What Does Medicare Actually Cover? A No-Jargon Breakdown

Medicare can feel like a different language. Part A, Part B, Part C, Part D, Medigap, premiums, deductibles, formularies, networks. Understanding what each term means is an important first step toward understanding your coverage.

Here’s a plain-language breakdown.

Part A: Hospital Coverage

Part A is Medicare’s hospital insurance.

It helps cover certain inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.

Think of Part A as coverage primarily associated with hospital and inpatient services.

Part B: Medical Coverage

Part B is Medicare’s medical insurance.

It helps cover services from doctors and other healthcare professionals, outpatient care, durable medical equipment, certain home health services, and many preventive services.

Part B is generally associated with medical care you receive outside of an inpatient hospital stay.

Part C: Medicare Advantage

Part C is another way to receive your Medicare benefits.

Medicare Advantage plans are offered by Medicare-approved private health plans. They provide Part A and Part B coverage and most include prescription drug coverage.

Depending on the plan, Medicare Advantage may also include additional benefits. Plans can have different provider networks and rules for accessing certain services.

Part D: Prescription Drug Coverage

Part D helps cover prescription medications.

You can generally get Part D through a separate Medicare prescription drug plan if you have Original Medicare, or through a Medicare Advantage plan that includes drug coverage.

Each plan has a formulary, which is the plan’s list of covered medications. Formularies can vary between plans.

What About Medigap?

Medigap is different from Medicare Advantage.

Medigap policies are supplemental insurance policies sold by private companies that can help pay certain costs that Original Medicare does not cover.

You cannot use Medigap with a Medicare Advantage plan.

Putting the Pieces Together

Here’s the simplest way to think about Medicare:

Part A: Hospital and inpatient coverage

Part B: Medical and outpatient coverage

Part C: Medicare Advantage, an alternative way to receive Part A and Part B benefits through a private Medicare-approved plan

Part D: Prescription drug coverage

Medigap: Supplemental coverage that can help with certain Original Medicare costs

Your actual coverage and costs depend on the Medicare option and plan you choose.

What Should You Check?

When reviewing Medicare coverage, consider:

• Which doctors and hospitals you use
• Your prescription medications
• Your expected healthcare needs
• Monthly premiums
• Deductibles and copayments
• Out-of-pocket costs
• Provider networks
• Additional benefits
• Rules such as referrals or prior authorization

If you’re unsure how the different parts of Medicare apply to you, Medicare.gov and your healthcare or Medicare counseling resources can help you understand your options.

Champion Health Plan is here to help you better understand your Medicare coverage and available benefits.

Explore Benefits

This article is for educational purposes only and is not a substitute for official Medicare guidance or personalized insurance advice. Medicare coverage, costs, benefits, and plan availability can change.

References

1. Medicare.gov. Parts of Medicare.
2. Medicare.gov. Your Coverage Options.
3. Medicare.gov. Original Medicare. Medicare.gov: Original Medicare