What do Medicare Parts A & B cover?

Original Medicare, which is Medicare Parts A & B, covers both inpatient and outpatient care. 

Inpatient means you are “admitted” to the facility on a doctor’s orders, whereas outpatient means care you can get without staying more than 24 hours. If you’re admitted to a hospital, you’re inpatient (and at some point you may feel impatient!). If you’re seeing your primary care doctor, or even urgent care, you’re outpatient. 

One way to remember the difference is by where you’re staying overnight. If you’re staying overnight IN a facility, you’re INpatient. If you’re coming to the place from outside and staying overnight OUTside the facility (at your home), you’re OUTpatient.

Part A is inpatient. Part B is outpatient.

What Does Part A Cover?

Most people think of hospitals when they think about Part A, but it’s really all kinds of inpatient care, including things like Skilled Nursing Facilities, certain types of assisted living, and event hospice. 

What’s weird about Part A is that it also covers Home Health Care, where you generally don’t feel like you’re in a hospital.

Another weird thing is that even though many people get prescription medications from the local pharmacy and that’s paid for by Part B, if you’re in the hospital, medications prescribed there are covered under Part A.

What Does Part B Cover?

Part B is basically doctor care, but as you’ll notice, it covers other things like medical equipment, lab tests, preventive visits, and even home health care again! 

Part B covers things like:

• Doctor office visits
• Preventive services, such as certain tests and screenings
• Flu shots
• Pneumococcal shots
• Mental health care (outpatient)
• Alcohol use counseling
• Chemotherapy
• Physical therapy
• Diabetes screenings, supplies, and self-management therapy
• Durable medical equipment, such as wheelchairs

Wait, how can home health care be covered by both Medicare Parts A and B?

Home health care is Part B if you’re homebound but need skilled care. There is no prior hospital stay requirement for Part B coverage of home health care. There is also no deductible or coinsurance for Part B-covered home health care.

Home health care is Part A if you spend at least 3 consecutive days as a hospital inpatient or have a Medicare-covered SNF stay. It covers your first 100 days of home health care. 

What are the other parts of Medicare?

Part C is Medicare Advantage, which can replace Parts A and B, plus can add drug coverage.

Part D is prescription drug coverage, as long as you’re not in Medicare Advantage. You might have only parts A and B, or you might have a MedSupp (MediGap) plan, which is letters F through N, and want to add-on drug coverage. For that, you get Part D.

Parts F-N are MedSupp plans, also known as MediGap plans.

Who provides these plans? The government? Insurance companies?

Original Medicare, parts A and B, are from the government. Everything else (C to N) are plans you contract through private insurance companies who must follow government standards for Medicare plans. 

If you go beyond parts A and B, then whether you get a C or a D or a G or an N, all these plans are standardized by the government, so the only difference between them is the price, not what they cover. In other words, although a C plan might be different than a G one, all the G ones have the same coverage.

* Some illustrations on this page come from the free book “Medicare and You” published by the Centers for Medicare and Medicaid Services, which is a division of the U.S. Department of Health and Human Services. We highly recommend you get your own copy (print or download) at Medicare.gov here.