Medicare Benefits Explained

Original Medicare (Part A and Part B) is administered by the federal government and is a health insurance program for people 65 years and older as well as individuals with certain disabilities and medical conditions.

Each part of Medicare covers different medical costs. This page outlines the basic benefits of each part of Medicare.

What Does Medicare Part A Pay For?

Medicare Part A (hospital insurance) does not usually require recipients to pay a monthly premium.

Medicare Part A includes coverage for:

• Inpatient hospital stays

• Hospice care

• Skilled nursing facility care

• Some home health care

Although most people do not pay a premium for Medicare Part A, there can be some required out-of-pocket expenses such as a deductible, coinsurance and copayments.

What Are Medicare Part B Benefits?

Medicare Part B (medical insurance) is optional and usually requires a monthly premium.

Medicare Part B includes coverage for:

• Certain doctor's services

• Outpatient care

• Medical supplies and durable medical equipment (DME)

• Preventive services

Medicare Part B requires an annual deductible, as well as coinsurance and/or copayments you are typically required to pay for covered services.

What Is Covered by Medicare Part C?

Medicare Part C (Medicare Advantage) is not administered by the federal government. Instead, Part C plans are sold by private insurance companies as a replacement for Original Medicare benefits.

By law, Medicare Advantage plans must provide at least the same benefits as Original Medicare. Sometimes, Medicare Advantage plans will include prescription drug coverage, vision, dental and wellness programs, depending on which plan you choose. 

Some Part C plans may offer coverage for things like non-emergency medical transportation, caregiver support services and home modifications related to aging in place.

Medicare Advantage allows you to bundle your Medicare coverage into one plan.

Medicare Advantage plan premiums, deductibles, coinsurance and copayments vary by plan. Some Medicare Advantage plans feature $0 monthly premiums.

What Does Medicare Part D Cover?

Medicare Part D prescription drug plans are sold through private insurance companies to help cover the costs of prescription medications.

These plans work alongside your Original Medicare coverage. Part D plan premiums, deductibles, coinsurance and copayments may vary by plan. Some Part D plans feature $0 deductibles.

If you think Medicare Part D is right for you, it is important to enroll in a plan when you are first eligible so that you do not have to pay a late enrollment penalty.

If you are enrolled in a Medicare Part C plan that includes prescription drug coverage, you are not eligible to enroll in a Medicare Part D plan.

If you do enroll in a Medicare Part D plan while you have Medicare Advantage, you will likely be disenrolled from Medicare Part C and automatically enrolled in Original Medicare

You can be enrolled in Original Medicare, a Medicare Part D plan and a Medicare Supplement Insurance (Medigap) plan at the same time.

You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

What Are Medicare Supplement Plans and What Do They Cover?

If you are enrolled in Original Medicare, you may be eligible for a Medicare Supplement Insurance plan.

Also known as Medigap, Medicare Supplement Insurance helps cover some of the out-of-pocket costs of Medicare Part A and Part B, such as deductibles, copayments and coinsurance. 

Medigap plans are sold by private insurance companies. There are 10 different standardized Medigap plans that are available in most states. Each type of plan offers a different combination of benefits.

You can reference the chart below to compare 2023 Medicare Supplement plans.

Medicare Supplement plans are accepted by any health care provider who accepts Medicare, in any location in the U.S.

What Is Not Covered by Medicare?

Between the four parts of Medicare, you can obtain coverage for a wide variety of products and services. But there are a few things that are not covered by any part of Medicare.

These non-covered services include:

• Cosmetic procedures

• Acupuncture and other alternative medicines

• Medicinal marijuana and CBD oil

• “Comfort items” like a hospital TV or private room

• Long-term care

• Most chiropractic services

• Routine foot care

Some Medicare Advantage plans and Medicare Supplement plans may include coverage for items that are not covered by Original Medicare. Be sure to speak with your plan carrier to find out exactly what is covered by your plan.

How did Medicare benefits change in 2020?

Medicare benefits are subject to change every year, but there are a few key changes that happened in 2020.

Some notable Medicare changes in 2020 include:

• Medigap plans will no longer be allowed to cover the Medicare Part B deductible for anyone who becomes eligible for Medicare on or after January 1, 2020. Two Medigap plans cover the Part B deductible: Medigap Plan F and Plan C.

  If you are eligible for Medicare before that date, you may be allowed to apply for a Medigap plan that includes coverage of the Part B deductible after 2020, if either Plan F or Plan C is available where you live.

  If you are already enrolled in Plan F or Plan C, you will be able to keep your plan in 2020 and beyond.

• The Medicare Part D “donut hole,” is a temporary period during which a Part D plan doesn't provide coverage for your drug costs. You reach the Part D donut hole after you  pay a certain amount in out-of-pocket costs for your covered drugs in a year.

  In 2020, the Part D donut hole closed. After 2020, once you reach this level of drug coverage, you will be responsible for no more than 25% of the cost for covered brand-name drugs and generic drugs until you reach the out-of-pocket spending limit (which is $5,030 for the year in 2024).

Learn About Your Medicare Coverage Options

For more information about your Medicare options, speak with a licensed agent today.