Medicare Part A vs Part B: What's Actually Covered

Medicare Part A and Part B are the two components of Original Medicare — the federal health insurance program that's been serving Americans since 1965. While most people know Part A covers hospital stays and Part B covers doctor visits, the details are much more nuanced. Let's break down exactly what each part covers, what it costs, and where the gaps are.

Part A vs Part B: Side-by-Side Comparison

What Part A Covers in Detail

Part A is often called "Hospital Insurance" because it primarily covers services you receive as an inpatient. However, it covers more than just hospital stays.

• Inpatient hospital stays: Semi-private room, meals, nursing care, drugs given in the hospital, and other hospital services. Days 1–60 cost the deductible only; days 61–90 have a $419/day coinsurance; days 91–150 use lifetime reserve days at $838/day.
• Skilled Nursing Facility (SNF): Up to 100 days per benefit period following a qualifying 3-day hospital stay. Days 1–20 are $0; days 21–100 cost $209.50/day coinsurance.
• Home Health Care: Part-time skilled nursing, physical therapy, occupational therapy, speech therapy, home health aide services, and medical social services.
• Hospice Care: Pain relief, symptom management, and support services for people who are terminally ill. Includes drugs for symptom control, respite care, and counseling.

What Part B Covers in Detail

Part B covers medically necessary services and preventive care. After meeting your $276 annual deductible, you typically pay 20% of the Medicare-approved amount for most services.

• Doctor and specialist office visits
• Outpatient surgery and procedures
• Diagnostic tests (X-rays, MRIs, blood work)
• Preventive screenings (mammograms, colonoscopies, flu shots)
• Durable medical equipment (wheelchairs, walkers, oxygen equipment)
• Mental health services (outpatient therapy, psychiatric visits)
• Ambulance services (when medically necessary)
• Limited outpatient prescription drugs (certain cancer drugs, injectable osteoporosis drugs)

Free Preventive Services Under Part B

One of the most valuable — and underused — aspects of Part B is its preventive care coverage. These services are covered at 100% with no copay or deductible.

What Neither Part A Nor Part B Covers