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Medicare 101: A Simple Guide to Understanding Your Coverage

Medicare can seem confusing at first, but it’s easier to understand when you break it down into its parts. At Guardian Health & Wealth, we make Medicare basics simple so you can make confident decisions. This guide provides a clear overview of Medicare and explains the different Medicare parts, what they cover, and how much they cost.

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Medicare beneficiary discussing coverage with an insurance agent

Part A: Hospital Insurance

What it covers:

  • Inpatient hospital care
  • Skilled nursing facility care (short-term)
  • Hospice care
  • Some home health services

2026 Costs (for most people):

  • Premium: $0 if you or your spouse worked 10+ years
  • Deductible: $1,736 per benefit period
  • Coinsurance:
    • Days 1–60: $0
    • Days 61–90: $433/day
    • Days 91+: $866/day (lifetime reserve days apply)

Why it matters: Part A helps cover major medical events, like surgeries or long hospital stays, so you don’t face unexpected bills.

Part B: Medical Insurance

What it covers:

  • Doctor visits
  • Outpatient services (tests, lab work, X-rays)
  • Preventive care (vaccines, screenings, wellness visits)
  • Durable medical equipment (wheelchairs, walkers)

2026 Costs:

  • Premium: $202.90/month (income-based adjustments may apply)
  • Deductible: $283/year
  • Coinsurance: Usually 20% of Medicare-approved services

Why it matters: Part B helps with everyday care you need, like visiting your doctor or getting tests, and keeps your routine health needs covered.

Part C: Medicare Advantage

What it covers:

  • All services are included in Parts A and B
  • Often includes Part D prescription drug coverage
  • May add extras like dental, vision, hearing, or fitness programs

2026 Costs:

  • Premiums vary by plan (some start at $0/month; you still pay the Part B premium)
  • Out-of-pocket costs vary, but all plans have a yearly limit

Why it matters: Medicare Advantage plans are private alternatives to Original Medicare. They combine coverage into a single plan and may include extras not covered in Parts A or B.

Part D: Prescription Drug Coverage

What it covers:

  • Prescription medications
  • Drugs are categorized into tiers (generics usually cost less)

2026 Costs:

  • Premiums vary by plan and location
  • Deductible: Up to $590 per year (plan-dependent)
  • Copays/Coinsurance: Depends on the plan and drugs
  • Out-of-Pocket Cap: $2,100

Why it matters: Original Medicare doesn’t cover most prescriptions. Part D helps lower your medication costs and ensures you can afford essential drugs.

Medicare Part What It Covers Who Offers It Includes Drug Coverage? Monthly Premium (2026)
Part A Hospital stays, skilled nursing, hospice Federal government No Usually $0
Part B Doctor visits, outpatient care, preventive services Federal government No $202.90+
Part C All of A & B, usually D + extras Private insurance Usually Varies by plan
Part D Prescription drugs Private insurance Yes Varies by plan
Medicare beneficiary comparing Parts A, B, C, and D with an insurance agent

Do You Need All the Parts?

Not everyone needs every part. Your choice depends on your health needs, budget, and prescription requirements.

  • For basic coverage: Parts A and B (Original Medicare) may be enough.
  • If you need prescription coverage: Add Part D or choose a Medicare Advantage plan with drug coverage.
  • If you want one plan that combines hospital, medical, and prescription coverage, consider Medicare Advantage (Part C).

How Guardian Health & Wealth Can Help

Understanding the parts of Medicare is just the first step. At Guardian Health & Wealth, we guide you through Medicare enrollment periods, eligibility rules, and Medicare costs. Our licensed advisors provide personalized Medicare advice to help you choose the plan that works best for your situation, without pressure. 

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