Q. What does Medicare cover?
The Short Answer
Generally, Medicare covers hospital expenses, physician visits, prescription drugs and skilled nursing care following a hospital stay. Outpatient prescription drugs are covered only if you have a Part D plan.
The program is divided into these four parts:
- Part A – Hospital Insurance. Think of this part as places, like a hospital, hospice or a skilled nursing facility (after a hospital stay). For most people, there is no monthly premium for this coverage. But you may have deductibles and copayment for certain hospital expenses.
- Part B – Medical Insurance. Think of this part as people, like doctors or specialists. This pays for outpatient care at clinics and doctors' offices. You pay a copay of up to 20 percent. In addition, you pay a monthly premium which is set by the federal government each year.
- Part A and B together are sometimes called "traditional medicare" or "original Medicare."
- Part C – Medicare Advantage Program. This program delivers benefits through private managed care networks, like a Preferred Provider Organization (PPO) or Health Maintenance Organization (HMO). They include Part A and Part B benefits. They may also pay for essentials not covered by Medicare, like hearing aids and dental care. Frequently, benefits for Part D (see below) are also included.
- Part D – Prescription Drugs. This pays for prescription drugs. You share in the cost with copays. This coverage is not required but is strongly recommended. You sign up for it with a private insurance company that is paid by Medicare.