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What Does Medicare Cover?

There are four parts of Medicare: Part A, Part B, Part C, and Part D. The different parts of Medicare help pay for different types of health care services, and each has different costs that you may have to pay. Medicare costs depend on what coverage is chosen and on what healthcare services are used. Subject to some limitations on combinations of plans (you must select between Part A and Part D as an example), the different parts of Medicare can be put together in a variety of ways to provide coverage based on your needs.

Medicare Costs

We've defined some key terms, so you better understand each part's coverage benefits. Medicare helps pay for many health care items and services, but you will pay a share of the cost, as well. Your Medicare costs can include:

  • Premiums
  • Deductibles
  • Co-payments
  • Co-insurance

Premiums are payed outright. Deductibles, co-payments (co-pays) and co-insurance are ways that Medicare shares the cost of your care with you (cost sharing).


A premium is a fixed amount that you pay. Depending on your coverage, you may pay a premium to Medicare, to a private insurance company or to both. Most premiums are charged monthly and can change from year to year.


A deductible is a set amount that you pay out of pocket for covered services before your plan begins to pay.


A co-payment, or co-pay, is a fixed amount you pay at the time you receive a covered service. For example, you might pay $12 when you fill a prescription or $20 each time you go to the doctor.


Co-insurance is when you and your plan split the cost of a covered service. For example, your plan might pay 80% and you would pay 20% of the allowed amount.


Part A

What it covers

  • Inpatient Care
  • Hospital Stays
  • Skilled Nursing Care
  • Qualified Home Care
  • Hospice Care

What you'll pay

  • No premium for most people — if owed, up to $506 each month.
  • A per benefit period deductible
  • Coinsurance

Part B

What it covers

  • Outpatient Care
  • Doctor Visits
  • Some Preventive Care
  • Diagnostics Tests and Exams
  • Durable Medical Equipment

What you'll pay

  • A monthly premium — The standard Medicare Part B monthly premium is $164.90 in 2023 and may be higher based on income.
  • An annual deductible — Medicare Part B's deductible is $226 in 2023.
  • Coinsurance — typically pay 20% of the Medicare approved amount for covered services.

Part C

Medicare Advantage

What it covers

All Part A Services

All Part B Services

Some plans may fully cover:

  • Wellness Services
  • Dental Exams
  • Vision Exams
  • Hearing Exams

Some plans may partially cover:

  • Dental Fillings and Crowns
  • Eye Glasses
  • Hearing Aids

What you'll pay

Monthly Premium:

  • The Part C monthly premium varies by plan.

Deductibles, copayments & coinsurance:

  • Varies by plan.

Part D

Prescription Drug Plans

Helps with the cost of prescription drugs not covered by Original Medicare.

Each plan covers different:

  • Brand Name Prescription Drugs
  • Generic Prescription Drugs

Monthly Premium:

  • Varies by plan.

In addition to premiums, you'll also potentially have to pay:

  • The maximum deductible for 2023 is $505, but some plans may offer smaller deductibles.
  • Copays or coinsurance amounts when purchasing prescription drugs.

Medicare Part A Coverage

Medicare Part A is hospital coverage. It covers care you receive while an inpatient in a hospital or skilled nursing facility. Medicare manages Part A coverage and costs based on a benefit period. The Part A deductible, for example, is charged for each benefit period.

Medicare Part B Coverage

Medicare Part B is medical coverage. It covers doctor visits, clinic services and care you receive as an outpatient.

What Part A & Part B (often referred to collectively as “Original Medicare”) Doesn't Cover

Original Medicare (Parts A and B) covers many medical and hospital services, but it doesn't cover everything. Many people are surprised to learn that prescription drugs aren't covered. Prescription drug coverage can be purchased through Medicare Part D, but it's not provided by Part A or Part B. You may have to pay for these costs yourself unless you have other insurance that covers them. Some Medicare Advantage (Part C) plans may help with certain services not covered by Original Medicare, such as prescription drugs.

Here are some other services that are not covered by Original Medicare:

  • Dental exams, most dental care, or dentures
  • Routine eye exams, eyeglasses, or contacts
  • Hearing aids or related exams or services
  • Most care while traveling outside the United States
  • Help with bathing, dressing, eating, etc. (custodial care)
  • Comfort items such as a hospital phone, TV, or private room
  • Long-term care
  • Cosmetic surgery
  • Most chiropractic services
  • Acupuncture or other alternative treatments
  • Routine foot care

Medicare Advantage (Part C) Covers

Medicare Part C also called Medicare Advantage, is an alternative to Original Medicare. These plans combine the coverage of Parts A and B into one plan. They often include prescription drug coverage and other services such as dental, vision and hearing care. Plans may vary with in-network providers.

Medicare Part D Covers

Medicare Part D offers prescription drug coverage. It helps pay for medications your doctor prescribes. You can get a standalone Part D plan or get a Medicare Advantage plan that includes drug coverage.

Medicare Supplement Insurance: Medigap

Medicare Supplement Insurance, also known as Medigap, helps pay some out-of-pocket costs that come with Original Medicare. There are 10 Medicare supplement insurance plans standardized by the federal government. Each is labeled with a letter: A, B, C, D, F, G, K, L, M, and N.

Every plan with the same letter offers the same benefits, no matter what state it's offered in or by which insurance company. The difference is that the level of coverage between plan letters varies. There are standardized plans that cover all Medicare deductibles, copayments and coinsurance, while others require out-of-pocket payments.

Medicare supplement plans provide nationwide coverage. While you may enroll in a plan at any time, you may be denied coverage or charged more based on your health history or if you enroll after the Medigap Open Enrollment Period ends.

Medicare Coverage Combinations:

Additional coverage can be added to Original Medicare, or you can choose a Medicare Advantage plan that has all the coverage you need. You may add a standalone Part D plan, a Medicare Supplement Insurance plan, or both to Original Medicare (Parts A & B).

Medicare Coverage

Part A,

Part B

Original Medicare (Parts A & B) or just Part A, or just Part B

Medicare Coverage

Part A,

Part B

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Part D

Original Medicare (Parts A & B) plus a standalone Part D plan

Medicare Coverage

Part A,

Part B

Plus sign

Part D

Plus sign

Med Sup (Medigap)

Original Medicare (Parts A & B) plus a standalone Part D plan plus a Medicare Supplement Insurance plan (Medigap)

Medicare Coverage

Part A,

Part B

Plus sign

Med Sup (Medigap)

Original Medicare (Parts A & B) plus a Medicare Supplement Insurance plan

Medicare Coverage

Part C

Plus sign

Part D

A Medicare Advantage (Part C) plan with built-in drug coverage

Medicare Coverage

Part C

A Medicare Advantage (Part C) plan without drug coverage

Medicare Coverage

Part C + Part D

A Medicare Advantage (Part C) plan without drug coverage plus a standalone Part D plan. This only works with certain Medicare Advantage plan types

Note: Combination 7 is only available if you choose a Private Fee-For-Service (PFFS) Medicare Advantage plan without drug coverage or a Medicare Savings Account (MSA) plan. These are the only types of Medicare Advantage plans that can be combined with a standalone Medicare Prescription Drug plan.

How do I choose one or more Medicare plans?

Think about your needs so you can see how different coverage options might work for you. Answering the following questions can help you get started.

How is your health?

  • How often do you go to the doctor?
  • What health problems do you have?
  • What medications do you take regularly?

What are your preferences?

  • Which doctors, hospitals and pharmacies do you like to go to?
  • How important is it for you to have access to health care while traveling?
  • What other coverage do you have, such as an employer or retiree plan?

What is your budget?

  • What are you able to pay each month in premiums?
  • How comfortable are you covering co-pays or co-insurance for health services?
  • What is your risk tolerance of high out-of-pocket costs?

Enrolling in a Medicare Plan

Annual Enrollment Period

Medicare's Annual Enrollment Period (AEP) occurs from October 15th to December 7th each year, providing an opportunity for you to evaluate your coverage and adjust if necessary. Whether you want to switch from Original Medicare to a Medicare Advantage plan or make a change within your existing Medicare Advantage options, AEP allows you to ensure that your health needs are met by your plan.

Initial Enrollment Period

The Initial Enrollment Period (IEP) is 7 months long. It includes your 65th birthday month plus the 3 months before and the 3 months after. It begins and ends 1 month earlier if your birthday is on the first of a month. For example – If you turn 65 on November 1, your Initial Enrollment Period is the same as those who have birthdays in October (except for on the 1st of October).

You may enroll in Original Medicare – Part A, Part B or both. You can also choose to join a Medicare Advantage plan (Part C) or a prescription drug plan (Part D).

You will receive your Medicare Benefits card approximately a few months before your 65th birthday. Have this card ready when you call or begin online enrollment. Below is an example of what your Medicare Benefits card would look like

Medicare Card
General Enrollment Period

If you missed your Initial Enrollment Period, you could still sign up for a plan between January 1 - March 31 each year. This is called the General Enrollment Period. Your coverage would start July 1. If you enroll during this time, you might pay a monthly late enrollment penalty if you don't qualify for a Special Enrollment Period.

Medigap Open Enrollment Period

The Medigap Open Enrollment Period is 6 months long. It begins the month you are 65 or older and are enrolled in Medicare Part B. You cannot be denied coverage or charged more based on your health history if you enroll during the Open Enrollment Period. Some states may allow for additional Open Enrollment Periods.

Special Enrollment Period: Working past 65

There are certain situations when you can sign up for Part B (and Premium-Part A) during a Special Enrollment Period without paying a late enrollment penalty. A Special Enrollment Period is only available for a limited time. If you don't sign up during your Special Enrollment Period, you'll have to wait for the next General Enrollment Period, and you might have to pay a monthly late enrollment penalty.

Other FAQs About Medicare Coverage

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