Medicare Explained

At a glance...

Medicare is a federally tax-funded health insurance program tailored to seniors ages 65 and up.

The word “coverage” will often appear when reading about Medicare. This not only constitutes the services themselves but the costs for coinsurance and copayments as well.

Medicare’s components

Medicare is broken down into subcategories called “Parts,” all of which are to be purchased separately. Premiums differ in each category. The Parts are A, B, C, and D.

Part A offers coverage for inpatient services. Your hospital visits, including costs like the room you stay in and the food provided for you, are part of Part A’s coverage. The same can be said for hospice care and care in skilled nursing facilities.

Part B centers on outpatient care, which is essentially anything you would get outside of an emergency room, hospice center, or skilled nursing facility. A routine appointment at a doctor’s office would fall under Medicare Part B coverage. Chemotherapy, x-rays, cancer screenings, lab tests, and general checkups are other examples of this.

Part C, which is more often referred to as “Medicare Advantage,” is a combination of other Medicare Parts. Medicare Advantage is sold via private insurance. It features inpatient (Part A), outpatient (Part B), and prescription drug (Part D) coverage together.

Part D reduces prescription medication costs, but only for select medications in certain categories. This list is called a “formulary,” and the formulary must cover at least two medications in each of the six medication categories.

Part D categories are:

  • Antidepressants
  • Anticonvulsants
  • Anticancer
  • Immunosuppressants
  • Medications for HIV/AIDS
  • Antipsychotics

Benzodiazepines, barbiturates, medications taken for cosmetic reasons, and flu medications are examples of what Medicare Part D does NOT cover.

For further information

Medicare is extensive in many respects. There’s no shame in having questions about it, and after all, when you’re on the right path, you have a plan that’s cost-effective and right for you. For further information about Medicare and Medicare Supplements, call me today at (407) 924-8109. You can also email me at