The Four Parts of Medicare Coverage Explained

Medicare is a federally funded health insurance program that provides coverage to eligible individuals in the United States. It comprises four parts: A, B, C, and D.

Below is a detailed look at each of the four parts of Medicare coverage, including the extent of coverage and coverage limits.

Medicare Part A

Medicare Part A is the primary coverage for inpatient hospital care. In most cases, you will be automatically enrolled in Medicare Part A once you turn 65.

The only caveat is that you should have been paying Medicare taxes for at least 10 years. Typically, you do not have to pay a premium for this coverage. However, you may have to pay deductibles and copayments for the services you receive.

Here are some things that Part A may cover:

• Inpatient hospital care, including the cost of meals, a private room, and medical and surgical services
• Skilled nursing care, such as physical, occupational, and speech therapy
• Hospice care, which includes medical and support services for people who are terminally ill
• Home health care services, such as nursing care and medical social services

The above benefits are only covered if they are medically necessary and provided by a Medicare-approved facility or provider.

Additionally, Part A has specific rules and limits, such as the length of time it will cover certain services and the number of days it will cover for hospital stays.

For example, there is a limit on the number of days it will cover for hospital stays. Generally, Medicare Part A will cover the full cost of inpatient hospital care for the first 60 days of a hospital stay. After that, you may have to pay a daily copayment for each additional day you remain in the hospital.

The copayment amount varies depending on your situation, but it can be as much as $352 per day in 2021. It only covers up to 100 days of skilled nursing care per benefit period. It may cover home health care services for a limited number of visits per benefit period.

Medicare Part B

Medicare Part B is a type of insurance that helps cover the cost of outpatient medical care. If you are eligible for Medicare, you can enroll in Part B, but you will be required to pay a monthly premium.

Some of the things that Part B may cover include:

• Doctor’s visits, including specialist consultations
• Preventive treatments, such as flu shots and cancer screenings
• Durable medical equipment, such as oxygen equipment and wheelchairs
• Certain medical supplies, such as bandages and blood sugar test strips
• Outpatient mental health services, such as counseling and therapy
• Some home health care services, such as physical therapy and speech therapy

Similar to Part A, Part B only covers these services if they are medically necessary and provided by a Medicare-approved facility or provider. As with other Medicare parts, some rules and limits apply.

For example, you will typically have to pay a deductible for Part B services, which is the amount that you must pay out-of-pocket before Medicare begins to cover the cost of your care. The deductible amount varies yearly, but it was $203 in 2021.

After you meet your deductible, you will generally have to pay a copayment or coinsurance for the services you receive. The amount you pay depends on the type of service you receive and how much it costs.

Medicare Part B has a “coverage gap” or “donut hole.” This is a temporary limit on your insurance coverage. It means that after you have spent a certain amount on covered drugs, you will have to pay a higher percentage of the cost of your medications until you reach the out-of-pocket threshold for the year.

Once you reach this threshold, your coverage will resume, and you will pay a lower copayment or coinsurance for your medications.

Medicare Part C

Medicare Part C is also known as Medicare Advantage. It is an alternative to Medicare that private insurance companies offer.

If you are eligible for a Medicare plan, you can choose to enroll in a Medicare Advantage plan instead of Original Medicare (Parts A and B).

Medicare Advantage plans cover the same benefits as Original Medicare, but many insurance companies offer additional benefits.

For example, most Medicare Advantage plans offer coverage for routine vision and dental care, which Original Medicare does not cover.

Some plans may also provide coverage for fitness programs, hearing aids, or other services.

Additionally, some Medicare Advantage plans may have lower out-of-pocket costs than Original Medicare, such as lower deductibles or copayments.

These Medicare supplement plans typically have networks of healthcare providers, doctors, and hospitals, that you must use to receive covered benefits. They may also have copayments, coinsurance, and deductibles that you must pay for the services you receive.

Additionally, some services covered by Original Medicare, such as emergency or certain types of specialty care, may be subject to different rules or restrictions under a Medicare Advantage plan.

A Medicare Advantage plan’s specific terms and conditions vary depending on your chosen plan, so it’s important to carefully review the terms before enrolling.

Here are some of the things that Medicare Advantage plans may cover:

• Inpatient and outpatient medical care, including doctor’s visits and hospital stays
• Preventive treatments, such as flu shots and cancer screenings
• Durable medical equipment, such as oxygen equipment and wheelchairs
• Certain medical supplies, such as bandages and blood sugar test strips
• Outpatient mental health services, such as counseling and therapy
• Some home health care services, such as physical therapy and speech therapy
• Routine vision and dental care
• Fitness programs, hearing aids, and other services

Note that the Medicare Advantage plan is not the same as a Medigap. Medigap is a type of Medicare supplement insurance that bridges gaps in Parts A and B coverage. Conversely, Medicare Advantage is not a Medicare supplement plan but an alternative to the original coverage.

Medicare Part D

This is Medicare prescription drug coverage. It helps to cover the cost of prescription drugs and is available as a stand-alone plan or as part of a Medicare Advantage plan. Like Part B, Part D has a monthly premium that most people pay directly to Medicare.

Private insurance companies offer part D plans. Prescription drug coverage is available through various providers, such as pharmacies, health plans, and Medicare Advantage plans.

The specific drugs covered by a Part D plan vary depending on your chosen plan. However, all plans must cover at least two drugs in each category.

Some of the things covered in Medicare Part D include:

• Prescription drugs for various medical conditions, including high blood pressure, diabetes, and depression
• Vaccines, such as the flu shot or pneumonia vaccine
• Some medications that are administered by a doctor, such as chemotherapy drugs
• Some drugs that are used in a hospital or nursing home

The specific coverage limits for Medicare Part D. For example, you will typically have to pay a deductible for Part D services, which is the amount that you must pay out-of-pocket before Medicare begins to cover the cost of your drugs.

The deductible amount varies from year to year and from plan to plan. Therefore, it is essential to carefully review the terms of the plan you are considering before enrolling.

After you meet your deductible, you will generally have to pay a copayment or coinsurance for the drugs you receive. The amount you pay depends on the type of drug you receive and how much it costs. Like parts c, Medicare Part D has a “coverage gap” or “donut hole.”

Conclusion

In a nutshell, the four parts of Medicare coverage are:

• Medicare Part A. It covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services.
• Medicare Part B. Covers medical services and supplies considered medically necessary to treat an illness or condition, as well as some preventive services.
• Medicare Part C. Also known as Medicare Advantage. It is an alternative way to get the Original Medicare Parts A and B benefits.
• Medicare Part D. It covers prescription drugs. It is available as a stand-alone prescription drug plan or through a Medicare Advantage plan that includes drug coverage.

These four parts of Medicare work together to provide a comprehensive range of health coverage for eligible individuals.

While Medicare offers Part A and B, Parts C and D are provided by private insurance companies. Not everyone is eligible for all four parts of Medicare, and the specific benefits and costs will vary depending on your situation.

If you have questions about the coverage limits for Medicare parts A, B, C, and D, contact the Social Security Administration, which administers the Medicare program. They can provide more information and help you understand your coverage options.

You can also contact a private insurance company that offers Parts c and D plans to learn more about their specific plans and how their coverage limits may affect you.