What Do Medicare Parts A, B, C, and D Cover in 2026?
Understanding the four parts of Medicare and how they work together to provide complete coverage.
Important Disclaimer
This content is for educational purposes only and should not replace professional medical advice, diagnosis, or treatment. Always seek guidance from qualified healthcare providers and licensed insurance professionals.
Official Sources:
Medicare Parts A, B, C, D Comparison
Understanding what each part covers helps you make informed decisions
Hospital Coverage
$0 for most people
Covers
- • Hospital stays
- • Skilled nursing facilities
- • Hospice care
- • Some home health care
Doesn't Cover
- • Doctor visits
- • Prescription drugs
- • Dental care
- • Vision care
Medical Coverage
$185/month (2025)
Covers
- • Doctor visits
- • Outpatient care
- • Medical supplies
- • Preventive services
Doesn't Cover
- • Prescription drugs
- • Dental care
- • Vision care
- • Long-term care
Medicare Advantage
Varies by plan
Covers
- • Everything Parts A & B cover
- • Often prescription drugs
- • Sometimes dental/vision
- • Extra benefits may include
Doesn't Cover
- • Out-of-network care (limited)
- • Care when traveling
- • Some specialists
- • Certain procedures
Prescription Drugs
~$35/month average
Covers
- • Prescription medications
- • Some vaccines
- • Insulin (capped at $35/month)
- • Generic & brand drugs
Doesn't Cover
- • Over-the-counter drugs
- • Drugs not on formulary
- • Cosmetic medications
- • Vitamins & supplements
Hospital Coverage
$0 for most people
$1,676 per benefit period
Covers
- • Hospital stays
- • Skilled nursing facilities
- • Hospice care
- + 1 more
Doesn't Cover
- • Doctor visits
- • Prescription drugs
- • Dental care
- + 1 more
Medical Coverage
$185/month (2025)
$257 per year
Covers
- • Doctor visits
- • Outpatient care
- • Medical supplies
- + 1 more
Doesn't Cover
- • Prescription drugs
- • Dental care
- • Vision care
- + 1 more
Medicare Advantage
Varies by plan
Varies by plan
Covers
- • Everything Parts A & B cover
- • Often prescription drugs
- • Sometimes dental/vision
- + 1 more
Doesn't Cover
- • Out-of-network care (limited)
- • Care when traveling
- • Some specialists
- + 1 more
Prescription Drugs
~$35/month average
$580 maximum (2025)
Covers
- • Prescription medications
- • Some vaccines
- • Insulin (capped at $35/month)
- + 1 more
Doesn't Cover
- • Over-the-counter drugs
- • Drugs not on formulary
- • Cosmetic medications
- + 1 more
The Big Decision: Original Medicare vs. Medicare Advantage
Both are valid Medicare options, but they work very differently
Original Medicare (Parts A & B)
Traditional Medicare with the freedom to choose
Pros
- • Accepted by most doctors nationwide
- • No networks or referrals needed
- • Stable benefits that don't change annually
- • Can add Medigap for extra protection
Cons
- • No prescription drug coverage (need Part D)
- • No out-of-pocket maximum
- • May need Medigap for full protection
- • Separate premiums for different parts
Medicare Advantage (Part C)
All-in-one plans through private insurance
Pros
- • Often includes prescription drugs
- • Annual out-of-pocket maximum
- • May include dental, vision, hearing
- • Sometimes lower monthly costs
Cons
- • Network restrictions apply
- • Benefits can change annually
- • May need referrals for specialists
- • Limited to plan's service area
Important: About Medigap (Supplemental Insurance)
Medigap policies help fill the "gaps" in Original Medicare by covering costs like copayments, coinsurance, and deductibles. Medigap only works with Original Medicare, not Medicare Advantage.You have guaranteed issue rights for Medigap during your 6-month open enrollment period that begins when you're 65 and enrolled in Part B.
Learn More About Medigap PlansPart D Coverage Gap Guide
Navigate the "donut hole" today and prepare for the $2,000 cap coming in 2025 under the Inflation Reduction Act
Major 2025 Change: $2,000 Out-of-Pocket Cap
Game-Changing Update for 2025
Starting January 1, 2025, the Inflation Reduction Act implements a $2,000 annual out-of-pocket cap on prescription drug costs under Medicare Part D. Once you reach this cap, you'll pay nothing for covered drugs for the rest of the year.
Before 2025
Complex coverage phases with a "donut hole" where you paid 25% of costs (for most drugs) until reaching catastrophic coverage threshold (approximately $8,000 in total drug costs).
Starting 2025
Simplified structure: You pay deductible and copays/coinsurance until you reach $2,000 in out-of-pocket spending, then pay $0 for the rest of the year.
Understanding the 2024 Coverage Gap ("Donut Hole")
The Part D coverage gap, commonly called the "donut hole," is a temporary limit on what your Part D plan will cover. In 2024, after you and your plan have spent a certain amount ($5,030) on covered drugs, you enter the gap phase.
Phase 1: Annual Deductible
You pay 100% until you meet your plan's deductible (up to $545 in 2024). Some plans have $0 deductible.
Phase 2: Initial Coverage Period
You pay copays/coinsurance until total drug costs (what you + your plan pay) reach $5,030.
Typical cost-sharing: 25% of drug costs or tier-specific copays
Phase 3: Coverage Gap ("Donut Hole")
You pay 25% of the cost for both brand-name and generic drugs. The coverage gap ends when your out-of-pocket costs reach $8,000.
Phase 4: Catastrophic Coverage
After $8,000 in out-of-pocket costs, you pay the greater of: 5% coinsurance OR $4.50 for generics and $11.20 for brand-name drugs for the rest of the calendar year.
Smart Strategies for Managing Costs Today
While you're navigating the 2024 coverage gap or preparing for 2025's simplified structure, these strategies can help reduce your costs:
Ask for the "Non-Insurance Best Price"
When in the coverage gap, ask your pharmacist for the cash price or discount program price. Sometimes this is lower than your Part D cost-sharing, and it still counts toward your out-of-pocket costs.
Use Manufacturer Coupons & Patient Assistance
Many drug manufacturers offer copay cards or patient assistance programs. These can significantly reduce your out-of-pocket costs, especially for brand-name medications.
Switch to Generic When Possible
Ask your doctor if a generic alternative is available. Generics typically cost 25% during the gap phase versus higher brand-name costs.
Apply for Extra Help (LIS)
If your income is limited, you may qualify for Extra Help (Low-Income Subsidy), which eliminates the coverage gap and reduces copays to $0-$11.20 per prescription.
Shop Your Part D Plan Annually
During Annual Enrollment (Oct 15 - Dec 7), review and compare plans. Different plans have different formularies and cost structures, especially important with the 2025 changes.
Use Mail-Order for Maintenance Drugs
Many plans offer lower cost-sharing for 90-day supplies through mail-order pharmacies. This can reduce your overall costs even in the coverage gap.
Prepare for 2025
The $2,000 out-of-pocket cap will significantly simplify Part D and provide substantial savings for high-cost drug users. During the 2024 Annual Enrollment Period, review your plan options to ensure you're positioned for these beneficial changes.
Beyond Medicare: Planning for Your Healthcare
Understanding Medicare coverage is important—but so is making informed decisions about your complete healthcare picture. Explore our guides on enrollment, costs, and choosing the right plan for your needs.
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