Medicare Parts A, B, C & D — Explained Simply
Medicare has four main parts, each covering different aspects of your health care. Here's everything you need to know — in plain English, no jargon.
Hospital Insurance
Inpatient & Facility Care
What It Covers
- Inpatient hospital stays
- Skilled nursing facility care (after a qualifying hospital stay)
- Hospice care
- Some home health care
- Inpatient care in a religious nonmedical health care institution
What It Does NOT Cover
- ✕Private-duty nursing
- ✕Personal care items (TV, phone in hospital room)
- ✕Long-term custodial care
- ✕Most dental, vision, and hearing care
Cost Breakdown
Free if you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters).
Medical Insurance
Doctors & Outpatient Care
What It Covers
- Doctor visits and specialist consultations
- Outpatient hospital care and surgery
- Preventive services (annual wellness visit, screenings)
- Durable medical equipment (wheelchairs, walkers, oxygen)
- Mental health services
- Lab tests, X-rays, and diagnostic imaging
- Ambulance services
- Some home health care
What It Does NOT Cover
- ✕Routine dental, vision, and hearing care
- ✕Prescription drugs (covered by Part D)
- ✕Cosmetic surgery
- ✕Acupuncture (except for chronic low back pain)
- ✕Long-term custodial care
Cost Breakdown
Higher-income beneficiaries may pay more due to IRMAA surcharges. Lower-income individuals may qualify for help paying this premium.
Medicare Advantage
All-in-One Private Plans
What It Covers
- Everything Parts A and B cover
- Usually includes Part D prescription drug coverage
- Often includes dental, vision, and hearing benefits
- May include fitness benefits (SilverSneakers)
- May include transportation to medical appointments
- Over-the-counter allowances on some plans
What It Does NOT Cover
- ✕Out-of-network providers (in most HMO plans)
- ✕Care outside the U.S. (generally)
- ✕Some services may require prior authorization
Cost Breakdown
Many plans have $0–$60 premiums, but you still pay your Part B premium. Costs vary significantly by plan and location.
Prescription Drug Coverage
Medication Cost Help
What It Covers
- Prescription medications on the plan's formulary (drug list)
- Generic and brand-name drugs
- Specialty medications
- Vaccines not covered by Part B
What It Does NOT Cover
- ✕Drugs not on the plan's formulary
- ✕Over-the-counter medications
- ✕Drugs used for weight loss or gain
- ✕Fertility drugs
Cost Breakdown
Premiums vary by plan. Higher-income beneficiaries pay an IRMAA surcharge. Late enrollment penalties apply if you don't sign up when first eligible.
When Can You Enroll?
Missing your enrollment window can mean penalties and gaps in coverage. Here are the key periods to know.
Initial Enrollment Period
3 months before, the month of, and 3 months after you turn 65. This is your primary window to enroll without penalty.
General Enrollment Period
If you missed your Initial Enrollment Period, you can sign up here — but late enrollment penalties may apply.
Annual Enrollment Period
Switch between Original Medicare and Medicare Advantage, or change your Part D drug plan. Changes take effect January 1.
Special Enrollment Period
Losing employer coverage, moving out of a plan's service area, or other qualifying events allow you to enroll or change plans outside normal windows.
Late Enrollment Penalties Are Permanent
If you don't sign up for Part B when you're first eligible, your monthly premium may go up 10% for each 12-month period you were eligible but didn't enroll. For Part D, the penalty is 1% of the national base premium for each month you went without coverage. These penalties last as long as you have Medicare. Don't wait — call me to make sure you enroll on time.
Still Have Questions About Medicare?
I've been helping Idahoans navigate Medicare since 1994. Let's talk through your specific situation — free of charge, no obligation.