Hello there!  Hopefully you’ve visited our page explaining what Medicare is before reading further.  That article will give you a more general understanding of Medicare. Now, let’s dive in a little deeper and explore each part in detail!

Part A | Part B | What Does Medicare A/B NOT Cover | Part C | Part D

First we will cover Parts A and B. Together these parts are known as ‘Original Medicare’ and are the foundation of your Medicare coverage. Then we will look at Part C - Medicare Advantage and Part D -Prescription Drug Insurance. We have in-depth sections devoted to both Part C and Part D.

Part A is generally referred to as Hospital insurance. It provides coverage for you in a variety of inpatient settings and is most commonly associated with helping you cover the cost of being hospitalized in some form.

Part A - Hospital Insurance - helps to cover:

• Inpatient care in a hospital: It covers semi-private rooms, meals, general nursing, and medications as part of your inpatient treatment as well as other hospital services and supplies.  This includes care you receive in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals (not to be confused with Long-term care coverage), inpatient care as part of a qualifying clinical research study, and inpatient mental health care received in a psychiatric hospital or psychiatric unit within a hospital.

• Inpatient care in a hospital does NOT cover: a private room (unless medically necessary), private-duty nursing, a television or phone in your room (if these items are a separate charge), or personal care items like razors or slipper socks.

• Inpatient care in a skilled nursing facility: semi-private rooms, meals, skilled nursing and rehabilitative services,  and other medically necessary services and supplies furnished in a skilled nursing facility. *These services are generally only covered after a 3-day minimum, medically necessary, inpatient hospital stay for a related illness or injury.

Curious about the difference between inpatient and outpatient? Read this.

• Hospice care: All items needed for pain management and symptom management; Medical, nursing, and social services; drugs; durable medical equipment; aide and homemaker services; spiritual and grief counseling.

• Home health care: Medically necessary part-time or intermittent skilled nursing care; physical, speech and occupational therapy; medical social services, part-time or intermittent home health aide services, durable medical equipment, and medical supplies for use at home.

  • You must be “Homebound”.

  • You pay nothing for home health services, however you will pay the 20% for Medicare- covered durable medical equipment and the Part B deductible applies.

• Inpatient care in a religious non-medical health care institution: inpatient - non-religious, non-medical items and services such as: room and board, or any items that don’t require a doctor’s written order.

• Blood: You are responsible for hospital costs for the first 3 units of blood, unless the hospital is able to get the blood from a blood bank or you are able to have the blood donated by someone else.

As always, Our ‘Even Better’ Medicare plan experts are happy to help walk you through how Part A works should you have any questions! Or continue on to:

Part A | Part B | What Does Medicare A/B NOT Cover | Part C | Part D

Part B is generally referred to as Medical insurance, however it is important to remember that it covers things beyond just a simple doctor’s visit or outpatient procedure.  In fact it can even cover certain things while you are hospitalized.  

Part B - Medical Insurance - helps to cover the following items and more:

• Medically necessary doctors’ services

• Outpatient Care

• Home Health Services

• Durable Medical Equipment (DME): Medicare covers items like oxygen and oxygen equipment, wheelchairs, walkers, and hospital beds ordered by a doctor or other health care provider enrolled in Medicare for use in the home. Some items must be rented. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

  • **Make sure your Doctors or Durable Medical Equipment Suppliers are enrolled and participating in Medicare!  If they are not enrolled then Medicare will not pay for the claims they submit on your behalf!!**

• Mental Health Services

• Preventative screening, Yearly Wellness visits, and tests

• Prescription Drugs (limited): Medicare does cover some prescription drugs like injections you receive at a physician’s office, certain oral anti-cancer drugs, drugs administered with durable medical equipment (DME) like nebulizers, or external infusion pump) and immunosuppressant drugs.   

  • **Drugs administered as part of you outpatient services may have a copayment.  However, self-administered drugs (drugs you’d normally take on your own) during your outpatient stay aren’t covered by Part B, but may be covered by your Part D coverage.**

• Vaccines: Medicare Part B covers yearly flu shots, hepatitis B shots, and Pneumococcal shots. However, Part D covers all other recommended adult immunizations (i.e. shingles, TDAP etc) to prevent illness.

• Ambulance services: Medicare will only cover ambulance services to the nearest appropriate medical facility that can care for you.

• Ambulatory surgical centers: These are centers where surgical procedures are performed and the patient is expected to be released within 24 hrs.  Medicare covers the facility service fees related to approved procedures.  In most cases You will be responsible for paying 20% of the Medicare approved amount to both the ambulatory surgical center and the doctor who treats you.  The annual Part B deductible applies.  You will also be responsible for paying 100% of facility services for procedures that Medicare doesn't cover. ( You can research outpatient procedure costs here https://www.medicare.gov/procedure-price-lookup/)

• Blood 

• Cardiac rehabilitation and many types of cardiovascular screenings

• Chemotherapy: Medicare covers Chemotherapy in a doctor's office, freestanding clinic, or hospital outpatient setting.

  • For Chemotherapy in a doctor’s office or freestanding clinic, you pay 20% of the Medicare approved amount and the Part B deductible applies.

  • For Chemotherapy in a hospital inpatient setting, it is usually covered under Part A.

• Chiropractic services: Usually limited to Subluxation (when one or more of the bones of your spine move out of position) of the spine.

• Certain Cancer screenings. 

• CPAP therapy.

• Depression and mental health screenings.

• Diabetes screening, prevention, and self-management trainings.

• Diabetes equipment and supplies: Medicare covers medically necessary blood sugar or glucose testing monitors and infusion pumps and equipment for these items (lancets, test strips, glucose sensors, tubing and insulin), as well as therapeutic shoes (custom molded or extra-depth models) and inserts. 

  • **Some Part D prescription drug plans or Part C (Medicare Advantage) plans may cover insulin, certain medical supplies like syringes, disposable pumps, and some oral diabetes drugs.  You can check with the health plan or ask one of our friendly ‘Even Better’ Medicare plan experts to help verify coverage.**

• Emergency Services

• Hepatitis and HIV screenings

• Home Health

• Obesity counseling

• And more…

For a complete list of Medicare covered services please visit https://www.medicare.gov/coverage or or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

It’s best to think of Part B as coverage for Physician administered services in an outpatient setting.  Don’t fret if that sounds a little confusing. Our ‘Even Better’ Medicare plan experts are happy to help walk you through how Part B works at your convenience! Or visit:

Part A | Part B | What Does Medicare A/B NOT Cover | Part C | Part D

It’s important to remember that Medicare does not cover everything.  If you need certain services that aren’t covered by Part A or B you will likely have to pay for them yourself unless: 

• You have other coverage (Medicaid or Employer sponsored coverage)

• You enroll in Part C Medicare Advantage or certain Medicare Supplement (Medigap) plans.

Here are some items and services that Medicare does not cover**:

• Most dental care

• Eye exams for prescribing glasses

• Routine foot care

• Dentures

• Cosmetic surgery

• Massage therapy

• Routine physical exams

• Acupuncture

• Hearing aids and exams or fitting them

• Long-term care

• Concierge care (also referred to as boutique medicine, direct care, retainer-based medicine)

**Our ‘Even Better’ Medicare plan experts know the Part C (Medicare Advantage) or Medigap plans in your area that may offer coverage for some of the above listed services not covered under Medicare.

Part A | Part B | What Does Medicare A/B NOT Cover | Part C | Part D

Part C is generally referred to as Medicare Advantage. Part C is different than Parts A, B and D because Part C is a category of Medicare insurance products instead of specific part of your health (Part A - Hospital, Part B - Medical, Part D - Prescription Drugs). Medicare Advantage plans are operated by private health insurance companies who are contracted with the federal government and follow rules set by Medicare. 

These plans are designed to cover the 20% gap in your healthcare costs that Original Medicare (your Parts A & B together) does not cover and are required by law to cover all of the services covered under Original Medicare. 

Medicare Advantage plans often include prescription drug coverage at no additional premium  and can be a great way to satisfy Medicare requirements for Part D coverage in order for you to avoid Part D late enrollment penalties.  

Many plans also include additional coverage and benefits that Original Medicare does not offer: vision, dental, hearing, over-the-counter item allowances, no cost gym memberships, private transportation to your doctor visits, tele-health, acupuncture and more.

There are even Medicare Advantage plans tailored to people with chronic conditions like diabetes, cardiovascular disorders and more.  These plans may cover drugs needed to treat your chronic condition at a much cheaper price or may even offer additional wellness benefits proven to help with your specific chronic condition.

For more, visit our Medicare Advantage section, or visit:

Part A | Part B | What Does Medicare A/B NOT Cover | Part C | Part D

Part D is another term for Medicare prescription drug coverage. It is an important part of the federal Medicare program and was created in order to help cover the costs of prescription drugs, which have long been a source of financial ruin for Medicare beneficiaries. Part D plans are offered by health insurance companies and other private companies that must abide by the rules set forth by Medicare.

In general, Part D covers:

• Outpatient prescription drugs.  However, some drugs may be actually covered under Part B - medical insurance instead of Part D.  Drugs covered under other Parts of Medicare and not Part D tend to be drugs that you cannot administer yourself - things like nebulizer solutions administered via a nebulizer machine, chemotherapy, most injections and infusions and more. You can see a list here (https://www.medicare.gov/coverage/prescription-drugs-outpatient).

Part D does not cover:

• over-the-counter medications like cough syrup or antacids. 

• some prescription drugs, such as Viagra, when it is used for erectile dysfunction; medicines used to help you grow hair; medicines that help you gain or lose weight; or most prescription vitamins.

For more, see our section on Part D Prescription drug coverage, or revisit:

Part A | Part B | What Does Medicare A/B NOT Cover | Part C | Part D

Common Questions

Medicare Parts Misconception 

Keep in mind that even though each part of Medicare has a specific function, some services  you might assume would be covered under the specific part actually may be covered by a different part of Medicare.  For instance, many people often assume that ALL of their prescription drugs are only covered under Part D, which may not be true because that drug is actually covered by Part B instead.

This is always a confusing concept for most people, and for good reason.  The difference between inpatient and outpatient is minimal.

**Staying overnight in the hospital does not automatically mean you are an inpatient!**  To be considered inpatient, your attending doctor must order your hospital admission and the hospital must formally admit you.  Without being formally admitted, even if you are receiving treatment in the emergency room or you end up staying overnight, you may still be considered an outpatient.  

Why is that important, you ask?

Your patient status can greatly affect the rates you’ll pay and may also affect your Part A coverage if/when you are admitted to a skilled nursing facility. Medicare recommends always asking the hospital, doctor, or hospital patient advocate each day during your stay whether you are inpatient or outpatient. 

Part A | Part B | What Does Medicare A/B NOT Cover | Part C | Part D

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