare options, two questions are "What’s covered?" and "How much will it cost?"

Let’s start with what’s covered. Medicare comes in four parts, each with a different role.

Reliance Medicare Helpline offers plans from Aetna, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Cigna, Devoted, Freedom Health, Healthy Blue, Humana, Optimum HealthCare, Simply, United Healthcare, Wellcare, and WellPoint.

Government Sponsored Medicare Program

Also known as Original Medicare, Parts A and B come standard for most who turn 65 years old or qualify due to an eligible disability. They cover most medically necessary services and supplies in hospitals, doctors’ offices, and other healthcare facilities.

Private Insurance Plans

Once you’re enrolled in Original Medicare, you can choose to switch to a Part C Medicare Advantage plan with a private insurance company. You can also purchase Part D coverage separately. These types of plans are designed to offer additional benefits not included in Original Medicare.

Part A Inpatient and hospital coverage

Medicare Part A helps cover hospital costs such as room and board, and other inpatient services. It also helps with a limited stay in a skilled nursing facility and covers hospice care and home-health care.

Ambulance services
Skilled nursing facility care
Inpatient hospital services
Home-health care & hospice

Part B Outpatient coverage, doctor visits, and supplies

Medicare Part B helps cover medical expenses, such as doctor visits and other medical supplies. It also helps cover occupational and physical therapy services, as well as some home health care. Part B covers some preventive services. Typically, the monthly premium you pay for Medicare Part B is paid from your Social Security benefits.

Outpatient services
Medical & lab services
Doctor visits & preventive care
Durable medical equipment & supplies

Part C Medicare Advantage plans

Known as Medicare Advantage, Medicare Part C plans cover all of your Medicare Parts A and B benefits. They may also have Medicare Part D prescription drug coverage. With a Medicare Advantage plan that includes prescription drug coverage, you simply choose to get your benefits through a private health insurance company, giving you the ease of an all-in-one plan. These plans may include some of the following benefits:

Basic dental services
Vision
Hearing

Part D Prescription Drug coverage

Original Medicare does not include prescription drug coverage. For help managing the costs of your prescription medications, you will need to add a Medicare Part D plan, also known as prescription drug coverage. Prescription drug coverage is included in many Medicare Advantage Plans (Part C), but there are also Medicare Advantage plans available without prescription drug coverage.

Breaking down Original Medicare Parts A and B

Learn the ins and outs of Original Medicare: what it covers, what it doesn’t, and how much you can expect to pay.

What is Part A?

Part A helps cover different costs like inpatient stays, inpatient mental health, skilled nursing, and hospice care.

Inpatient hospital stays

What’s covered:

Overnight hospital stays
Semi-private room
Meals
General nursing
Medications included in your treatment
Some other services and supplies

Costs for inpatient stays:

Depending on how long you stay, you’ll first pay an inpatient hospital deductible. In 2026, this totaled $1,600.

A complete cost breakdown of an inpatient hospital stay includes:

Days 1–60: $0 after you meet your Part A deductible $1,676.

Days 61–90: $419 each day.

Days 91 and beyond: $838 each day for each lifetime reserve day (up to a maximum 60 reserve days over your lifetime).

Each day after you use all of your lifetime reserve days, you’ll be responsible for all costs. After day 90, you enter your bank of “lifetime reserve days,” which is up to 60 reserve days of inpatient hospital coverage that can be used over your lifetime. You’ll pay $800 per day during your lifetime reserve days. Once you’ve used these up, you’ll be responsible for all costs.

Skilled nursing facility stays

Skilled nursing facilities give a high level of medical care such as:

Wound care
IVs
Injections
Physical therapy
Watching vital signs

These facilities may be used for rehabilitation after an injury, stroke, or other condition. They may also be used to treat patients who need constant monitoring and care, but don’t need to be in a hospital.

Original Medicare will cover 100% of the cost for the first 20 days of a qualified stay. If you are admitted for longer, you will pay $200 per day for days 21 through 100. After 100 days, you will be responsible for all costs.

Inpatient mental health

Part A covers admittance to an inpatient mental health facility or psychiatric hospital for a maximum of 190 days over your lifetime.

The costs for an inpatient mental health stay are the same as inpatient hospital stay costs. For the doctor’s care, you will generally pay 20% of the Medicare-approved amount for mental health services you get from doctors and other health care providers while you're a hospital inpatient.

A full breakdown of costs for an inpatient mental health stay include:

Days 1–60: $0 after you meet your Part A deductible $1,676.

Days 61–90: $419 each day.

Days 91 and beyond: $838 each day for each lifetime reserve day (up to a maximum of 60 reserve days over your lifetime).

Each day after you use all of your lifetime reserve days you will pay all costs out-of-pocket.

Things to know

You can get these inpatient services either in a general hospital or a psychiatric hospital (a facility that only cares for people with mental health disorders).

If you're in a psychiatric hospital (instead of a general hospital), Part A only pays for up to 190 days of inpatient psychiatric hospital services during your lifetime.

Hospice care

Hospice care focuses on improved quality of life through pain relief and symptom control. They also treat mental and emotional health needs. Sometimes called “end of life care,” hospice is typically for when the diagnosis is terminal or when a cure is not expected. It’s usually given where the patient lives, either at home or a nursing home or other assisted nursing facility.

Original Medicare will generally cover 100% of hospice care costs if you get care from an approved provider. A copay of up to $5 may be charged for each outpatient prescription drug prescribed for pain relief and symptom control. For short-term inpatient respite care, you may have to pay for 5% of the Medicare-approved charges at a Medicare-approved facility.

What is Part B?

Body text: Part B, also known as medical insurance, helps cover:

Doctor visits
Urgent care
Outpatient care
Home health care
Durable medical equipment
Many other preventive services

Benefits of Part B

Doctor, specialist, and urgent care visits

Part B covers visits to your primary care doctor and/or specialists, as long as they accept Medicare. Specialists are doctors who focus on a specific type of care, like allergists, cardiologists, endocrinologists, and dermatologists. You’ll also be covered for visits to urgent care if you need treatment for a sudden illness or injury that isn’t a medical emergency. You may have a co-pay for these visits.

Durable medical supplies, equipment, and prosthetics

Part B will cover many supplies, equipment, and prosthetic devices. It may also cover artificial eyes and limbs, as long as they are prescribed by your doctor and the supplier of the device is enrolled in Medicare. Suppliers must meet a strict quality standard and offer competitive pricing for the equipment.

Some of the most common medical supplies and equipment include:

Wheelchairs
Scooters
Canes and walkers
Oxygen equipment and accessories
Diabetic monitoring supplies
Therapeutic shoes and inserts
Slings and brace
CPAP devices
hospital beds and lifts.
Medicare will also cover prosthetic devices, artificial eyes, and limbs.

Outpatient physical, occupational, and speech therapy

Part B will cover medically necessary therapy. Outpatient therapy is provided outside a hospital or skilled nursing facility. Therapy received in an inpatient setting is generally covered by Original Medicare Part A. Types of therapy included are:

Physical
Occupational
Speech
Pulmonary rehabilitation services

You might think of therapy as helping you get back the use of a certain function after injury or illness. In some cases, therapy is also a preventive measure to help manage chronic conditions.

Emergency Ambulance Transportation (Part B)

If you need medically necessary services and traveling via another vehicle could endanger your health, Part B will cover ground ambulance transportation to the nearest hospital, critical access hospital, or skilled nursing facility able to give the care you need.

If you need urgent help, Original Medicare may cover emergency transportation in an airplane or helicopter. Original Medicare may cover non-emergency but medically necessary ambulance transportation if you have an order from your doctor.

Cost without insurance (for all Part B items)

For everything under Part B, you’ll have to meet your yearly deductible. In 2026, the Part B deductible is $288. Once you meet your deductible, Original Medicare will pay 80% of the Medicare-approved amount. You’ll pay the remaining 20% out of pocket.

Before you visit a doctor, schedule a surgery, or buy supplies, it’s important to ask if providers take Original Medicare. If they don’t, you’ll likely have to pay more.

What’s 100% covered?

Original Medicare covers the cost of some preventive services like screenings, shots, and vaccines.

Clinical laboratory tests

Services deemed medically necessary like blood tests, urinalysis, tests on tissue samples, and certain screenings are all fully covered. They must be ordered by your doctor and performed in a Medicare-approved laboratory.

Preventive screenings and programs

Dozens of screenings and services are fully covered, such as:

Diabetes screenings
Depression screenings
Mammograms
Colonoscopies
Glaucoma tests
Cancer screenings

For a full list of covered preventive screenings and programs, check Medicare.gov.

Yearly wellness visit

Once you’ve had Original Medicare Part B coverage for over 12 months, Original Medicare covers an annual wellness visit. In this appointment, you can get care and advice based on your current mental and physical health. You’ll fill out a Health Risk Assessment questionnaire with your doctor that will help them create, update, and maintain a personalized plan and routine screening schedule for your health.

Vaccines and Shots

Depending on your physical health, Part B may cover shots and vaccines, including pneumococcal shots, Hepatitis B shots, and flu shots. Some shots are covered at 100% if given by an in-network Medicare provider.

What’s not fully covered?

Certain services and procedures like dental, vision, prescription drugs, and other benefits are not covered by Original Medicare. There are also deductibles and copays on some medical coverage.

Prescriptions

With few exceptions, Original Medicare Parts A and B don’t cover prescription drug costs. You must get prescription drug coverage as soon as you’re eligible for Medicare, unless you have drug coverage somewhere else. This could be with a spouse’s employer-sponsored health plan. If you enroll later, you may be subject to a late enrollment penalty.

There are two options for Prescription Drug coverage, also known as Part D. The first is a stand-alone Part D Prescription Drug plan, which can only be added to:

Original Medicare
some Medicare Cost Plans
some Private Fee-for-Service (PFFS) Plans
Medicare Medical Savings Account (MSA) Plans

You can enroll in a Medicare Advantage Prescription Drug plan, which combines all the benefits of Part A and Part B coverage with Prescription Drug coverage (Part D). This will replace Original Medicare. Without this coverage, you could have to pay 100% of the cost of your prescriptions.

Dental

Original Medicare does not cover most dental care, but you can get separate dental coverage from a private insurance company.

There are two options for dental coverage. You can add a stand-alone dental insurance plan to your Original Medicare, or enroll in a Medicare Advantage plan, also known as Part C. Medicare Advantage replaces Original Medicare, and some plans include dental insurance. If you choose not to purchase dental insurance, you could have to pay 100% of the cost of your dental care.

Vision

Part B covers a simple vision test as part of the “Welcome to Medicare” visit, but it’s only offered once during your first year of Part B coverage. Part B also covers a yearly eye exam for those living with diabetes and diabetic retinopathy, as long as it’s done by a licensed eye doctor.

Eye exams for diagnostic purposes, such as testing for glaucoma or macular degeneration, may also be covered. If treatment may improve a chronic eye condition and is viewed as necessary by a physician participating in Medicare, Part B may cover it. You’ll need to check with your doctor to see if your condition is deemed medically necessary.

Most regular vision care, like routine eye exams, eyeglasses, contacts, and corrective procedures, won’t be covered by Original Medicare. Adding a stand-alone vision insurance plan to your Original Medicare or enrolling in a Medicare Advantage plan with some routine vision coverage, may replace your Original Medicare with a more robust offering. If you choose not to purchase vision coverage, you could have to pay 100% of the cost of your vision care.

Hearing

Part B covers diagnostic hearing and balance exams if ordered to determine whether medical treatment is needed. However, Original Medicare does not cover hearing exams, hearing aids or fittings. That’s where Medicare Advantage plans with routine hearing coverage can help. They may have some coverage for routine hearing care in addition to the benefits that come with Parts A and B. If you choose not to purchase hearing coverage, you could have to pay 100% of the cost of your hearing care.

Personal Assistance

Original Medicare covers some in-home health services, like skilled nursing care, physical therapy, speech pathology, and occupational therapy. Original Medicare will not pay for 24-hour in-home care or meals delivered to you at home. If your in-home care needs are more than what can be classified as part-time or intermittent skilled nursing care, they will not be eligible for coverage.

If you choose to enroll in a Medicare Advantage plan with an in-home health benefit, you may have access to additional in-home health programs at no additional cost.

Cost without insurance for all items

You may be responsible for paying 100% of the cost of your prescriptions, dental, vision, hearing, and in-home care.

This is not a full summary of Original Medicare coverage, benefits, and costs. For a full list of covered services use the “Is my test, item, or service covered?” search tool on Medicare.gov.