Medicare has four parts but which ones are right for you? It is important to know how to make the Medicare alphabet work for you. First, you need to know what each part covers.

Part A is your main hospital coverage. What makes it tricky is that it does not cover ALL the care you receive in a hospital. For one, any physician fees will default to Medicare Part B. Also, even if you stay in a hospital overnight, you are not necessarily an IN-patient. You could be placed under observation instead … for days! You need inpatient orders on your medical chart for Part A coverage to kick in. Be sure to ask your healthcare provider about your orders.

Part A also covers care associated with any inpatient hospital stays once you leave the hospital, whether it’s getting care at home or in a skilled nursing facility. It also covers end of life care under hospice.

Inpatient hospitalizations	Inpatient only surgeries	Skilled nursing facility stays (limited)
Home health services	Hospice care

Most of the care you receive will be under the Part B umbrella. You will pay 20% for most of the services listed below. The exception are preventive services which may be free to you if your doctor “accepts assignment”. That means that your doctor not only takes Medicare, they also signed a contract with the government that does not allow them to charge more than what Medicare recommends.

Doctor and other provider visits	Diagnostic tests	Diabetic supplies
Dialysis	Durable medical equipment (DME)	ER and urgent care visits
Imaging studies	Laboratory studies	Medications (limited)
Observation hospitalizations	Outpatient surgeries	Physical, occupational, and speech therapy
Physician fees for inpatient hospitalizations	Preventive screening tests	Telehealth (limited)
Vaccines (limited)	Welcome to Medicare Visit (once)	Wellness visits (annual)

This is not an all inclusive list by any means but it gives you a sense of the breadth of care you will receive with Medicare Part B.

Part C, also known as Medicare Advantage, is an alternative to Original Medicare. It covers everything that Part A and Part B do but it goes a step further. These plans allowed to cover extra services, referred to as supplemental benefits, that Original Medicare does not cover.

Dental benefits	Fitness benefits	Foreign travel emergency coverage
Hearing benefits	Home safety devices and modifications	In-home support
Over-the-counter drugs	Telehealth coverage	Transportation for non-emergency care
Vision benefits	Wellness programs

Some of these plans even have prescription drug coverage included so you would not need to enroll in a separate Part D plan (see below). That makes them an enticing all-in-one solution.

These benefits are meant to entice you but be careful. Unlike Part A and Part B, these plans are managed by private insurance companies. These insurers have signed a contract with the government that requires them to meet certain standards for care and coverage but their plans are limited to a local network of providers and facilities. This could leave you without coverage if you have to go out of network for any reason, especially when you travel.

Part B is unlikely to meet your needs when it comes to drug coverage. Most medications taken by mouth are not covered, unless they are for chemotherapy, immunosuppressive medications for people who have had organ transplants, or medications used by people with end-stage renal disease. If you need any other kind of medication, you’re going to need additional coverage. That is where Part D comes in.

Part D coverage is broad and that’s great news! The federal government requires these plans cover all drugs in each of six drug classes (see below). They also cover at least 2 drugs in most other drug categories. They never cover over-the counter drugs, drugs purchased from other countries, vitamins/minerals (except for fluoride preparations, niacin, prenatal vitamins, and Vitamin D for a medical reason), or drugs used for the following purposes: cosmetic reasons, cough/cold symptoms, erectile dysfunction, fertility, hair growth, or weight management.

Anti-seizure medication	Antidepressant medication	Antipsychotic medication
Cancer medication (including chemotherapy and immunotherapy)	HIV/AIDS medication	Immunosuppressant medication (i.e., for people who have had organ transplants)

Like Medicare Advantage, Part D plans are privatized, i.e., they are run by private insurance companies that signed a contract with the federal government. Although the government put a cap on how much you can be charged for a deductible each year, they do not regulate how much you will pay in coinsurance or copays for each drug. You will definitely want to shop around for a plan that covers the medications you need at the most affordable rate.

100-16: Medicare Managed Care Manual. (2022). CMS.gov. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS019326

CY 2023 Medicare Advantage and Part D Final Rule (CMS-4192-F). (2022). CMS.gov. https://www.cms.gov/newsroom/fact-sheets/cy-2023-medicare-advantage-and-part-d-final-rule-cms-4192-f

What Medicare Part D drug plans cover | Medicare. (2022). Medicare.gov. https://www.medicare.gov/drug-coverage-part-d/what-medicare-part-d-drug-plans-cover