The 4 Parts of Medicare

Medicare Part A primarily covers hospital-related expenses for inpatient care. This includes not only care received during a hospital stay but also skilled nursing facility care (following a hospital stay), hospice care for those with a terminal illness, and some limited home health services. Most people don’t pay a monthly premium for Part A if they or their spouse have paid Medicare payroll taxes for at least 10 years while working. However, there are deductibles and coinsurance amounts associated with hospital stays and other services under Part A, and it’s important to know the specifics of what is and isn’t covered. 

Part B covers a wide range of medically necessary services, including doctor visits, preventive care (such as screenings, vaccines, and wellness checkups), lab tests, x-rays, outpatient surgeries, and durable medical equipment like wheelchairs and walkers. It also pays for certain doctor services and treatments you may receive while in the hospital, even though you are admitted as an inpatient. While most people pay a monthly premium for Part B—which varies based on income—some individuals with low incomes may qualify for programs that help cover this cost. There is also an annual deductible, and typically a 20% coinsurance for most covered services. Part B is essential for managing your healthcare both in and out of the hospital and for early detection and treatment of health conditions. 

Medicare Part C, known as Medicare Advantage, is an alternative way to get your Medicare benefits through a plan offered by private insurance companies that contract with Medicare. These plans are required to provide at least the same coverage as Original Medicare (Parts A and B), but many also offer additional benefits like routine dental, vision, and hearing care, wellness programs, and even transportation to medical appointments. Most Medicare Advantage plans also include prescription drug coverage, so you have your hospital, medical, and often drug coverage all in one plan. Plan costs, provider networks, and available extra benefits can vary from one insurer to another, so it’s important to compare options available in your area. 

Part D is designed specifically to help with the cost of prescription medications. Offered by private insurance companies approved by Medicare, Part D plans can be added to Original Medicare. Each plan has its own formulary, or list of covered drugs, along with tiers for medications and specific costs such as premiums, deductibles, and copayments. Coverage is available for both brand-name and generic medications, and there are protections in place to help limit out-of-pocket drug costs, especially for those with high medication needs. Signing up for Part D when you are first eligible helps you avoid late enrollment penalties down the road.