Medicare Part A and Medicare Part B are otherwise known as Original Medicare. Under Original Medicare, the government pays directly for the health care services you receive. You can see any doctor and hospital that takes Medicare (and most do) anywhere in the country.
Below is a brief summary of health care expenses that Part A and Part B covers.
Medicare Part A
This is the hospital portion of the plan and it covers the following:
- Inpatient hospital care
- Hospice care
- Some skilled nursing care
- Home health care
Coverage includes inpatient hospital care or stays include a semi-private room, as well as general nursing, meals, and various supplies and services. Home health care includes medically necessary part time care and services, and may include medical equipment. Skilled nursing care must be related to a diagnosis received during a stay at a hospital (admitted as a patient, NOT “under observation”). Hospice care is provided for symptom control and pain relief drugs, as well as medical services and grief counseling.
Before we go any further, there is benefit period for Medicare cover and it refers to the number of days you receive care in a hospital or skilled nursing facility. Medicare uses this count to determine the amount it will pay per a benefit period. Three factors determine your benefit period:
- The length of stay in skilled nursing facility
- The length of your stay in hospital as an admitted patient (not “Under Observation)
- The length of release before you return to a skilled facility or a hospital
Your benefit period begins the day you are accepted to a hospital and continues as long as you: (1) Stay in a hospital (2) Transfer to a Medicare approved skilled care facility within 30 days of your stay. And it ends if you don’t receive hospital or skilled nursing care for consecutive 60 days whenever you leave hospital or skilled nursing home care.
Remember, Part A covers only the cost of your hospital or skilled care facility, it doesn’t include any doctors, nurses or the cost of your prescription drugs.)
Medicare Part B
Part B covers doctors’ services, outpatient hospital services, medical services and supplies.
With Part B, you are responsible for paying expenses such as:
- Premium: Part B monthly (income-adjusted) premium (which may be automatically taken out of your social security check)
- Deductible: The Part B annual deductible
- Co-Insurance: After the deductible, you pay approximately 20% of physician-related expenses, Medicare pays 80%
Original Medicare Does NOT Cover Everything
Depending on your annual healthcare needs, there can be substantial gaps in coverage with Original Medicare. Hence the need for supplemental coverage.
To address these gaps, the government has made provisions via Medicare Supplement Plans (also known as Medigap plans), Medicare Advantage plans and Prescription Drug Plans.
These plans are standardized by the government, and provided by state approved insurance carriers. These insurance policies are designed to fill the gaps that Medicare does not cover, thereby limiting your out-of-pocket costs.
Medicare Can Be Confusing
The process of learning about Medicare can be a bit overwhelming. Many people start researching a year before they even turn 65. If you feel intimidated by Medicare, you’re not alone. That’s why It is highly recommended that you consult a Medicare Insurance specialist.
We are here to help you navigate your decisions with Medicare. We’ll provide the information you need to compare the various plans that are available in your area, so you can make an informed decision about which one best suites your unique needs.
Our services are free. And, there is no cost or obligation to get a quote.
For help with your unique situation, call us at (831) 641-7127.
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I hope you found this blog post helpful!