Medicare is divided into four parts, each covering different services. Understanding what each part does — and what it leaves out — is essential to making smart coverage decisions.
Part A: Hospital Insurance
Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
What It Covers:
- Inpatient hospital stays
- Skilled nursing facility care (up to 100 days)
- Hospice care
- Some home health care services
What It Does NOT Cover:
- Long-term care (custodial care)
- Most dental, vision, and hearing
- Private-duty nursing
Cost: $0 premium for most people (if you or your spouse paid Medicare taxes for 10+ years). The 2026 deductible is $1,736 per benefit period.
Key Gap: You pay $0 for days 1-60, then $434/day for days 61-90, then $868/day for "lifetime reserve days" (60 total). After that, you pay everything.
Part B: Medical Insurance
Covers doctor visits, outpatient care, preventive services, and durable medical equipment.
What It Covers:
- Doctor and specialist visits
- Outpatient surgery and procedures
- Preventive services (screenings, vaccines)
- Durable medical equipment (wheelchairs, walkers)
- Mental health services
- Ambulance services
What It Does NOT Cover:
- Most dental, vision, and hearing
- Cosmetic surgery
- Routine foot care
- Care outside the U.S. (with limited exceptions)
Cost: Standard 2026 monthly premium: $202.90. Annual deductible: $283. After deductible, Medicare covers 80% and you pay 20%.
Key Gap: That 20% coinsurance has no annual limit. A $500,000 cancer treatment means $100,000 out of pocket with no cap.
Part C: Medicare Advantage
An alternative to Original Medicare offered by private insurers. Bundles Part A, Part B, and usually Part D into one plan.
What It Covers:
- Everything Part A and Part B cover
- Often includes Part D (prescription drugs)
- May include dental, vision, and hearing
- May include fitness programs (SilverSneakers)
- Annual out-of-pocket maximum
What It Does NOT Cover:
- Out-of-network care (HMO plans)
- Services not covered by Original Medicare
- Care outside the plan's service area
Cost: Often $0 premium (you still pay the Part B premium). Out-of-pocket maximum: $9,250 in 2026.
Key Gap: Network restrictions mean you may not be able to see your preferred doctors. Prior authorizations can delay or deny care.
Part D: Prescription Drug Coverage
Standalone drug plans that work with Original Medicare, or built into Part C.
What It Covers:
- Prescription medications (varies by plan formulary)
- Vaccines covered under Part D
- Some insulin at capped costs
What It Does NOT Cover:
- Drugs not on the plan's formulary
- Over-the-counter medications
- Drugs covered under Part A or B
Cost: Average monthly premium: $34.50 in 2026. Maximum deductible: $615.
Key Gap: Coverage has phases: deductible, initial coverage, coverage gap, and catastrophic. Costs vary significantly depending on which phase you are in.
Quick Comparison
| Part A | Part B | Part C | Part D | |
|---|---|---|---|---|
| Covers | Hospital | Medical/Doctor | All-in-one (private) | Prescriptions |
| Premium | $0 (most) | $202.90 | Varies ($0-$200+) | ~$34.50 |
| Deductible | $1,736/period | $283/year | Varies | Up to $615/year |
| Network | Any Medicare provider | Any Medicare provider | Plan network only | Plan formulary |
Think of it this way: Part A is your hospital card, Part B is your doctor card, Part D is your pharmacy card, and Part C is an alternative that bundles everything into one private plan. Most of my clients do best with Original Medicare (A + B) plus a Medigap plan plus a standalone Part D plan. That combination gives you the most freedom and the most predictable costs.
Knowledge Check
Answer all questions to unlock the next lesson
Q1.Which part of Medicare covers hospital stays and inpatient care?
Q2.What is the relationship between Medicare Part C (Medicare Advantage) and Original Medicare?
Q3.If you have Original Medicare (Parts A and B) only, which of these would you still need to pay for?
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