The Basics of Medicare

If you recently had a medical procedure or were hospitalized, you may be confused about a recent bill and are wondering what Medicare will cover, what your gap insurance will cover, and what you will be responsible for. It may help to have a better understanding of the four main parts of Medicare.

Part A helps pay for inpatient stays in hospitals and skilled nursing facilities, some home care and end-of-life hospice care that accept Medicare. Hospital services covered include a semi-private room and meals, general nursing, drugs and supplies, inpatient rehabilitation, and some blood transfusions. Skilled nursing services include care for things like recovering from hip replacement surgery or stroke. Part A charges a deductible for hospital stays (the fee for 2025 is $1,676) but your Medigap insurance may cover that expense as well as other deductibles. Hospital stays for up to 60 days and virtually most services are covered by Medicare; but the one exception is not in a private room.  

Part B covers doctors and outpatient services, and together with part A make up what is considered “Original Medicare.” Part B pays for diagnostic screenings, lab tests, preventive services, some medical equipment and transportation. It covers doctor visits and other outpatient services. There is a monthly premium with Part B, and in 2025 it is $185. For those making over $106,000 annually it may be higher. 

Part C is what Medicare Advantage comes under, and is privately held insurance rather than Medicare, which is run by the federal government. If you choose Medicare Advantage, you will still need to sign up for Medicare part A and B and pay the premium for part B. Medicare Advantage plans set their own deductibles and you typically need to stay in a Network and use your plan’s approved providers or pay higher out of pocket costs. 

Part D is again from a private insurer and pays for some of your prescription drugs. Generally there is a co-pay for each prescription, and you may have a premium, and a yearly deductible. Check with Medicare regarding rules for higher yearly drug costs and your responsibility.

Remember Medicare offers an open enrollment period each year to allow recipients to make changes to their plan. The period starts on October 15 and ends December 7. Any changes you make during this time will go into effect the following year. 

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