Figuring out the parts of Medicare can be both intimidating and time-consuming, especially if you have been confusing the different Medicare parts with Medicare plans.
But, it doesn’t have to be:
You can actually learn about the different parts of Medicare without pulling out all your hair and that once you have learned each part, they will pretty much always be the same.
In this guide today we will go over how each part works, why they are different, and how to know which parts you do or don’t need.
See Current Costs for Part A and Part B
The program was established in 1965 as a federal government program that offers health insurance if you are 65 or older, under 65 and received Social Security Disability Insurance or people who are under the age of 65 and have End-Stage-Renal Disease, also known as ESRD.
A federal agency, known as CMS or (Centers for Medicare & Medicaid Services is who is responsible for running the program.
Program benefits are being funded by Social Security and Medicare taxes that you pay on your income, from premiums that people pay who have Medicare and as part of the budget of the federal government.
Once you become eligible to enroll, you will start hearing about different parts of Medicare which we discuss below.
There are four main parts, and as we discussed earlier, they can be confusing.
Each part will play its own role in your journey and understanding the differences can save you both money and heartache.
In some instances, it makes a lot of sense to also consider purchasing separate Medicare Supplement Plans aka Medigap Plans to fill in the gap where Medicare does not.
The first part is Part A, which is your hospital insurance.
Your hospital insurance will cover things like the cost of hospice, home health care, skilled nursing facility stays or even semi-private room for stays.
Part A will also cover blood transfusions requiring more than 3 pints of blood.
And guess what:
If you have worked for at the least 10 years in the United States, this benefit is usually free.
When you think about anything revolving around a hospital stay, think of Part A.
If you have a qualifying hospital inpatient stay then Part A will cover a skilled nursing facility stay (SNF).
In order to qualify for the SNF care, your stay has to be a minimum of three days and must be provided at a Medicare-certified facility.
Approved charges for covered skilled nursing care covers, but is not limited to:
Remember, your doctor has to certify that you need daily skilled care that you cannot receive at home.
If you have been diagnosed with a terminal illness and only given six months or less to live, you can get hospice care.
The primary focus of the hospice is to make you as comfortable as possible while you are dealing with your illness, there is no focus on curing your disease.
Before a hospice stay is covered, you must meet all of the following conditions:
Part A hospice care is usually received in your home and it may include:
If you are under hospice care, Part A will sometimes cover some costs that Medicare normally does not include, like spiritual and grief counseling.
Inpatient care can be covered for places like
Keep in mind that Part A does not cover a private room unless it is considered medically necessary.
You also have home health care benefits that are covered when considered to be medically necessary and get ordered by your doctor.
These home health care services can include:
Keep in mind that Part A of Medicare will not cover any type of 24-hour home care, meals, or homemaker services if they aren’t related to your treatment.
It also won’t cover things like help with bathing and dressing, if that is the only care that you need.
Your home health care must be provided by a Medicare-certified home health agency, and a doctor must certify that you are home-bound.
The Three Most Commonly Asked Questions About: Medicare Part A
The next part of Medicare is going to be Part B, this part is responsible for your doctor’s visits.
It is going to mainly be used for outpatient services that are considered to be medically necessary.
It is going to include coverage for things like doctor office visits, preventative care, lab tests, chemotherapy, ambulance rides, diagnostic imaging surgeries or even kidney dialysis.
Medicare Part B is just as important as Part A and together they make up coverage for both at the hospital and outside of the hospital.
There is definitely a chance that your Part B Medicare premiums may go up every year and there is no way to figure out by how much.
For 2025 the standard monthly premiums for Part B will be $185.00 and if you have Social Security benefits it will be deducted from your benefits automatically. Keep in mind that if you are a higher income earner, then you will pay more for your Part B premiums. You can check to see if you fall into the higher income earner category here.
There are a ton of things that you are covered for under Medicare Part B so we put together a list of the items.
Remember that you need to look at the specifics of how each benefit will work when you sign up for your Part B coverage.
Ambulance Services
Cardiac Rehabilitation
Chiropractic Services
Diabetes Self Management Training
Diabetes Supplies
Durable Medical Equipment
Emergency Room Services
Eyeglasses
Kidney dialysis services and supplies
Mental health care (outpatient)
Occupational therapy
Outpatient medical and surgical services and supplies
Physical Exams
Physical Therapy
Prescription Drugs (limited)
Prosthetic and orthotic Items
Pulmonary rehabilitation
Rural health clinics and free or low-cost health clinics
Screenings (tests and scans)
Second surgical opinions
Shots
Smoking cessation (help to quit smoking)
Speech therapy
Telehealth
Transplants and immunosuppressive drugs
Urgently needed care
3 Questions You Should Ask About Medicare Part B
So, Part C of Medicare is different than Part A & Part B in that it is actually you obtaining your Medicare benefits through private insurance companies.
Part C is most known as Medicare Advantage.
These Advantage plans are basically private health plans that you can sign up for instead of Original Medicare.
You will still get Parts A & B of Medicare, and some of them come with Part D as well, all from one private insurance company.
These Advantage plans usually offer a few more benefits than original Medicare; however, some of them will carry an additional monthly premium.
If you are considering an Advantage plan, then you should also think about if you would prefer a Medicare Supplement plan as well.
Knowing the different types of Advantage plans are important, so, below we put together a list of the different types:
The last part of Medicare is going to be Part D, this is going to help cover and lower the cost of your prescription drugs.
Unlike Parts A & B, you don’t enroll in Part D through Social Security, instead, you will go through a private insurance company for your prescription plan.
Each plan will function differently depending on the insurance company, and once you sign up for coverage you would be considered enrolled in Part D.
These plans are optional and will come with an additional monthly premium that you will have to pay the insurance company directly.
If you are taking any prescriptions it is probably worth it to have a plan that will help you with co-pays in regards to prescriptions.
Keep in mind that new legislation passed in 2022 will start to lower your overall out of pocket costs even more over the next few years.
The most confusing part of Medicare can come from trying to figure out Parts vs Plans.
This is because Parts and Plans are both Letter Based.
To clear things up, just remember that there are only 4 parts to Medicare and that Medicare Plans are actually Medicare Supplement Plans also known as Medigap plans.
Medicare Supplement Plans are offered through private insurance companies and are Supplement to Original Medicare.
They basically pickup in areas when Medicare falls short in coverage.
You still have to be enrolled in Part A & Part B of Medicare to qualify for enrollment into a Medicare Supplement plan.
Below we show how Original Medicare (Parts A & B) work with Medicare Supplement Plans:
Now you know the different parts of Medicare and how they work differently from Medicare Plans.
It should be much easier to navigate your way around Medicare and all of its different workings.
If you are turning 65 this year or have already turned 65, get enrolled as early as possible because the longer you wait, the more costly getting enrolled can become.
Getting the correct combination of coverage will be essential when it comes to living your best life and staying healthy.
To ensure you make the most informed and beneficial choices regarding your Medicare coverage, reach out to Senior Benefit Services, Inc., where experienced professionals can guide you through the intricate details and help tailor a plan that best fits your individual needs.
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