What Do Medicare Parts A, B, C, and D Cover? A Simple Guide
Understanding what each part of Medicare covers is the first step in managing your healthcare. The system is broken down into four distinct Parts (A, B, C, and D) each with a specific purpose. Knowing what each Part is responsible for is crucial, especially when you need to challenge a coverage denial.
Below is a straightforward breakdown of what to expect from each Part of Medicare.
Medicare Part A: Hospital Insurance
Part A is your hospital insurance. It primarily covers services related to inpatient care, such as:
Inpatient care in a hospital.
Skilled nursing facility care.
Hospice care.
Some home health care.
Medicare Part B: Medical Insurance
Part B is medical insurance that covers the services you need to prevent or treat an illness, including:
Medically necessary services (e.g., doctor's visits, outpatient therapy).
Outpatient care and services.
Durable medical equipment (e.g., wheelchairs, walkers).
Certain preventive services.
Medicare Advantage (Part C):
Medicare Advantage plans are offered by private health plans that contract with Medicare. By law, these plans must cover all of the benefits included in Original Medicare (Parts A and B). However, they may also offer:
Supplemental benefits not covered by Original Medicare, such as vision and dental.
Their own rules about how and when services are accessible, such as requiring prior authorization or limiting services to a specific network of providers.
Medicare Part D: Prescription Drug Coverage
Part D is prescription drug coverage offered by private insurance companies. It helps cover the costs of prescription drugs. Each plan manages its own list of covered drugs, known as a formulary, and may use rules like tiers and prior authorizations.