No, Original Medicare (Part A) does not cover 100% of hospital bills; you'll pay deductibles per benefit period, and then coinsurance for longer stays (days 61+), but you can use Medicare Advantage (Part C) or Medigap (Medicare Supplement) plans to cover these gaps, potentially reaching zero out-of-pocket costs for hospital care with the right supplemental plan, according to sources like NCOA and Healthgrades.
Medicare pays 100% of the first 20 days of a covered SNF stay. A copayment of $217 per day (in 2026) is required for days 21-100 if Medicare approves your stay.
No, Medicare Part A does not cover 100% of hospital bills; beneficiaries pay a deductible per benefit period, followed by daily coinsurance for longer stays (days 61-90, plus lifetime reserve days), meaning you're responsible for costs beyond Medicare's approved amounts unless you have a supplemental plan like Medigap or Medicare Advantage. While Part A covers many inpatient services like semi-private rooms, meals, and general nursing after the deductible, significant out-of-pocket costs remain for extended hospitalizations.
Medicare covers 80% of approved expenses, after you meet an annual deductible. When you sign up for Medicare, you will have options on the amount you pay: You pay 20% of the Medicare-approved amount after you meet the annual deductible.
Original Medicare Safety Net (OMSN)
Your gap expenses count towards the OMSN. Once your gap expenses reach the threshold in a calendar year, Medicare will reimburse you 100% of the schedule fee (instead of 85%) for any further out-of-hospital medical services you need that are subsidised under the MBS.
Key Takeaways. Original Medicare does not cover 100% of your medical costs, and it does not cover prescription drugs. To help bridge the cost gaps, you can choose a Medigap policy or a Medicare Advantage plan. Deciding between Medigap and Medicare Advantage depends on many factors, including where you live.
Medicare Part B covers ER visits, but you still pay a deductible and 20% of costs. Part A helps only if you're admitted to the hospital. Medigap can help cover ER costs if you have Original Medicare. Medicare Advantage plans (which replace Original Medicare) cover ER care and may offer lower copays or extra services.
Here are some of the biggest Medicare mistakes to avoid:
Some of the items and services Medicare doesn't cover include:
Whether you're new to Original Medicare or have been enrolled for some time, understanding the limitations of your coverage is important as you navigate decisions about your healthcare. One of the main reasons why Original Medicare doesn't cover 100% of your medical bills is because it operates on a cost-sharing model.
Once you meet your deductible, Part A will pay for days 1–60 that you are in the hospital. For days 61–90, you will pay a coinsurance for each day. If you need to stay in the hospital for longer than 90 days, you can use up to 60 lifetime reserve days. These are extra days of Medicare coverage for long hospital stays.
You will pay the Part B deductible for services where the deductible applies. After that, Supplement G covers all the remaining charges for Medicare-approved services. Medicare pays 80% of your outpatient costs, including emergency care, and your Supplement will pay the other 20% for medical procedures.
You pay a portion of the cost, called coinsurance, for each day you are in the hospital beyond 60 days in each benefit period. You pay: Nothing additional for the first 60 days of covered inpatient care each benefit period after you pay the $1,600 Part A deductible in 2023, which rises to $1,632 in 2024.
Your Original Medicare coverage does not run out as long as you pay the monthly premium (the monthly payment). If you have a Medicare Advantage plan, the company might stop offering that plan, but you'll have a chance to choose a new one.
The Medicare "3-Day Rule" requires a beneficiary to have a qualifying 3-day inpatient hospital stay (admission day counts, discharge day doesn't) before Medicare will cover services in a Skilled Nursing Facility (SNF) for rehabilitation or skilled care, though this rule can be waived in certain Medicare Advantage plans or through specific Accountable Care Organization (ACO) initiatives. Time spent in observation or the Emergency Department doesn't count towards these 3 days, but new demonstration projects and waivers are emerging to offer more flexibility for patients needing SNF care.
Vermont, Utah and Minnesota topped the Commonwealth Fund's Medicare performance scorecard in 2025, whereas Kentucky, Mississippi and Louisiana struggled the most.
You may have to pay a portion of the costs, called coinsurance, if you stay in a hospital or skilled nursing facility for a long time. Medicare covers your first 60 days as a hospital inpatient, but in 2023, you pay $400 a day for days 61 to 90 and $800 a day for up to 60 lifetime reserve days.
Medicare generally does not cover routine, wellness, or self-requested blood tests without clear medical necessity, such as tests for employment, most genetic panels, or extensive vitamin/micronutrient panels, but it does cover medically necessary lab work ordered by a doctor to diagnose, treat, or prevent a specific condition, including certain screenings. Key non-covered areas include routine bloodwork during Annual Wellness Visits, tests for third parties, and extensive "wellness panels," with coverage hinging on your doctor documenting a specific medical reason.
Part A (Hospital Insurance)
Part A helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.
Medicare Advantage (Part C): In 2026, the federal cap for in-network maximum out-of-pocket limit is $9,250, but it can be less depending on the plan you choose. The combined in- and out-of-network cap is $13,900.