Medicare Basics

Part A covers inpatient hospital stays, hospice care, nursing home costs, and even limited home health benefits. The types of hospitals covered under Medicare Part A include:

• Acute care hospitals (meaning urgent or immediate need)
• Critical access hospitals
• Long-term care hospitals
• Inpatient rehabilitation centers
• Mental health care facilities
• Some clinical research studies

Medicare Part A (and Part B) covers some in home medical care for individuals who meet CMS' criteria for such care. Eligibility for such care must be documented during a face-to-face visit with a qualified provider and provided by a Medicare certified home health provider. See Home Health Services Coverage for more information

These at home services can include:

• Physical therapy
• Part-time skilled nursing services
• Speech and language pathology services
• Part-time home health aide care
• Medical social services
• Occupational therapy
• Durable medical equipment

Additional care covered by Part A:

• Skilled Nursing Care

If you need skilled nursing care, these services must be provided at a Medicare-certified facility in order to meet coverage requirements. To meet coverage requirements for a nursing home, your doctor must certify that you need daily, skilled nursing services that cannot be given in your home. This can include things like IV medications or physical therapy. Medicare Part A won’t cover long-term or personal care.

• Hospice Coverage

Hospice care focuses on palliative, not curative, care during which the terminally ill patient is made as comfortable as possible. Hospice care under Medicare Part A focuses on palliative care for individuals with a terminal illness, emphasizing comfort and quality of life. It includes a wide range of services such as nursing care, medications, medical equipment, and counseling. If a patient requires hospitalization for pain or symptom management, Medicare Part A covers the full scope of medically necessary services—not just room and board—provided the hospice team arranges the care.

Medicare Part B is medical insurance that helps cover medically necessary services and supplies needed to diagnose or treat a medical condition. It also includes preventive services to help detect or prevent illnesses at an early stage. Some of the services covered under Medicare Part B include:

• Outpatient care
• Ambulance services
• Durable medical equipment
• Preventative services

In some instances, Medicare Part B will also cover intermittent or part-time rehab and home health services.

Medicare Part C, also called Medicare Advantage, is an alternative way to receive your Medicare Part A and Part B benefits through a private insurance company approved by Medicare. Plans must cover all medically necessary services that Original Medicare covers, except hospice care and certain clinical research costs, which Original Medicare continues to cover. Many plans also include Part D prescription drug coverage and may offer additional benefits such as routine dental, vision, hearing, fitness, or over-the-counter allowances. Benefits and availability vary by plan and service area.

Common Medicare Advantage plan types include:

• Health Maintenance Organization (HMO) plans
• Preferred Provider Organization (PPO) plans
• Private Fee-for-Service (PFFS) plans
• Special Needs Plans (SNPs)

Other plan types include HMO Point-of-Service (HMOPOS) and Medical Savings Account (MSA) plans. Premiums, deductibles, copayments, coinsurance, provider networks, and coverage rules vary by plan.

Learn more about Medicare Advantage Plans

Medicare Part D helps cover prescription drugs. Coverage is available through a standalone Medicare prescription drug plan or, in many areas, through a Medicare Advantage plan that includes drug coverage. Premiums, formularies, pharmacy networks, deductibles, copayments, and coinsurance vary by plan.

You may enroll in a standalone Part D plan if:

• You are enrolled in Medicare Part A or Part B.
• You live in the plan’s service area.

When comparing plans, review whether your prescriptions are on each plan’s formulary, the applicable drug tiers and utilization rules, and whether your preferred pharmacies are in network. Medicare Part D has three coverage stages: deductible, initial coverage, and catastrophic coverage. Once you reach the annual out-of-pocket spending limit, you pay $0 for covered Part D drugs for the remainder of the calendar year.

Learn more about Medicare Part D