Hospital Coverage
Part A is your hospital insurance — covering inpatient stays, skilled nursing facility care, hospice services, and some home health care. Most people who've paid Medicare taxes for at least 10 years pay no monthly premium.
When you're formally admitted to a hospital, Part A pays for your room, nursing care, meals, and most services during your stay.
- Semi-private room & meals
- General nursing care
- Hospital services & supplies
- Medications given during stay
After a qualifying 3-day hospital stay, Part A covers up to 100 days in a skilled nursing facility for recovery and therapy.
- Days 1–20: fully covered
- Days 21–100: daily coinsurance
- Physical, occupational & speech therapy
- Requires prior qualifying hospital stay
For those with a terminal illness, Part A covers comfort-focused hospice care at home or in a hospice facility.
- Pain and symptom management
- Nursing and aide services
- Grief and family support
- Medications for comfort
Part A may cover limited skilled nursing or therapy services in your home if you're homebound and meet Medicare's requirements.
- Skilled nursing visits
- Physical & occupational therapy
- Speech therapy
- Home health aide services
Most people pay no premium for Part A. Main costs are the deductible per benefit period and daily coinsurance for longer stays.
- Premium: $0 for most people
- Hospital deductible: $1,676 per benefit period
- Days 61–90: $419/day coinsurance
- Lifetime reserve days available
Most people are automatically enrolled at 65. If not, you can sign up during a 7-month Initial Enrollment Period.
- Auto-enrolled if receiving Social Security
- 7-month Initial Enrollment Period
- Late penalty if you pay a premium
- Special Enrollment Period options exist
Part A is your hospital insurance — covering inpatient stays, skilled nursing recovery, hospice care, and some home health visits. Most people pay $0 in premiums if they worked and paid Medicare taxes for at least 10 years.
Explore Part B — Medical Coverage →Part A Quick Facts — 2026
| Item | Amount |
|---|---|
| Monthly Premium (40+ quarters) | $0 |
| Monthly Premium (30–39 quarters) | $285 |
| Monthly Premium (under 30 quarters) | $518 |
| Hospital Deductible (per benefit period) | $1,676 |
| Hospital Days 1–60 coinsurance | $0 |
| Hospital Days 61–90 coinsurance/day | $419 |
| SNF Days 1–20 coinsurance | $0 |
| SNF Days 21–100 coinsurance/day | $209.50 |
Questions About Part A?
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Medical Coverage
Part B covers your everyday medical care — doctor visits, outpatient procedures, lab tests, preventive screenings, and medical equipment. There's a monthly premium, and enrollment timing matters. Missing the window means a lifetime penalty.
Part B covers medically necessary services from doctors and healthcare providers — in an office, clinic, or outpatient hospital setting.
- Primary care doctor visits
- Specialist appointments
- Mental health services
- Second surgical opinions
Part B covers many preventive screenings at no cost to you — when provided by a Medicare-accepting doctor.
- Annual Wellness Visit (free)
- Cancer screenings (mammogram, colonoscopy)
- Flu, pneumonia & COVID vaccines
- Diabetes & cardiovascular screening
Outpatient lab tests, X-rays, MRIs, and other diagnostic imaging are covered under Part B when ordered by your doctor.
- Blood tests & urinalysis
- X-rays and MRIs
- CT and PET scans
- EKGs and other diagnostics
If your doctor prescribes equipment for home use, Part B covers 80% of the approved cost for medically necessary items.
- Wheelchairs & walkers
- Hospital beds for home use
- Oxygen equipment
- Blood sugar monitors
Part B has a standard monthly premium plus an annual deductible. After the deductible, Medicare pays 80% and you pay 20% — with no out-of-pocket cap.
- Standard premium: $185/month
- Annual deductible: $257
- You pay 20% after deductible
- Higher income = IRMAA surcharge
Miss your enrollment window without qualifying coverage and you'll pay 10% extra for every 12 months delayed — permanently added to your premium.
- 10% added per 12-month delay
- Penalty is permanent — for life
- Exceptions for active employer coverage
- Talk to Betsy before deciding
Part B covers your everyday medical care — doctor visits, outpatient services, lab tests, and preventive screenings. There is a monthly premium and enrollment timing matters — missing the window means a lifetime penalty.
Explore Part C — Medicare Advantage →Part B Quick Facts — 2026
| Item | Amount |
|---|---|
| Standard Monthly Premium | $185.00 |
| Annual Deductible | $257 |
| Your Share After Deductible | 20% of approved costs |
| Out-of-Pocket Maximum | None (Original Medicare) |
| Late Enrollment Penalty | 10% per 12-month delay (lifetime) |
| Initial Enrollment Period | 7 months around your 65th birthday |
| General Enrollment Period | January 1 – March 31 |
Questions About Part B?
Enrollment timing is critical. Let's talk through your situation before you make any decisions — free, no pressure.
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Medicare Advantage
Part C — Medicare Advantage — bundles your hospital and medical coverage into a single plan through a private insurer. These plans often include extra benefits like dental, vision, and hearing that Original Medicare doesn't cover, and always include an annual cap on out-of-pocket spending.
Medicare Advantage plans must cover everything Original Medicare covers — plus many offer substantial additional benefits.
- Hospital coverage (Part A)
- Medical coverage (Part B)
- Emergency & urgent care
- Often includes Part D drug coverage
Many Advantage plans offer benefits that go beyond Original Medicare — extras that can make a real difference in daily life.
- Dental, vision & hearing coverage
- Fitness memberships (SilverSneakers)
- Transportation to appointments
- Over-the-counter allowances
Every Medicare Advantage plan must have an annual limit on how much you can pay out of pocket. Original Medicare has no such cap.
- Annual maximum out-of-pocket limit
- After cap: plan pays 100%
- Protects against catastrophic costs
- Original Medicare has no such limit
Most Advantage plans are HMO or PPO. The difference affects how you access care and flexibility with your doctors.
- HMO: stay in network, referrals often needed
- PPO: more flexibility, higher out-of-network costs
- PFFS: pay-as-you-go structure
- SNP: plans for specific conditions
Many Advantage plans have $0 extra monthly premium on top of your Part B premium. Costs vary by plan, area, and benefits.
- Many plans: $0 additional premium
- You still pay Part B premium ($185/mo)
- Copays vary by service type
- Annual out-of-pocket maximum applies
You can join, switch, or drop a Medicare Advantage plan during specific enrollment windows each year.
- Annual Enrollment: Oct 15 – Dec 7
- Open Enrollment: Jan 1 – Mar 31
- Initial Coverage Election Period
- Special Enrollment Periods available
Medicare Advantage bundles Parts A, B, and usually D into one plan through a private insurer. It often adds dental, vision, and hearing — but uses provider networks. Whether it's right for you depends on your doctors, drugs, and location.
Explore Part D — Drug Coverage →Medicare Advantage vs. Original Medicare — 2026
| Feature | Original Medicare | Medicare Advantage |
|---|---|---|
| Out-of-Pocket Maximum | ❌ None | ✅ Required annual cap |
| Doctor Choice | Any Medicare provider | Usually network-based |
| Dental / Vision / Hearing | ❌ Not included | ✅ Often included |
| Drug Coverage (Part D) | Add separately | Many plans include it |
| Referrals Needed | Generally no | Depends on plan type |
| Coverage When Traveling | Any US Medicare provider | Emergency/urgent (HMO) |
Is Medicare Advantage Right for You?
The answer depends on your doctors, your medications, and where you live. Let me run the numbers for your situation — free.
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Prescription Drug Coverage
Part D helps pay for your prescription medications. Every plan has its own formulary and cost tiers — the right plan depends entirely on which medications you take. Comparing plans against your actual drug list can save you hundreds per year.
Each Part D plan covers a specific list of drugs called a formulary. Drugs are grouped into cost tiers — lower tiers cost you less.
- Tier 1: Preferred generics (lowest cost)
- Tier 2–3: Non-preferred & brand-name drugs
- Tier 4–5: Specialty drugs (highest cost)
- Formularies vary by plan — compare carefully
Part D covers prescription drugs available at retail, mail-order, and specialty pharmacies.
- Generic and brand-name medications
- Insulin & diabetes supplies
- Many recommended vaccines
- Specialty & biologic medications
There is a $2,000 annual cap on drug costs under Part D — a major improvement for people with expensive medications.
- $2,000 out-of-pocket cap per year
- After cap: plan pays 100%
- Medicare Prescription Payment Plan available
- Spread costs across the year monthly
Part D plans work with preferred pharmacy networks. Using preferred pharmacies can significantly lower your copays.
- Preferred pharmacies = lower costs
- Mail-order often cheaper per fill
- 90-day supplies typically available
- Networks vary by plan and area
Part D premiums vary by plan, ranging from around $10 to over $100/month. There's also an annual deductible before coverage kicks in.
- Premiums vary: avg. ~$46/month
- Max deductible: $590
- Higher income = IRMAA surcharge
- Extra Help available for lower income
Go 63+ days without creditable drug coverage after becoming eligible and you'll pay a late penalty added permanently to your premium.
- 1% of national base premium per month delayed
- Penalty is permanent
- Creditable employer coverage avoids penalty
- Don't wait — call Betsy first
Part D pays for your prescription medications. Each plan has its own drug list and cost tiers. Missing your enrollment window by 63+ days means a permanent late penalty added to your monthly premium for life.
Talk to Betsy about your coverage →Part D Quick Facts — 2026
| Item | Amount |
|---|---|
| National Base Premium | $36.78/month |
| Maximum Annual Deductible | $590 |
| Out-of-Pocket Cap | $2,000 |
| Late Enrollment Penalty | 1% × base premium × months delayed |
| Annual Enrollment Period | Oct 15 – Dec 7 |
| Extra Help Income Limit (individual) | ~$22,590/year |
| Extra Help Income Limit (couple) | ~$30,660/year |
Let Me Compare Part D Plans for You
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