Original Medicare (parts A and B) provides hospitalization and outpatient coverage. Part D covers prescription drugs. Part C offers a private option for parts A and B, along with additional benefits.
Medicare has five main options that offer healthcare benefits to people age 65 years and older and people with disabilities and some chronic conditions:
- Medicare Part A provides basic hospitalization coverage.
- Medicare Part B covers outpatient care like doctor visits and diagnostic tests.
- Medicare Part C (Medicare Advantage) is a private option that combines Part A and Part B coverage and offers additional benefits.
- Medicare Part D is prescription drug coverage.
- Medicare supplement (Medigap) is private insurance that helps cover out-of-pocket costs like copays, coinsurance, and deductibles.
Medicare is the insurance plan offered by the federal government for people age 65 years and older, as well as people with disabilities and people with end stage renal disease, a type of kidney failure.
When it comes to healthcare, it’s important to know what is covered and what isn’t. Some tools can make it easier for you.
Medicare has four parts: A, B, C, and D. Each part covers different aspects of healthcare.
You can enroll in one or more parts of Medicare, but the most common parts people enroll in are parts A and B, known as Original Medicare. These parts cover the majority of services.
People usually have to pay a monthly premium, but this varies based on income.
Medicare Part A covers hospital inpatient costs when you’re formally admitted to a hospital with a doctor’s order. It provides benefits for services like:
- hospice care
- some home healthcare services
- blood transfusions
Part A also provides limited coverage for skilled nursing facilities if you have a qualifying inpatient hospital stay.
A qualifying stay is 3 consecutive days resulting from a formal inpatient admission order written by your doctor.
What does Medicare Part A cost?
Depending on your income, you may have to pay a premium for Part A coverage. If you have worked and paid FICA taxes for 10 years, you pay no premium for Part A.
However, you may have to pay copayments or a deductible for any services under Medicare Part A. You can apply for assistance or help if you can’t pay.
According to Medicare, in addition to a $1,632 deductible, your 2024 Part A costs include:
- $0 coinsurance for hospitalization days 1 to 60
- $408 coinsurance per day for hospitalization days 61 to 90
- $816 coinsurance per day for hospitalization day 91 and beyond for each lifetime reserve day
- all costs for each hospitalization day over your lifetime reserve days
- no charge for the first 20 days of approved skilled nursing facility care
- $204 per day for 21 to 100 days of approved skilled nursing facility care
- all costs after 101 days of approved skilled nursing facility care
- no charge for hospice care
For hospital services to be covered by Medicare, you must be approved and receive care in a Medicare-approved facility.
Medicare Part B covers your doctor’s services and preventive healthcare, such as yearly doctor visits and tests. People often have parts A and B together to get the most coverage.
For example, if you stay in a hospital, the stay would be covered under Medicare Part A and the doctor’s services would be covered under Part B.
Part B covers a wide range of tests and services, including:
- screening for cancer, depression, and diabetes
- ambulance and emergency department services
- influenza and hepatitis vaccinations
- medical equipment
- diabetes supplies
- prescription medications administered by a doctor, such as infusions or infections
What does Medicare Part B cost?
Some of your Part B cost is a monthly premium of $174.70. However, your premium could be more or less depending on your income.
Some services are covered under Medicare Part B at no additional cost to you if you have an appointment with a doctor who accepts Medicare. If you need a service outside of what is covered by Medicare, you will have to pay for that service yourself.
Medicare Part C, also called Medicare Advantage, refers to privately sold insurance options that include the same coverage as parts A and B, in addition to extra benefits like:
To purchase a Medicare Advantage plan, you must be enrolled in Original Medicare.
What does Medicare Part C cost?
You usually pay a premium for these plans, and you have to have services performed by doctors within your network. Otherwise, copayments or other fees may apply. Your Medicare Part C cost depends on the type of plan you select.
Medicare Part D covers prescription drugs not covered by Part B. Although this plan is optional, many people choose it for medication coverage.
What does Medicare Part D cost?
The cost for Medicare Part D varies depending on the kinds of medications you take, the plan you have, and which pharmacy you choose. You have to pay a premium, and depending on your income, you may have to pay additional costs. You may also have to make copayments or pay a deductible.
While Medicare covers a wide range of care, not everything is covered. Original Medicare doesn’t typically cover:
Medicare also doesn’t cover long-term (custodial) care, such as a long-term stay in a nursing home. If you think you or a loved one may need long-term care, consider a separate long-term care insurance policy.
Medicare consists of five main types of coverage: Part A, Part B, Part C, Part D, and Medigap. These choices offer many options to meet your healthcare needs.
While Medicare covers many healthcare services like hospitalization, doctor visits, and prescription drugs, there are medical services it doesn’t cover.
Medicare doesn’t cover long-term custodial care, cosmetic procedures, glasses, or hearing aids, among other services. You can consult the Medicare coverage tool or call 800-MEDICARE to see if a specific service is covered.