PharmSurance Field Guide
Medicare Parts,
A, B, C & D
Explained
Medicare isn't one plan — it's a system of parts. Here's what each one covers, what it costs, and how they work together.

Most people turning 65 are surprised to learn that Medicare doesn't come as a single package. It's actually made up of four parts — and understanding each one before you enroll can save you thousands of dollars and a lot of frustration later.

Tap any card to learn more
Part A
Hospital insurance
The basics

Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Most people get it at no premium.

What it covers
  • Inpatient hospital care (semi-private room, meals, nursing, drugs)
  • Skilled nursing facility care — after a qualifying 3-night hospital stay
  • Hospice care for terminal illness
  • Some home health care (medically necessary, part-time or intermittent)
  • Does NOT cover long-term custodial care (assisted living, nursing home)
  • Does NOT cover private-duty nursing or private room upgrades
What it costs
  • Premium-free for most people, if you or your spouse worked at least 10 years paying Medicare taxes
  • A deductible applies per benefit period — not per year, but per hospital stay
  • Cost-sharing structure changes the longer a hospital stay lasts
Premium-Freefor most people
Part B
Medical insurance
The basics

Covers doctor visits, outpatient care, preventive services, medical equipment, and most lab tests. This is the part you pay a monthly premium for.

What it covers
  • Doctor visits (primary care and specialists)
  • Outpatient surgery and procedures
  • Preventive screenings and annual wellness visits
  • Durable medical equipment (walkers, wheelchairs, oxygen)
  • Mental health services
  • Some home health care
  • Does NOT cover most prescription drugs
  • Does NOT cover routine dental, vision, or hearing care
What it costs
  • Carries a standard monthly premium, set annually by the federal government (higher earners pay more via IRMAA)
  • An annual deductible applies
  • After the deductible, you're responsible for a share of the Medicare-approved amount
  • No out-of-pocket cap — this is why Medigap or Advantage matters
Monthly Premiumstandard, set annually
Part C
Medicare Advantage · the "bundled" option
The basics

A private-carrier plan that replaces Original Medicare — bundling Parts A and B (and usually D) into one plan with a yearly cost cap.

What it covers
  • Everything Parts A and B cover — through a private carrier
  • Usually includes Part D drug coverage
  • Plans may structure additional coverage differently from one another
  • Yearly out-of-pocket cap (Original Medicare has no cap)
  • You must use the plan's provider network
  • May require referrals for specialist visits
  • You still pay the Part B premium on top of any plan premium
Good to know
  • Plans vary significantly by county — what's available in your area matters
  • Prescription coverage varies by plan — always check your medications before enrolling
  • A PharmSurance advisor can walk through the current cost structure for plans in your area
Capped Annuallyout-of-pocket max required on every plan
Part D
Prescription drug coverage
The basics

Covers prescription medications. Either as a standalone plan added to Original Medicare, or bundled inside a Medicare Advantage plan.

What it covers
  • Prescription drugs based on each plan's own list of covered medications
  • Out-of-pocket drug costs are capped annually under federal law
  • Extra Help program available for low-income beneficiaries
  • Not all drugs are covered — check your specific medications
  • Covered-drug lists can change each year — review annually at open enrollment
The late enrollment penalty
  • If you don't enroll when first eligible and don't have other creditable drug coverage, you'll pay a permanent penalty added to your premium for every month you waited
  • This penalty applies for as long as you have Part D coverage
Capped Annuallyfederal law limits your yearly drug costs
Putting it together
The two most common paths
Path 1: Original Medicare + Medigap + Part D

You keep Parts A and B (Original Medicare), add a Medigap supplement to cover what Medicare doesn't, and add a standalone Part D plan for prescriptions.

Best for: people who travel frequently, want maximum doctor choice, or see many specialists. Usually higher monthly cost, but fewer surprise bills.

Path 2: Medicare Advantage (Part C)

You replace Original Medicare with a private plan that bundles A, B, and usually D. One card, one plan.

Best for: people who want simplicity, have a local provider network they're comfortable with, and prefer a predictable monthly cost with a built-in cap.

Not sure which path fits you?

A PharmSurance advisor can look at your doctors, medications, and budget — and walk you through every option. At no cost to you.

PharmSurance.com

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048) to get information on all of your options. If you submit your information on this site, it will be provided to one or more licensed insurance agents, who may call, email, or text you about Medicare Advantage, Medicare Supplement, and Prescription Drug Plan options. This is a general educational overview only, not specific to any plan.

For consumer use · Not affiliated with the U.S. government or federal Medicare program.

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