Learn About Medicare Part A and B Coverage

Understanding the Two Main Parts of Medicare

Medicare is a federal health insurance program created in 1965 that serves people age 65 and older, some younger people with disabilities, and people with end-stage renal disease. The program is divided into different sections, each covering different aspects of healthcare. Part A and Part B form the foundation of Original Medicare — the traditional government-run insurance option that's been around since the program began.

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Part A covers hospital-related services, while Part B covers doctor visits and outpatient care. Together, they form what most people think of when they hear the word "Medicare." Understanding how these two parts work separately and together helps you see what types of medical expenses would be covered under each section and where potential gaps might exist in your coverage.

It's worth noting that Original Medicare (Parts A and B) operates differently from Medicare Advantage plans (Part C), which are an alternative way to receive Medicare coverage through private insurance companies. Many people stick with Original Medicare, while others choose the alternative route. This guide focuses specifically on how Part A and Part B work, since those are the foundational components most Medicare beneficiaries encounter first.

The distinction between Part A and Part B matters because each has different costs, different coverage rules, and different things you need to do to maintain coverage. Mixing up what's covered under which part is one of the most common sources of confusion for people new to Medicare.

Practical Takeaway: Part A and Part B are complementary pieces of Original Medicare. Part A handles institutional care (hospitals, skilled nursing), while Part B handles outpatient and doctor services. Neither one covers everything you might think it does, and neither one is automatically right for every person.

What Part A Covers: Hospital and Institutional Care

Medicare Part A is hospital insurance. It covers inpatient hospital stays, skilled nursing facility care, hospice care, and home health services under certain conditions. The word "inpatient" matters here — it means you're formally admitted to the hospital as a registered patient, not just visiting an emergency room or getting treated and sent home the same day.

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If you're admitted to a hospital, Part A covers your room, meals, nursing care, medications while you're hospitalized, and basic medical supplies and equipment. For a typical inpatient hospital stay in 2024, you pay a deductible of $1,632 for the first 60 days of hospitalization in a benefit period. After 60 days, costs begin to increase. From day 61 to day 90, you pay a daily coinsurance amount ($408 per day in 2024). If you stay longer than 90 days, you enter what's called "lifetime reserve days," where your coinsurance increases further.

Skilled nursing facility care is a specific type of coverage. After a hospital stay of at least three days, if your doctor determines you need skilled care (not just basic assistance), Part A may cover up to 100 days in a qualifying facility. The first 20 days are fully covered. Days 21 through 100 require a daily coinsurance payment ($204 per day in 2024). It's important to understand that Part A doesn't cover long-term custodial care in a nursing home — only skilled nursing care, which is medically necessary treatment provided by nurses or therapists.

Home health services are another Part A benefit. If you're homebound and your doctor orders medically necessary care at home, Part A covers skilled nursing visits, physical therapy, occupational therapy, and speech-language pathology services. You pay nothing for these services if provided by a Medicare-certified home health agency, though some equipment rentals may have copayments.

Hospice care is covered when a doctor certifies that you have a terminal illness and you're expected to live six months or less. Part A covers all hospice services related to your terminal condition, including pain management and comfort care, though you may have small copayments for medications and respite care.

Practical Takeaway: Part A is your safety net for serious, acute medical situations requiring hospitalization or professional care facilities. It doesn't cover routine doctor visits, outpatient procedures, or long-term custodial care. Understanding the difference between inpatient and outpatient is key to knowing what Part A will and won't pay for.

What Part B Covers: Doctor Visits and Outpatient Services

Medicare Part B is medical insurance that covers doctor services, outpatient hospital care, medical equipment, and various outpatient treatments and therapies. If Part A is for when you're admitted and staying overnight, Part B is for everything else in the healthcare system — the vast majority of your actual interactions with doctors.

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Part B covers visits to your primary care doctor, specialists, urgent care clinics, and hospital emergency rooms. It covers diagnostic tests like blood work and X-rays when ordered by your doctor. It covers imaging services like MRI and CT scans. It covers physical therapy, occupational therapy, and speech therapy on an outpatient basis (meaning you go to an office or clinic, not a hospital). It covers mental health counseling, including therapy and psychiatric care. It also covers certain preventive services like annual wellness visits, cancer screenings, and vaccinations.

Medical equipment and supplies fall under Part B, including things like walkers, wheelchairs, oxygen equipment, and diabetic testing supplies. However, Part B doesn't cover all equipment — only items deemed medically necessary and ordered by a doctor. Hearing aids, for example, are not covered by Original Medicare at all. Eyeglasses are covered only in specific situations, like after cataract surgery.

Part B has a different cost structure than Part A. In 2024, the standard monthly premium for Part B is $174.70, though many people have this deducted from their Social Security payments. There's also an annual deductible of $240. After you've met the deductible, you typically pay 20 percent of the Medicare-approved amount for most Part B services, with Medicare paying the other 80 percent. This means your costs depend on the actual cost of the service — a specialist visit might run you less out-of-pocket than a complex procedure.

One important distinction: Part B covers "medically necessary" services as determined by Medicare's rules, not necessarily every service you or your doctor might want. If a procedure is considered experimental or not medically necessary for your condition, Medicare may not cover it, and you'd be responsible for the full cost.

Outpatient hospital services are also covered by Part B. This includes emergency room visits, outpatient surgery, and diagnostic services provided by a hospital on an outpatient basis. Many people don't realize that a hospital emergency room visit where you're treated and released falls under Part B, not Part A.

Practical Takeaway: Part B is your primary insurance for routine and specialty medical care. You'll use it constantly — for doctor visits, tests, preventive care, and most outpatient treatments. The 20 percent coinsurance after your deductible means your out-of-pocket costs vary depending on what services you receive.

How Part A and Part B Work Together

Part A and Part B operate as a coordinated system, but each has its own costs, rules, and payment structures. Understanding how they interact helps you anticipate what you might pay for various medical scenarios.

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Consider a common scenario: you fall and break your hip. You go to the emergency room (Part B covers this, with a 20 percent coinsurance after you meet the deductible). The doctor orders an X-ray (Part B covers this). You're admitted to the hospital for surgery (Part A kicks in, and you pay the Part A deductible). After three days in the hospital, your surgeon determines you need skilled nursing facility care for rehabilitation (Part A covers this, after your three-day qualifying stay). During your nursing facility stay, you need physical therapy (Part A covers this as part of your skilled nursing stay). Eventually you go home, and your doctor orders home health visits for continued physical therapy (Part A covers this, with no copayment). The next month, you have a follow-up visit with your orthopedic surgeon (Part B covers this, with 20 percent coinsurance).

In this scenario, Part A and Part B each paid for different portions of your care based on the type of service and setting. Because you had the three-day hospital stay, you became eligible for the skilled nursing facility coverage and home health coverage that follow. This is called the "three-day qualifying stay requirement," and it's one of