What does Medicare actually cover for seniors?

Medicare is the foundation of health coverage after 65, but its gaps cause some of the most expensive surprises in senior care. Understanding what it does — and pointedly doesn’t — cover is essential to any plan.

The four parts

Part A (hospital insurance): inpatient hospital stays, short skilled-nursing rehab, and hospice. Usually premium-free. Part B (medical insurance): doctors, outpatient care, tests, and preventive services, for a monthly premium. Part C (Medicare Advantage): a private plan that bundles A and B (and usually D), sometimes with extra dental/vision benefits but a restricted network. Part D: prescription drug coverage, through a private plan.

The gaps that cost families

The biggest one: Medicare does not cover long-term custodial care — not assisted living, and not an ongoing nursing-home stay. It covers only short, skilled rehab after a qualifying hospital stay. (Skilled coverage does not depend on the person improving — under the Jimmo v. Sebelius settlement, care needed to maintain function or slow decline can qualify. But it is still short-term, and it is still not long-term care.) It also generally doesn’t cover routine dental, vision, or hearing, and Original Medicare has no out-of-pocket maximum, which is why most people add a Medigap supplement or choose Advantage.

Medigap and Advantage

To fill the cost-sharing gaps in Original Medicare, people buy a Medigap supplement (standardized plans, guaranteed renewable, works with any Medicare provider) or choose Medicare Advantage (lower premiums, extra perks, but a network and prior-authorization). Neither covers long-term care.

Plan for the long-term-care gap

Because Medicare stops where long-term care begins, that cost falls to savings, LTC insurance, Medicaid, or VA benefits. Model the gap in My Plan and see how families pay.

This guide is general information, not medical, legal, or financial advice. Rules vary by state and change over time. For personalized, unbiased help, your Area Agency on Aging and your state’s Long-Term Care Ombudsman are free.