• Medicare coverage is divided into several programs that each cover a different aspect of care.
  • Medicare Part A, which covers inpatient care, is often premium-free.
  • Medicare Part B, which covers outpatient care, has an income-based premium.
  • Medicare Part C — or Medicare Advantage — is a private insurance product that combines multiple Medicare programs into one.
  • Medicare Part D is a private insurance product offered through Medicare that covers prescription medications.
  • Medicare supplement plans — or Medigap — are supplemental insurance plans offered through Medicare that cover costs like copayments and coinsurances.

Medicare provides healthcare coverage people over age 65 and those with disabilities or certain health conditions. This complex program has many parts, and it involves the federal government and private insurers working together to offer a wide variety of services and products.

Original Medicare is made up of parts A and B. This coverage allows you to go to doctors and facilities that accept Medicare without getting permission or pre-approval from your plan. Premiums and copayments apply, but they’re usually income-based and may be subsidized.

Medicare Advantage (Part C) plans are private insurance plans.

These plans combine multiple elements of Medicare, like parts A and B, with other services, such as prescription, dental, and vision coverage. They offer more services, but they might cost more and come with network restrictions.

While Medicare’s many options give you flexibility in your healthcare coverage, it also means you have to navigate through and understand a lot of information. Read on for a detailed breakdown of the different parts of Medicare and how they can help you.

Medicare Part A is the part of original Medicare that covers your hospital bills and other inpatient care. Most people do not pay a monthly premium for Part A because they paid into the program through taxes during their working years.

Specifically, Medicare Part A will cover:

  • an inpatient hospital stay
  • care in a skilled nursing facility
  • a stay in a long-term care hospital
  • nursing home care that is not long-term or custodial
  • hospice care
  • part-time or intermittent home health care

To ensure that Medicare covers your stay, you must:

  • have an official order from your doctor stating that you need the care for an illness or injury
  • make sure the facility accepts Medicare
  • ensure you have days left in your benefit period to use (for skilled nursing facility stays)
  • confirm that Medicare and the facility approve the reason for your stay

Under Medicare Part A, you can expect to pay:

  • no premium if you worked more than 39 quarters in your lifetime and paid Medicare taxes (in 2020, you’ll pay at most $458 per month if you worked less than 39 quarters)
  • a $1,408 deductible for each benefit period
  • coinsurances based on the number of days you’ve had in your benefit period, ranging from $0 for days 1 to 60, $352 per day for days 61 to 90, and $704 per day for days 91 and beyond
  • all costs if you are in the hospital for more than 90 days in one benefit period and you have exceeded your 60 lifetime reserve days

Medicare Part B is the part of original Medicare that covers the costs of your outpatient care. You’ll pay a monthly premium for this coverage based on your income level.

Medicare Part B will cover the cost of things like:

  • doctors’ visits
  • medically necessary medical supplies and services
  • preventive care services
  • ambulance transportation
  • some medical equipment
  • inpatient and outpatient mental health services
  • some outpatient prescription medications

To be sure Medicare Part B covers your appointment, service, or medical equipment, ask if your doctor or service provider accepts Medicare. You can also use the Medicare coverage tool to determine whether your appointment or service is covered.

Under Medicare Part B, you can expect to pay:

  • a premium of at least $144.60 per month (this amount increases if your individual income is above $87,000 per year, or $174,000 per year for married couples)
  • a $198 deductible for the year
  • 20 percent of Medicare-approved amounts after your deductible is met for the year

Medicare Part C (Medicare Advantage) is a private insurance product that gives you all the coverage of Medicare parts A and B, plus extra services.

Most of these plans offer prescription coverage in addition to inpatient and outpatient services. Benefits like dental and vision coverage can be added too.

You can customize your Medicare Advantage plan based on what the company that administers your plan offers and what you want to pay.

Medicare will pay a set amount each month to your Medicare Advantage plan provider to contribute to a share of your coverage.

Medicare Part C plans usually fall into a few different classifications:

Medicare Part C costs vary depending on the plan type and insurance provider you choose. You can compare the costs of various Medicare Advantage plans online with the Medicare Plan Finder tool.

Medicare Part D is a plan that offers coverage for prescription medications.

This is an optional Medicare program, but if you don’t enroll when you’re first eligible, you may pay penalties when you do sign up later. Those penalties will apply for as long as you have a drug plan and will be added to the cost of your monthly premium.

Prescription medication coverage must be offered at a standard level set by Medicare. But different plans can choose which medications they list in their drug lists, or formularies. Most prescription drug plans group covered medications by:

  • formulary, which is a list of prescription medications covered in the plan — typically with at least two choices for each drug class or category
  • generic medications that may be substituted for brand-name medications with the same effect
  • tiered programs that offer various levels of medications (generic only, generic plus name brand, and so on) for a range of copayments that increase with your medication prices

The cost of Medicare Part D plans depend on which plan you choose and what medications you need. You can compare the cost of various Medicare prescription drug plans online by clicking here.

Medicare supplement, or Medigap, plans are private insurance products meant to help cover costs not paid for by Medicare parts A, B, C, or D. These plans are optional.

Medigap plans can help cover Medicare expenses like:

  • copayments
  • coinsurances
  • deductibles

A few major changes have been made to the Medigap program in 2020.

Medigap plans can no longer be used to pay for the Medicare Part B deductible. This means that two types of Medigap plans — Plan C and Plan F — stopped being sold to new members as of January 1, 2020. People who already had these plans, however, are able to keep their coverage.

Medigap plans may not cover all out-of-pocket costs, but you can find the one that best suits your financial and health needs. You have a variety of plans and coverage levels to choose from.

Here’s a list of the 10 Medigap plans and what they cover.

Medigap plan comparison

Medigap planWhat it covers
Plan AMedicare Part A coinsurance and the costs of 365 days’ worth of care after Medicare benefits are exhausted, Part B coinsurance or copayments, the first 3 pints of a blood transfusion, and hospice care coinsurance or copayments
Plan BMedicare Part A coinsurance and the costs of 365 days’ worth of care after Medicare benefits are exhausted, Part B coinsurance or copayments, the first 3 pints of a blood transfusion, hospice care coinsurance or copayments, and your Part A deductible
Plan CMedicare Part A coinsurance and the costs of 365 days’ worth of care after Medicare benefits are exhausted, Part B coinsurance or copayments, the first 3 pints of a blood transfusion, hospice care coinsurance or copayments, skilled nursing facility coinsurance, your Part A deductible, your Part B deductible*, and foreign travel exchanges up to 80%
Plan DMedicare Part A coinsurance and the costs of 365 days’ worth of care after Medicare benefits are exhausted, Part B coinsurance or copayments, the first 3 pints of a blood transfusion, hospice care coinsurance or copayments, coinsurance for skilled nursing facilities, your Part A deductible, and foreign travel exchanges up to 80%
Plan FMedicare Part A coinsurance and the costs of 365 days’ worth of care after Medicare benefits are exhausted, Part B coinsurance or copayments, the first 3 pints of a blood transfusion, hospice care coinsurance or copayments, coinsurance for skilled nursing facilities, your Part A deductible, your Part B deductible*, Part B costs that your provider charges beyond what Medicare allows (excess charge), and foreign travel exchanges up to 80%
Plan GMedicare Part A coinsurance and the costs of 365 days’ worth of care after Medicare benefits are exhausted, Part B coinsurance or copayments, the first 3 pints of a blood transfusion, hospice care coinsurance or copayments, coinsurance for skilled nursing facilities, your Part A deductible, Part B costs that your provider charges beyond what Medicare allows (excess charge), and foreign travel exchanges up to 80%
Plan KMedicare Part A coinsurance and the costs of 365 days’ worth of care after Medicare benefits are exhausted, 50% of Part B coinsurance or copayments, 50% of the cost of the first 3 pints of a blood transfusion, 50% of hospice care coinsurance or copayments, 50% of coinsurance for skilled nursing facilities, 50% of your Part A deductible — with an out-of-pocket limit of $5,880 for 2020
Plan LMedicare Part A coinsurance and the costs of 365 days’ worth of care after Medicare benefits are exhausted, 75% of Part B coinsurance or copayments, 75% of the cost of the first 3 pints of a blood transfusion, 75% of hospice care coinsurance or copayments, 75% of coinsurance for skilled nursing facilities, 75% of your Part A deductible — with an out-of-pocket limit of $2,940 for 2020
Plan MMedicare Part A coinsurance and the costs of 365 days’ worth of care after Medicare benefits are exhausted, Part B coinsurance or copayments, the first 3 pints of a blood transfusion, hospice care coinsurance or copayments, coinsurance for skilled nursing facilities, 50% of your Part A deductible, and foreign travel exchanges up to 80%
Plan NMedicare Part A coinsurance and the costs of 365 days’ worth of care after Medicare benefits are exhausted, Part B coinsurance or copayments, the first 3 pints of a blood transfusion, hospice care coinsurance or copayments, coinsurance for skilled nursing facilities, your Part A deductible, and foreign travel exchanges up to 80%

*After January 1, 2020, people who are new to Medicare can’t use Medigap plans to pay the Medicare Part B deductible. But if you’re already enrolled in Medicare and your plan currently pays it, you can keep that plan and the benefit.

It can take time and effort to sift through the many types of Medicare plans. But these options give you more choices when it comes to coverage and the cost of your healthcare.

When you’re first eligible for Medicare, be sure to review all its parts to find the best fit for you and avoid penalties later.

The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.

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