Medicare Parts A, B, C, & D Explained

Medicare Parts A, B, C, and D cover health care for Americans 65 and older, including hospital care, doctor visits, and prescription drugs.

Parts A and B are the most widely used. Part A covers hospital care, while Part B covers medical services like doctor visits. If you’re unsure which coverage fits your needs, our Medicare guide can help you compare your options.

We break down what each part of Medicare covers, along with common exclusions and costs.

To speak with a licensed insurance agent about your Medicare needs, call (855) 634-0435 today. You can also enter your ZIP in our free tool to compare quotes.

What are Medicare Parts A, B, C, and D?

What are Medicare Parts A, B, C, and D? Medicare Parts A and B make up Original Medicare and provide hospital and medical coverage.

Medicare Part C, also called Medicare Advantage, includes Part A and Part B and may offer extra benefits.

Each part of Medicare covers different services and has its own costs, provider rules, and limits. Knowing how they work together can help you choose coverage that fits your health care needs and budget.

Medigap, also called Medicare Supplement Insurance, helps pay for deductibles, coinsurance, and copayments under Parts A and B. Many people choose these plans to lower their out-of-pocket health care costs.

Is Medicare Part C better than Parts A and B? Compare Medicare Advantage vs. Original Medicare to see which better fits your needs.

Medicare Parts A, B, C, and D Compared

For example, Medicare Advantage Plans often also include Medicare Part D, which helps cover the cost of prescription drugs.

Keep reading for a full breakdown of each of the parts of Medicare that make up both the Original and Advantage plans.

Medicare Part A

Medicare Part A helps cover hospital care and other types of inpatient services.

It also helps pay for care in skilled nursing facilities, hospice care, and some home health services.

Most people don’t pay a monthly premium for Part A because it’s funded in part by payroll taxes.

Part A does have limits. It only covers short-term stays in a skilled nursing facility, and you must first have a qualifying three-day hospital stay. It doesn’t cover long-term custodial care when you only need help with daily activities.

Some services must also be medically necessary for coverage to apply.

Hospice care is covered when a terminal illness is confirmed. Part A uses a benefit period that resets after 60 days. If you need care after that time, you may have to pay the deductible again.

Medicare Part A: Hospital Insurance

Each benefit period comes with a deductible you must pay before coverage begins. After a set number of days in the hospital or a skilled nursing facility, daily coinsurance may apply.

These out-of-pocket costs can add up, so it’s important to understand how your coverage works.

Medicare Part B

Medicare Part B is an important coverage that helps pay for the majority of health care needs and complements Medicare Part A by covering health care outside of the hospital.

Part B typically covers 80% of approved medical costs after meeting your annual deductible, leaving you responsible for the remaining 20%.

If you’re considering which parts of Medicare to buy, make sure your plan includes Medicare Part B, as it will help with care such as regular doctor appointments and lab tests.

Part B enrollees pay a standard monthly premium, but higher-income individuals may owe an added surcharge called the Income Related Monthly Adjustment Amount.

As with Medicare Part A, policyholders must meet certain criteria to have Medicare Part B help cover some health care aspects, which is typical of any health insurance coverage.

For example, you must have a doctor’s prescription to get medical equipment like hospital beds or oxygen covered.

Medicare Part B: Medical Insurance

Most customers will make the most use out of coverage from Medicare Part B, as it helps cover preventive care, doctor visits, and testing.

Taking advantage of coverage for screening, vaccinations, and more will also help customers stay on top of their health and catch conditions earlier.

Medicare Part C

Medicare Part C, also known as a Medicare Advantage plan, is slightly different than the Original Medicare plans we talked about earlier.

Like Original Medicare Plans, Medicare Part C also combines Part A and Part B, but it may also include Part D, which helps cover prescription drugs.

The catch is that customers have to sign up to get Medicare Advantage through a private insurance plan, which can be more time-consuming. Read More: How to Sign up for Medicare

Medicare Advantage may also not be as widely accepted by health care providers as Medicare Original plans, so it’s important to check provider coverage beforehand.

Medicare Part C: Medicare Advantage

However, Part C Medicare Advantage plans may include additional benefits. Some plans may also include Part D prescription drug coverage. The disadvantage of Medicare Advantage is that these plans may not be as widely accepted as Original Medicare (Parts A and B).

Benefits also vary based on your state laws and the provider you choose.

Always compare Medicare plans online before you buy or call (855) 634-0435 to speak with a local agent about your options.

Medicare Part D

What does Medicare Part D cover? The primary purpose of Medicare Part D is to help cover prescription drug costs, a large expense for many older adults and people managing chronic health issues.

It can be added to your Medicare plan but isn’t automatically included in Original Medicare or Medicare Advantage plans.

To get Medicare Part D, you must have at least Medicare Part A coverage.

For example, you may still have a deductible or copay you have to meet on your Medicare plan, so prescription drugs may not be 100% covered by Part D.

In some cases, Medicare Part B covers your medications instead of Part D.

Part B generally pays for drugs given in a doctor’s office or outpatient clinic, including injections or infusions that require medical supervision.

It can also cover medications directly connected to outpatient treatments. This includes drugs used during dialysis, immunosuppressive medications after a Medicare-covered organ transplant, and certain vaccines like the flu, pneumonia, and COVID-19 shots.

Learn More: Does Medicare cover prescription drugs?

If you’re hospitalized, Medicare Part A may cover the medications you receive during your inpatient stay.

These drugs are included in the hospital’s bundled payment, so they’re not billed separately under Part D.

Medicare Part D: Prescription Drug Coverage

However, Medicare Part D can still be a significant financial help to those on multiple medications, especially those who need very expensive medications.

If you have multiple medications that need to be filled regularly, you should consider looking into Medicare plans that include Medicare Part D.

How Much Medicare Parts A, B, C, & D Costs

Curious about your Medicare Parts A, B, C, and D cost? Medicare Part B has a monthly premium (based on your income) and a yearly deductible. After that, you usually pay 20% of the cost for most doctor visits and outpatient care.

Standard copays and deductibles are the same on most plans and generally increase after certain time limits.

Medicare Premium, Copay, & Coinsurance Breakdown

For example, Medicare Part A covers skilled nursing care at $0 for days 1 through 20. From days 21 through 100, the cost is $209 per day.

With Medicare Part A, copays and coinsurance start at $0 for a set period. After that, daily copays or coinsurance apply. Learn More: How much does Medicare cost?

Premiums can vary if you choose a Medicare plan through a private insurance company.

Costs for Medicare Advantage (Part C) and Part D plans vary based on your location, provider network, and drug coverage.

It’s a good idea to compare plans each year during Open Enrollment. Many Medicare Advantage plans include a yearly out-of-pocket maximum, which helps limit how much you spend on covered care.

Not sure what Medicare Parts you should pay for? The majority of Medicare holders use their Medicare coverage for hospital stays, outpatient care, and doctor visits.

Because of this, you should at least consider having Medicare Part A and Part B on your Medicare insurance plan. When comparing plans, look at your total yearly costs, not just the monthly premium. This includes deductibles, copays, and whether your doctors are in network.

Coverage is used less for prescription drugs, so Medicare Part D may not be necessary for all customers to purchase. Even if you don’t take medications now, a low-cost Part D plan can help you avoid penalties and give you coverage later if your needs change.

However, there is a Medicare enrollment late fee for buying Medicare Part D late, so if you think you’ll need it, it is best to buy it when you first enroll in Medicare coverage.

Medicare Parts A, B, C, & D Exclusions

Medicare helps cover a majority of medical costs, but like all health care plans, it doesn’t cover every medical bill that a patient receives.

There are certain exclusions to Medicare insurance coverage that are specific to each Medicare Part’s coverage policies.

For example, Medicare Part D only covers medications that are considered medically necessary. It doesn’t cover drugs used for cosmetic or fertility purposes.

If you’re hospitalized, Medicare Part A won’t cover private-duty nursing or a private room unless it’s medically necessary.

Medicare Coverage & Exclusions by Part

If you want help with out-of-pocket costs like copays and deductibles for covered services, you may want to consider a Medigap supplemental insurance (Medigap) plan.

Even with these exclusions, Medicare still provides valuable coverage. Each part offers benefits that help offset its limits.

How to Choose the Right Medicare Plan

Choosing a Medicare plan starts with a simple goal: find coverage that fits your health care needs and your budget without limiting how you get care. These steps can help you narrow your health insurance options and choose with confidence.

You can also use a licensed Medicare agent or our online comparison tool to review plans, compare costs, and see what’s available in your area.

Step 1: Review Your Health Care Needs

Take a close look at the care you use now and what you expect to need going forward. This includes primary care visits, specialists, and prescription drugs.

Since each part of Medicare covers different services, knowing how you use care will make it easier to choose the right coverage.

Step 2: Decide Between Original Medicare vs. Medicare Advantage

Choose whether you want Original Medicare (Parts A and B) with optional add-ons or a Medicare Advantage (Part C) plan that combines coverage into one plan. Original Medicare gives you broader access to providers, while Medicare Advantage plans often include extra benefits and may be easier to manage.

See if you’re eligible for a Medigap plan, which helps pay for out-of-pocket costs like deductibles and coinsurance that Original Medicare doesn’t cover.

Step 3: Check Prescription Drug Coverage

If you take medications, look closely at how each plan handles drug coverage. Waiting to enroll in Part B or Part D without other qualifying coverage can lead to long-term penalties.

Plans differ in which drugs they cover and how much you’ll pay. Review the formulary and pay attention to pricing tiers, since higher-tier drugs usually cost more.

Step 4: Add Up Your Costs

Look beyond the monthly premium. Consider deductibles, copays, and out-of-pocket limits to understand what you might pay during the year.

For Medicare Advantage plans, review the out-of-pocket maximum, which limits your annual spending on covered services.

Step 5: Check Providers and Benefits

Make sure your doctors and hospitals are included in the network, especially with Medicare Advantage plans.

Review extra benefits like dental or vision and any limits. You can also compare plan ratings on Medicare.gov before signing up.

Comparing Medicare Parts A, B, C, & D

Medicare gives seniors and eligible individuals a way to manage health care costs. Each part covers different needs, including hospital care, medical services, prescription drugs, and bundled plan options.

Learn More: How to Finance What Your Health Insurance Won’t Cover

All Medicare parts include out-of-pocket costs like deductibles and copays. Even so, the coverage can help lower your overall medical expenses.

For example, Medicare Part A is often premium-free for many people and helps cover inpatient hospital stays and hospice care. While it doesn’t cover most long-term care, it can still reduce costs.

Medicare Parts A-D Comparison: Pros & Cons

It’s a good idea to review your coverage each year to make sure it still fits your health needs and budget.

Need more assistance with your Medicare options? Call (855) 634-0435 to speak to a licensed representative or enter your ZIP code to learn more about your Medicare options.