What and How Much Medicare Part A and Part B Cover
Traditional Medicare also known as Part A and Part B don’t cover all the potential costs incurred by doctors and hospitalization. In this section we walk you through what and how much is covered by Parts A and B and then present options for Medigap coverage
What Is Medicare Part A (Hospital Insurance)?
Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care.
How Much Does Part A Cost?
Most people don’t pay a Part A premium because they paid Medicare taxes while working. This is called "premium-free Part A."
If you aren't eligible for premium-free Part A, you may be able to buy Part A if you meet one of these conditions:
- You're 65 or older, you're entitled to (or enrolling in) Part B, and you meet the citizenship or residency requirements.
- You're under 65, disabled, and your premium-free Part A coverage ended because you returned to work. (If you’re under 65 and disabled, you can continue to get premium-free Part A for up to 8.5 years after you return to work.)
In most cases, if you choose to buy Part A, you must also have Part B and pay monthly premiums for both. If you have limited income and resources, your state may help you pay for Part A and/or Part B.
How Do I Get Part A?
Some people automatically get Part A. Learn how and when you can sign up for Part A.
What Does Part A Cover?
To find out if Part A covers something specific, visit Your Medicare Coverage. In general, Part A covers:
- Inpatient care in hospitals (such as critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals)
- Inpatient care in a skilled nursing facility (not custodial or long term care)
- Hospice care services
- Home health care services
- Inpatient care in a Religious Nonmedical Health Care Institution
Note: Staying overnight in a hospital doesn’t always mean you’re an inpatient. You’re considered an inpatient the day a doctor formally admits you to a hospital with a doctor’s order. Being an inpatient or an outpatient affects your out-of-pocket costs. Always ask if you’re an inpatient or an outpatient. Read “ Are You a Hospital Inpatient or Outpatient? If You Have Medicare – Ask! ” for more information.
What Is Medicare Part B (Medical Insurance)?
Part B helps cover medically-necessary services like doctors' services, outpatient care, home health services, and other medical services. Part B also covers some preventive services. Check your Medicare card to find out if you have Part B.
How Much Does Part B Cost?
If you have Part B, you pay a Part B premium each month. Most people will pay the standard premium amount. Social Security will contact some people who have to pay more depending on their income. If you don't sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.
How Do I Get Part B?
Some people automatically get Part B. Learn how and when you can sign up for Part B.
What Does Part B Cover?
To find out if Part B covers something specific, visit Your Medicare Coverage. Part B covers two types of services:
Medically-necessary services — Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice. Preventive services — Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
What Is Medicare Part D (Medicare Prescription Drug Coverage)?
Medicare prescription drug coverage is insurance run by an insurance company or other private company approved by Medicare. There are two ways to get Medicare prescription drug coverage: Medicare Prescription Drug Plans. These plans (sometimes called "PDPs") add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
Medicare Advantage Plans (like an HMO or PPO) are other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A and Part B coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called "MA-PDs."
If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other credible prescription drug coverage, you will likely pay a late enrollment penalty.
How Much Does Medicare Prescription Drug Coverage Cost?
Each plan can vary in cost and drugs covered. The Medicare Drug Plan Finder can help you find and compare plans in your area.
Your Part D monthly premium could be higher based on your income. This includes Part D coverage you get from a Medicare Prescription Drug Plan, or a Medicare Advantage Plan or Medicare Cost Plan that includes Medicare prescription drug coverage. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain amount, you will pay a higher monthly premium. For more information, visit Social Security’s website.
Many people qualify to get Extra Help paying their Medicare prescription drug costs but don’t know it. Most who qualify and join a Medicare drug plan will get 95% of their costs covered. Don’t miss out on a chance to save. Extra Help and other programs (like Medicare Savings Programs ) may help make your health care and prescription drug costs more affordable.