Medicare is a crucial federal healthcare program that provides essential health coverage for individuals aged 65 and older, as well as for certain younger individuals with qualifying disabilities. This program covers a wide range of healthcare services, ensuring that seniors and eligible individuals can access the medical care they need. Understanding the different parts of Medicare  Parts A, B, C, and D—can be complex, but with the right knowledge, you can make informed decisions about your healthcare coverage. 

Table of Contents: 

• What is Medicare? 

• What are the different parts of Medicare? 

• Understanding Medicare Part A 

• Understanding Medicare Part B 

• Understanding Medicare Part C 

• Understanding Medicare Part D 

• Conclusion 

What is Medicare? 

Medicare is a federal program administered by the Centers for Medicare and Medicaid Services (CMS), designed to provide health coverage for people aged 65 and older and for some individuals under 65 with specific qualifying disabilities. The program addresses a broad spectrum of healthcare needs, including hospital stays, outpatient services, and prescription medications. 

While Medicare offers essential coverage, it does not cover every medical expense.  Therefore,  understanding the different parts of Medicare is vital to selecting the most suitable coverage for your healthcare needs. 

What are the different parts of Medicare? 

Medicare is divided into four main parts, each offering distinct  types of coverage: 

• Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services. 

• Part B (Medical Insurance): Covers outpatient services, including doctor visits, lab tests, preventive services, and durable medical equipment.  

• Part C (Medicare Advantage): Offered by private insurance companies approved by Medicare, these plans combine Parts A and B and often include additional benefits like dental, vision, and prescription drug coverage. Part D (Prescription Drug Coverage): Helps cover the cost of prescription medications. Part D is available as a stand-alone plan or through Medicare Advantage plans with drug coverage. 

Understanding Medicare Part A 

Medicare Part A is a key component of the Medicare program that provides hospital insurance. It covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.  Most beneficiaries do not pay a monthly premium for Part A if they or their spouse have paid Medicare taxes for at least 10 years. However, certain services require deductibles and coinsurance. 

What does Part A cover? 

Inpatient Hospital Stays: Medicare Part A covers the cost of inpatient hospital care, including room and board, nursing services, medications, and certain necessary medical supplies required during your hospital stay. This includes treatment for injuries, surgeries, illnesses, and certain hospital-based tests and procedures. 

Skilled Nursing Facility Care:   Covers short-term skilled nursing and rehabilitation services following a qualifying hospital stay of at least three days. 

Hospice Care:  Provides end-of-life care, including pain management, counseling, and support for patients with terminal illnesses.

Home Health Care:  Covers medically necessary skilled care provided at home for homebound individuals.

Costs of Medicare Part A 

• Premium: Most people do not pay a monthly premium for Medicare Part A, if they (or their spouse) have paid Medicare taxes for at least 10 years (40 quarters). This is known as “premium-free Part A.” 

• Deductible and Coinsurance: Although you may not pay a premium for Part A, you will still have to pay deductible and coinsurance costs when you receive the covered services. 

• Hospital Stays: For each benefit period, you must pay a deductible. After the deductible, you will pay a portion of the cost for each day of your hospital stay beyond a certain number of days. 

Days 1-60: $0 after you pay your Part A deductible 
Days 61-90: $419 each day 
Days 91-150: $838 each day while using your 60 lifetime reserve days 
After day 150: You pay all costs 

• Skilled Nursing Facility Care: After your hospital stay, you may pay coinsurance costs for skilled nursing care if you require a lengthy stay in a facility. 

Understanding Medicare Part B 

Medicare Part B is the portion of Medicare that provides medical insurance for outpatient services such as, doctor visits, outpatient surgeries, preventive services (like screenings and vaccinations), lab tests, and some home health care. Part B also covers durable medical equipment (DME) like wheelchairs and oxygen. Unlike Part A, Part B requires a monthly premium, which is based on income and includes an annual deductible and coinsurance for many services. 

What does Part B cover? 

Doctor Visits: Medicare Part B covers visits to both primary care physicians and specialists for diagnosis, treatment, and monitoring of chronic conditions. This also includes in-office consultations, follow-up visits, and telehealth services. 

Outpatient Services: It covers a wide range of outpatient care that does not require a hospital stay, including, outpatient surgeries and procedures, which could range from minor surgeries, such as the removal of a growth, to more complex outpatient procedures like cataract surgery, emergency services, preventive care, cancer screenings for breasts and colon, immunizations, cardiovascular and diabetes screenings, and annual wellness visits. 

Diagnostic Tests: If your doctor orders diagnostic tests, Medicare Part B will generally cover them, including laboratory tests, X-rays and imaging, Electrocardiograms, and Pulmonary function tests. 

Durable Medical Equipment (DME): Medicare Part B helps cover the cost of Durable Medical Equipment (DME), which includes equipment used at home that is medically necessary. This can help individuals with chronic health issues maintain their independence. Examples include wheelchairs and scooters, walkers and canes, oxygen equipment, blood glucose monitor, prosthetics, and orthotics. 

Mental Health Services: Medicare Part B also covers certain mental health services, which are critical for overall health and well-being like outpatient therapy, which includes therapy for depression, anxiety, and other mental health conditions, psychiatric services, substance abuse treatment, and more. 

Ambulance Services: Part B will help pay for emergency transportation via ambulance services to the nearest medical facility that can provide the necessary treatment. This is particularly helpful for individuals who have severe conditions or are in remote areas where emergency care needs to be transported quickly. 

Other Health Services: Medicare Part B also covers a variety of other health services that are not part of a hospital stay but are important for maintaining good health like outpatient physical therapy, speech therapy, and home health care services. 

Costs for Medicare Part B 

• Monthly premium: In 2025, the standard monthly premium for Part B is $185 (though it may vary based on your income). 

• Annual deductible: You must meet a deductible before Medicare starts to pay. For 2025, the Part B deductible is $257. 

• Coinsurance: After you meet the deductible, you will typically pay 20% of the cost for most services covered by Part B. 

Understanding Medicare Part C 

 Medicare Part C, or Medicare Advantage, is a private insurance alternative to Original Medicare, combining Parts A (Hospital Insurance) and B (Medical Insurance) and often including additional benefits like dental, vision, and prescription drug coverage. 

What does Part C cover? 

• Comprehensive Coverage: Medicare Advantage plans cover everything that Original Medicare covers under Parts A and B, including hospital care, doctor visits, outpatient services, and preventive care. 

• Prescription Drug Coverage (Part D): Many  Medicare Advantage plans include prescription drug coverage, eliminating the need for a separate Part D plan. 

• Dental Care: may cover for routine dental check-ups, cleanings, and possibly more extensive dental treatments. 

• Vision and Hearing: Coverage for eye exams, glasses, and hearing aids. 

Plan Types: 

Medicare Advantage plans come in different types, such as: 

• Health Maintenance Organization (HMO): Requires you to use network providers and get referrals from your primary care doctor for specialist visits. 

• Preferred Provider Organization (PPO): Offers more flexibility in choosing healthcare providers both in-network and out-of-network, though out-of-network care may cost more. 

• Special Needs Plans (SNPs): Tailored for people with specific conditions or circumstances, like chronic conditions or being in a nursing home. 

Cost for Medicare Part C: 

• Premiums: You still pay your Part B premium (which is deducted from your Social Security benefits), in addition to any premium charged by the Medicare Advantage plan.  

• Out-of-Pocket Costs: Medicare Advantage plans often have lower deductibles and copayments than Original Medicare, but they may have different rules for coverage and provider access. You may also need to meet an annual out-of-pocket maximum limit for services. 

Network and Provider Rules: 

Medicare Advantage plans often have provider networks (HMO or PPO plans), and you may need to stay within the network to receive full coverage, except in emergencies. It is important to confirm whether your preferred doctors and hospitals are in-network before enrolling. 

Eligibility: 

To enroll in a Medicare Advantage plan, you must: 

• Be enrolled in Medicare Part A and Part B. 

• Live in the service area of the Medicare Advantage plan you wish to join. 

•  Generally, not available for individuals with End-Stage Renal Disease (ESRD), with some exceptions. 

Understanding Medicare Part D 

 Medicare Part D is a federal program that provides prescription drug coverage, reducing medication costs for beneficiaries. Plans are offered by private insurance companies approved by Medicare. 

What does Medicare Part D cover? 

Medicare Part D helps cover prescription medications, including: 

• Generic drugs: Most common medications in generic form. Cost-effective, common medications. 

• Brand-name drugs: Brand medications that are more expensive. 

• Specialty drugs: Medications used to treat complex or chronic conditions, such as cancer or HIV. 

Part D plans have a formulary (a list of covered drugs), and the medications you need must be listed in the plan’s formulary for them to be covered. If your medications are not listed, you may be able to request an exception or look for an alternative covered drug. 

How does Medicare Part D work? 

• Standalone Prescription Drug Plans: If you have Original Medicare (Parts A and B), you can add a Part D plan for prescription drug coverage. Medicare Advantage Plans (Part C) with Drug Coverage: Some Medicare Advantage plans (Part C) include prescription drug coverage as part of the plan. These are known as MAPD (Medicare Advantage Prescription Drug) plans, and they combine health coverage and drug coverage in one plan. 

Cost of Part D 

Premiums: The monthly premium for a Part D plan can vary based on the plan you choose. The average premium in 2025 is about $46.50 per month, but this can be higher or lower depending on the plan and the region where you live. If your income is above a certain threshold, you may pay a higher premium. 

Deductibles: Most Part D plans have a deductible, which is the amount you pay out-of-pocket before your plan starts paying for your medications. The deductible for 2025 is $590, but not all plans have a deductible. 

Copayments and Coinsurance: After you meet the deductible, you will typically pay a copayment (a fixed amount) or coinsurance (a percentage of the cost) for each prescription. The amount you pay depends on the plan’s formulary, the type of drug, and whether it is generic or brand-name. 

Donut Hole (Coverage Gap): Once you and your plan have spent a certain amount on covered drugs, you may enter the coverage gap or “donut hole”. In this stage, you may pay a larger share of the cost for your medications until you reach the catastrophic coverage phase, where your costs are significantly reduced. 

Conclusion 

Understanding the ABCDs of Medicare helps you make informed choices about your healthcare coverage. Whether you choose Original Medicare or a Medicare Advantage plan, knowing the benefits and costs associated with each part ensures you select the best coverage for your healthcare needs. 

For more information, visit www.sarvacare.com/.