MEDICARE PART A & B

Original Medicare, also known as traditional Medicare, works on a fee-for-service basis. This means that you can go to any doctor or hospital that accepts Medicare, anywhere in the United States, and Medicare will pay its share of the bill for any service it covers. You pay the rest unless you have additional insurance that covers those costs. Original Medicare provides many health care services and supplies, but it doesn’t pay all your expenses.

With Original Medicare, you go directly to the doctor/hospital when you need medical care, without prior authorization from your primary care doctor. You are also required to pay a monthly premium fee for Medicare Part B, as well as coinsurance for each service received. Original Medicare has limits on the amounts you can be charged with.

Medicare Part A and Part B make up Original Medicare, but as a part of the Medicare program, there are also Medicare Part C, which represents Medicare Advantage, and Medicare Part D, which represent prescription drug coverage. When you qualify for Medicare, it is usually Medicare Part A and Part B that you are first enrolled in. Medicare Part A generally helps pay your costs as a hospital inpatient. Medicare Part B may help pay for doctor visits, preventive services, lab tests, medical equipment and supplies, and more. Parts A & B are not in competition, but instead, they are complementary, meaning that they together provide the best health coverage in hospitals and doctor`s offices as well. There are also Medigap plans that are designed to help fill the gaps in costs left by Original Medicare. Continue reading for the breakdown of the A & B parts of Medicare.

MEDICARE PART A

Medicare part A is basically hospital insurance that covers a variety of hospital services. Part A generally covers inpatient hospital stays, skilled nursing care, hospice care, and limited home health care services. In addition, it includes inpatient care received through Acute care hospitals, Critical access hospitals, Inpatient rehabilitation facilities, Long-term care hospitals, Mental Health care, and Participation in qualifying clinical research studies.

WHAT DOES MEDICARE PART A COVER

Inpatient hospital care: This covers any tests or treatments you need while admitted to the hospital. It includes services like meals, nursing services, physical therapy, and medications that a doctor says are needed.
Limited home healthcare: If you need care from a home health aid after you’ve been released from an inpatient hospital stay, Medicare will cover medically necessary care while you recover.
Hospice care: Once you have made the choice to seek hospice care instead of treatment for a terminal illness, Medicare will cover most of your healthcare costs.
Short-term skilled nursing facility stays: If you need skilled nursing facility care, Medicare will cover your stay and services for a certain amount of time.

SKILL NURSING FACILITY STAYS

Skilled nursing facility stays are covered under Medicare Part A after qualifying hospital inpatient stays for a related illness or injury. A skilled nursing facility must be certified by Medicare to be under Part A coverage. To qualify for this type of care, the hospital stay must be a minimum of three days. The day you are discharged does not count towards this minimum three-day requirement, as well as time spent under observation as an outpatient.

Skill nursing care includes:

Semi-private room
Meals
Skilled nursing services
Rehabilitation services
Medical social services
Medications received while in Skill nursing care
Medical supplies and equipment used in Skill nursing care
Ambulance transportation to the nearest provider
Dietary counseling

MEDICARE PART B

Medicare Part B provides insurance for outpatient medical care such as doctor visits, preventative services, ambulance services, mental health costs, and the cost of durable medical equipment. It is the other half of Original Medicare. Under Part B insurance, in most cases, you will pay 20% of the Medicare-approved amount for each item or service with no maximum.

WHAT DOES MEDICARE PART B COVER

Visits to the doctor's office
Preventive services
Flu shots
Pneumococcal shots
Outpatient mental health care
Alcoholism counseling
Chemotherapy
Physical therapy
Diabetes screenings, supplies, and self-management therapy
Durable medical equipment (wheelchairs, etc.)

MEDICARE PART B COSTS

Medicare Part B requires you to pay a monthly premium, given based on your adjusted gross income together with a yearly deductible before coverage begins. You are also responsible for paying part of the costs that Part B does not cover. So your costs if you enroll in part B will include Medicare Part B monthly premium, coinsurance (part of the cost that Medicare does not pay), and a yearly deductible.

The standard monthly fee for Part B is $174.70 in 2024. It is higher for recipients who have higher incomes exceeding $103,000. The annual deductible for Part B is $240 in 2024. In addition, the patient pays 20% of the bill as a coinsurance payment.

We are not connected with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area, and any information we provide is limited to those plans we do offer in your area. Please get in touch with Medicare.gov or 1-800-MEDICARE to get information on all your options. Health Insurance sold on vitalinsuranceprofessionals.com is processed through the licensed entity: Vital Insurance Professionals Inc.

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