Medicare Coverage

Original Medicare (Parts A and B) covers hospitalization, home health care, doctor visits, preventative care and more. Part D covers prescription drugs. Part C, also known as Medicare Advantage, is an alternative to Original Medicare and is provided by federally approved private insurance companies.

What Does Original Medicare Cover?

Original Medicare includes Part A and Part B. There is no monthly fee, or premium, for Part A coverage — but there is for Part B.

Part A and B require you to pay a deductible. Part B also requires copays or coinsurance.

Most prescriptions are not covered under Original Medicare. Benefits such as vision and dental are also excluded.

Medicare Part A

Medicare Part A is emergency insurance. It covers hospital stays and a limited window of skilled nursing care after hospitalization. Hospice care is also covered.

If you receive Social Security for at least four months before your 65th birthday, you will be automatically enrolled in Part A and Part B. If you don’t receive Social Security before turning 65, you’ll need to sign up with Social Security to receive Part A and Part B.

What Part A Covers
  • Inpatient hospital care
  • Skilled nursing facility care
  • Hospice care
  • Home health care
What You’ll Pay for Part A
  • No monthly premium.
  • A yearly deductible of $1,408 in 2020. (Note: You must pay this out-of-pocket amount before Medicare picks up the rest of the bill).
  • Nothing for the first 60 days in a hospital.
  • Nothing for the first 20 days in a skilled nursing facility.
Did You Know?
Most people don't pay a monthly premium for Part A. However, if you worked less than 10 years in the United States before turning 65, you may not qualify for premium-free Part A.

Medicare Part B

Medicare Part B covers most doctor visits, outpatient care, preventive services and some medical supplies. You may face a late enrollment penalty if you don’t sign up for Part B when you first become eligible.

What Part B Covers
  • Doctor visits
  • Lab tests
  • Diagnostic screenings and preventative care
  • Medical equipment
  • Ambulance services
  • Telehealth services
  • Mental health
  • A very limited number of outpatient prescription drugs.
What You’ll Pay for Part B
  • There is a monthly premium of $144.60 in 2020. This may be higher depending on your income. Those with limited income may qualify for Medicaid or other programs that help cover expenses.
  • You pay a deductible of $198 a year.
  • After paying your deductible, you’ll owe 20 percent coinsurance for Medicare-approved services.
  • No cost for most preventative services.

Medicare Advantage (Part C)

Medicare Part C, commonly known as Medicare Advantage, is an all-in-one alternative to Original Medicare. These plans are administered by private insurance companies approved by the federal government.

Medicare Advantage plans combine aspects of Part A, Part B and, usually, Part D drug coverage. Plans may also include other benefits such as vision and dental.

What Part C Covers
  • All the services covered by Original Medicare.
  • Vision, hearing and dental are usually included.
  • Emergency and urgent medical care is always covered.
  • Most plans offer some form of prescription drug coverage.
What You’ll Pay for Part C
  • Costs vary for Medicare Advantage plans.
  • You may pay a premium for Part C in addition to a monthly premium for Part B. The average monthly premium for a Medicare Advantage plan in 2020 is $23.
  • Plans may have a $0 premium or may help pay some or all of your Part B premiums.
Coverage Rules for Part C
In most cases, you’ll need to use doctors inside the plan’s network. Unlike Original Medicare, you may need to get a service or supply approved ahead of time for it to be covered by the Medicare Advantage plan.

Medicare Part D

Medicare Part D covers prescription drugs. This coverage is provided by private insurers that Medicare later reimburses.

What Part D Covers

All Part D drug plans must provide a minimum coverage level set by Medicare. However, the type of drugs covered depends on the formulary. A formulary is a list of prescription drugs covered by the Part D plan. Formularies vary from plan to plan.

Formularies are broken into tiers. Each tier costs a different amount. For example, Tier I drugs may include low-cost generic medications while Tier III drugs may include non-preferred name brand medications.

What You’ll Pay for Part D
  • Medicare Part D costs vary depending on your medications, the plan you select and the pharmacy you use.
  • The average monthly premium in 2020 is $30, according to the Centers for Medicare and Medicaid Services.
Did You Know?
If you’re enrolled in Original Medicare, you must purchase Part D coverage separately. Most Medicare Advantage plans include some Part D coverage.

Medicare Supplemental Insurance

If you’re enrolled in Original Medicare, enrolling in supplemental insurance — known as Medigap — may help cover additional costs such as copayments and deductibles.

Long-term care, vision, dental, hearing aids and eyeglasses generally aren’t covered with Medigap.

Medigap policies are sold by private insurance companies. You pay the insurer a monthly premium for your Medigap policy in addition to your monthly Part B premium.

You can purchase a Medigap policy from any insurer licensed in your state to sell one. If you’re already enrolled in a Medicare Advantage plan, you cannot apply for Medigap coverage.

Last Modified: May 18, 2020

9 Cited Research Articles

  1. U.S. Centers for Medicare & Medicaid Services. (2020, January). 2020 Medicare Costs. Retrieved from https://www.medicare.gov/Pubs/pdf/11579-medicare-costs.pdf
  2. O’Brien, S. (2019, December 30). Here’s what you need to know about your 2020 Medicare costs. Retrieved from https://www.cnbc.com/2019/12/30/heres-what-you-need-to-know-about-your-2020-medicare-costs.html
  3. U.S. Centers for Medicare and Medicaid Services. (2019, September 24). Trump Administration Drives Down Medicare Advantage and Part D Premiums for Seniors. Retrieved from https://www.cms.gov/newsroom/press-releases/trump-administration-drives-down-medicare-advantage-and-part-d-premiums-seniors
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  7. U.S. Centers for Medicare & Medicaid Services. (n.d.). Part B Costs. Retrieved from https://www.medicare.gov/your-medicare-costs/part-b-costs
  8. U.S. Centers for Medicare & Medicaid Services. (n.d.). Understanding Medicare Advantage Plans. Retrieved from https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf
  9. U.S. Centers for Medicare & Medicaid Services. (n.d.). What’s Medicare Supplement Insurance (Medigap)? Retrieved from https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap