Medicare, a federal health insurance program, helps pay for medical treatment and long-term care for people over 65 and certain younger people with disabilities. The program offers basic coverage of things like doctor visits, hospital stays, and surgeries. Each of Medicare's parts cover specific services. Here are its parts, explained.
Understanding which part of Medicare covers what helps you choose the best health insurance for your needs. Each has its own rules and involves different costs, participating doctors, and hospital networks.
If you're eligible, you can enroll in the original Medicare, parts A and B. These parts are run by the Centers for Medicare and Medicaid Services. The original Medicare covers the essentials, but there are a lot of services that aren't covered.
Part A: Meant for inpatient care
When you apply for Medicare, you're automatically enrolled in part A. Usually, part A covers:
- Inpatient hospital care expenses.
- Nursing facility care.
- Nursing home care.
- Hospice care.
- Home healthcare.
Part A, meant for inpatient care, doesn't require you to pay a premium if you or your spouse paid Medicare taxes for at least 10 years, or if you receive retirement benefits from Social Security or the Railroad Retirement Board. Alternatively, you can buy coverage by paying premiums, whose amount depends on how long you paid Medicare taxes while you worked.
Part B: Doctor and outpatient services
Part B helps pay for medically necessary services, such as doctors’ services or tests and outpatient care. It mainly covers:
- Medically necessary services, such as supplies needed to diagnose or treat a medical condition.
- Preventive services, including healthcare to detect illness at an early stage or vaccination to prevent illness, such as flu.
- Mental health services.
- Ambulance rides.
You can visit www.medicare.gov/coverage or call 1-800-MEDICARE (1-800-633-4227) to find out exactly what's covered. Part B involves more costs than part A and, unlike part A, part B has a standard premium. The part B monthly premium, set by the federal government, is $170.10 for 2022. It may be higher if your income is above $91,000.
Part C: Medicare Advantage
Part C offers a private health insurance alternative to the federally run, original Medicare. Combining various parts of Medicare into one plan, part C plans are offered by private insurance companies.
These plans provide the same coverage as the original Medicare with the benefit of supplemental coverage. Like traditional insurance structures, Medicare part C includes:
- Health maintenance organization plans.
- Preferred provider organization plans.
- Private fee-for-service plans.
- Special needs plans.
- Medicare savings account plans.
Some plans may also cover additional coverage for health-related perks, like gym memberships and meal delivery services after you’ve been released from a hospital. Part C’s inpatient and outpatient coverage includes at least that covered by parts A and B, and its cost depends on a number of factors. According to the Kaiser Family Foundation, the average monthly premium for Medicare part C enrollees was $25 in 2020.
Part D: Prescription drugs
Part D covers prescription drugs, and comprises only private insurance plans. It also covers a much wider range of vaccines and outpatient prescription drugs than part B, in addition to more specialized medications such as cancer drugs and insulin. To enroll in part D, you must have part A and B coverage. Moreover, if you get drug coverage through your Medicare Advantage plan, you don't need a separate part D plan.
There are also supplemental ("Medigap") plans. The 10 types (A, B, C, D, F, G, K, L, M, and N) vary in what and how much they cover. Medigap plans are standardized, meaning a plan A offered by one company has the same benefits as a plan A offered by another, but your premiums may differ based on a number of factors.