What Is Medicare And What Does It Cover?
Medicare is the federal health insurance program for:
- Individuals who are 65 or older
- Younger individuals with certain disabilities
- Individuals with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
- Individuals with ALS(Amyothropic Lateral Sclerosis is a progressive neurodegenerative disease that affects nerve cells controlling voluntary muscle movement)
PART A
Hospital Coverage
Inpatient Care In A Hospital
Skilled Nursing Facility Care
Inpatient Care In A Skilled Nursing Facility (Not Custodial Or Long-Term Care)
Hospice Care
Home Health Care
PART B
Medical Coverage
Medically Necessary Services
Preventive Services
Clinical Research
Ambulane Services
Durable Medical Equipment
Mental Health Services (Inpatient, Outpatient and Partial Hospitalization)
Limited Outpatient Prescription Drugs
What Costs Are Associated With Medicare?
Part A Premium-
Most people don’t pay a monthly premium for Part A (sometimes called “premium-free Part A”). If you buy Part A, you’ll pay up to $565 each month in 2026. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $565 in 2026. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $311 in 2026.
Part A inpatient hospital deductible and coinsurance
$1,736 deductible for each benefit period
Days 1-60: $0 copay for each benefit period
Days 61-90: $434 copay per day of each benefit period
Days 91 and beyond: $868 copay per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
Beyond lifetime reserve days: all costs
Part B Premium
The standard Part B premium amount is $202.90 in 2026(or higher depending on your income).
Part B Deductible and Coinsurance
The new Part B deductible for 2026 will be $283. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy, and durable medical equipment (DME).
What Doesn't Medicare Normally Cover?
Routine Eye Care including eye exams and articles of eye wear
Routine Hearing Care Including hearing aids, exams and fittings
Prescription Drugs excluding those normally covered under Part B
Medicare won’t limit your medical expenditures in any given calendar year
Routine Dental Care
Routine Foot Care
What Options Do I Have As A Medicare Recipient?
As a Medicare beneficiary, you can opt to get either a Medicare Advantage Plan with drug coverage or a Medicare Supplement Plan with a stand alone Prescription Drug Plan to cover medical and prescription drug expenses.
