Medicare can initially seem complex, especially when trying to understand what each part covers. If you’re wondering which part of Medicare will cover your hospital care, you’re not alone. This guide will break down the basics of Medicare and clearly explain which part steps in when you need hospital services.
Medicare Part A: Your Hospital Insurance Cornerstone
When it comes to hospital care, Medicare Part A is the segment you need to know. Often referred to as hospital insurance, Part A is designed to cover a significant portion of your expenses when you receive care as an inpatient in a hospital setting.
Specifically, Medicare Part A covers the following services:
- Inpatient Care in Hospitals: This is the core coverage of Part A. It includes your room in a hospital, nursing care, hospital services and supplies, lab tests, medical appliances and equipment provided during your inpatient stay, and rehabilitation services received as an inpatient. It’s crucial to understand that “inpatient” means you’ve been formally admitted to the hospital as an overnight patient by a doctor’s order.
Alt: A hand holding a Medicare card, emphasizing access to hospital insurance benefits under Part A.
- Skilled Nursing Facility Care: If you require skilled care after a hospital stay, such as rehabilitation or specialized nursing care, Part A can help cover this if it’s in a skilled nursing facility (SNF) and meets certain conditions. This is often for a limited time after a qualifying hospital stay.
- Hospice Care: For individuals facing a terminal illness, Part A provides hospice care benefits. This includes pain management, symptom control, and support services for both the patient and their family. Hospice care can be provided at home, in a hospice facility, or in other settings.
- Home Health Care: Part A can also cover some home health services if you are homebound and need skilled nursing care or certain therapy services. This is typically for short-term, medically necessary care at home following a hospital stay or illness.
It’s important to remember that while Medicare Part A is vital for hospital coverage, it doesn’t usually cover the full cost of your care. Beneficiaries are typically responsible for cost-sharing, which can include deductibles, coinsurance, and copayments for Medicare-covered services.
For most individuals, there isn’t a monthly premium for Part A because they or their spouse have accumulated 40 or more quarters (10 years) of Medicare-covered employment. However, if you have less than 30 quarters of Medicare-covered employment, the Part A premium in 2025 can be around $518 per month (it was $505 in 2024). For those with 30 to 39 quarters, the premium is approximately $285 per month in 2025 ($278 in 2024).
Understanding Medicare Part B: Medical Insurance and Beyond
While Part A focuses on hospital inpatient care, Medicare Part B is your medical insurance. Part B covers a wide range of outpatient and medical services. It’s important to understand that Part B does not primarily cover inpatient hospital stays, but it does cover many services you might receive in a hospital as an outpatient, or services related to your hospital care journey.
Here’s a summary of services covered under Medicare Part B:
- Provider Services: This includes medically necessary services from doctors, specialists, and other licensed health professionals. This could be services received in a doctor’s office, hospital outpatient clinic, or other healthcare settings.
- Durable Medical Equipment (DME): Part B helps cover the cost of DME like wheelchairs, walkers, and oxygen tanks, provided they are medically necessary and prescribed by a doctor.
Alt: Durable medical equipment examples, including a wheelchair and walker, highlighting Part B coverage for mobility aids.
- Home Health Services: While Part A covers some home health care, Part B can also cover home health services under different conditions. If you don’t meet the Part A requirements, Part B might still cover home health care if you are homebound and need intermittent skilled nursing care, therapy services, or home health aide services.
- Ambulance Services: Emergency ambulance transportation to a hospital is generally covered by Part B. Limited coverage exists for non-emergency ambulance services when medically necessary and no safe alternative transportation is available.
- Preventive Services: Staying healthy is a priority, and Part B covers many preventive services like flu shots, cancer screenings, and wellness visits, often with no coinsurance.
- Therapy Services: Outpatient physical, occupational, and speech therapy services are covered under Part B when deemed medically necessary.
- Mental Health Services: Part B provides coverage for outpatient mental health care, including therapy and counseling.
- X-rays and Lab Tests: Diagnostic tests and lab work ordered by your doctor are typically covered by Part B.
- Chiropractic Care: Limited chiropractic services are covered by Part B, specifically manual manipulation of the spine to correct subluxation.
- Select Prescription Drugs: While most prescription drugs are covered under Part D, Part B covers a limited number of medications, such as those administered by a physician in a clinic or hospital outpatient setting (e.g., infusion drugs).
Like Part A, Part B typically doesn’t cover 100% of costs, and you’ll likely have cost-sharing responsibilities. The standard monthly premium for Part B in 2025 is $185 (it was $174.70 in 2024). Premiums are higher for individuals with higher annual incomes.
For detailed information about Part A and Part B premiums, deductibles, and coinsurance for both 2025 and 2024, you can refer to official resources like the 2025 Medicare Part A & B Premiums, Deductibles, and Co-insurances.
Exploring Medicare Part C and Part D: Additional Coverage Options
Beyond Original Medicare (Parts A & B), you have options to customize your coverage through Medicare Part C (Medicare Advantage) and Medicare Part D (Prescription Drug Coverage).
Medicare Part C (Medicare Advantage Plans) are offered by private companies and are an alternative way to receive your Medicare benefits. These plans must cover at least everything Original Medicare covers (Parts A & B) but can offer additional benefits, like vision, dental, and hearing coverage. Many Medicare Advantage plans also include Part D (prescription drug coverage), creating a convenient all-in-one plan (MAPD). If you enroll in a Medicare Advantage plan, you’ll use the plan’s card instead of your red, white, and blue Medicare card for covered services.
Medicare Part D specifically covers outpatient prescription drugs. It’s also provided by private insurance companies. Enrolling in Part D is optional but recommended to avoid potential penalties later. You can get Part D coverage through a stand-alone Prescription Drug Plan (PDP) or through a Medicare Advantage plan that includes drug coverage (MAPD).
Medicare Supplement Plans: Filling Coverage Gaps
Medicare Supplement Plans, also known as Medigap plans, are private insurance policies designed to work alongside Original Medicare (Parts A & B). They help pay for some of the “gaps” in Original Medicare coverage, such as deductibles, coinsurance, and copayments. Some Medigap plans even offer coverage for services Original Medicare doesn’t, like healthcare when traveling abroad. It’s crucial to note that Medigap plans are not compatible with Medicare Advantage plans; they only work with Original Medicare.
There are various Medigap plan options (identified by letters like A, B, G, etc.), each offering a standardized set of benefits. While the benefits within each lettered plan are the same regardless of the insurance company, premiums can vary.
Need Further Medicare Guidance?
Navigating Medicare can be complex, but resources are available. For more in-depth information, explore resources like the New to Medicare page. You can also seek personalized assistance from programs like SHIIP (State Health Insurance Assistance Program) by calling their toll-free helpline at 1-855-408-1212. They offer free, unbiased guidance on Medicare and related products. Understanding which part of Medicare covers hospital care – Part A – is a key step in confidently managing your healthcare coverage.
