Navigating Medicare Part A & B

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An Introduction to Medicare Part A & B

Let’s take a deeper dive into what is covered by Medicare Part A and B, which is frequently referred to as Original Medicare.

Medicare Part A, or hospital coverage, is a key to your healthcare. Part A provides coverage for hospital bills that can be catastrophic. It helps cover the hospital charges you incur during a hospital stay, including meals, operating room fees, lab tests, and medical supplies. You will not be required to pay a premium for this as long as you have worked for at least ten years and paid Medicare taxes during that time. You will be responsible for a deductible. 

Part A helps cover most of your costs up to 60 days in a row. Part A does not cover doctor fees while you are in the hospital. They will be covered under your Medicare Part B. With Part A may incur some out-of-pocket expenses, but they will likely much less than they would be without Part A.

Understanding the Benefits of Original Medicare

Before getting started, let’s explore specific coverages of Original Medicare in more detail.

Medicare Part A coverage includes: 

• Inpatient hospital care, including a semi-private room.

• General nursing care in a special unit like intensive care or coronary care.

• Medically-necessary inpatient surgery.

• Inpatient lab tests and X-rays.

• Meals, including special meals.

• Rehab services during your stay.

Other coverage provided by Medicare Part A:

• Skilled nursing facility care following a related hospital stay.

• Nursing home care (not custodial or long-term).

• Hospice care when deemed appropriate by your healthcare provider (terminally ill).

• Home healthcare services when medically necessary.

Medicare Part B makes up the other part of Original Medicare. Part B provides medical insurance and helps cover doctors’ visits, preventative screenings, medically necessary treatments, some mental health services, medical equipment, many emergency services, and certain outpatient treatment such as physical therapy. Part B has a standard monthly premium and an annual deductible.

Part B coverage includes:

• Routine doctor visits.

• Preventative care such as flu shots or screening mammograms.

• Outpatient mental health services.

• Diagnostic tests (MRI, CT scans, X-rays).

• Emergency room services.

• Part-time skilled nursing care.

Original Medicare does not include the following:

• Most prescription drugs.

• Long-term care.

• Routine dental work or dentures.

• Routine vision care.

• Routine hearing care or hearing.

• Routine foot care.

• Alternative treatments.

Original Medicare does not cover everything, but let us at Health Plus Life help enroll you in a Medicare Advantage plan from a trusted carrier with one monthly premium (besides your Part B premium)

Costs Associated with Medicare Part A & B

The costs associated with Medicare Part A and Medicare Part B vary. Most people qualify for premium-free Part A, which means they don’t have to pay a monthly premium. This is usually because they or their spouse paid Medicare taxes for a certain amount of time while working. However, if you don’t qualify for premium-free Part A, you may have to pay a monthly premium.

For Medicare Part B, most people pay a standard premium amount. However, if your modified adjusted gross income reported on your IRS tax return from 2 years ago is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA), resulting in a higher premium for Part B.

Enrollment Process for Medicare Part A & B

You have a seven-month Initial Enrollment Period to sign up for Medicare Part A and Medicare Part B which begins three months before the month you turn 65, includes the month you turn 65, and ends three months after you turn 65. If you fail to sign up during your initial enrollment period, you can sign up during the General Enrollment Period which runs from January 1 through March 31 each year. However, late enrollment could lead to higher premiums unless you qualify for a Special Enrollment Period.

Common Questions about Medicare Part A & B

What is the difference between Medicare Part A and Medicare Part B?

Medicare Part A and Part B form what is known as Original Medicare. Each part serves a unique purpose and helps cover different aspects of healthcare. Medicare Part A is commonly referred to as hospital insurance. It provides coverage for inpatient hospital care, including hospital stays, semi-private rooms, meals, general nursing, and drugs for your treatment. It also helps cover care in a skilled nursing facility, hospice care, and even certain home health care, though it’s worth noting that it does not cover long-term or custodial care. On the other hand, Medicare Part B, often known as medical insurance, helps cover outpatient care, including doctors’ services, preventive services, mental health care, outpatient hospital care, and medical supplies such as wheelchairs, walkers, and oxygen. These are just the highlights; the coverage details of both Parts A and B are extensive.

Is it possible to enroll in both Medicare Part A and Medicare Part B?

Absolutely, when you first become eligible for Medicare, typically at age 65, you are given the option to enroll in both Medicare Part A and Part B. Some individuals may choose to delay enrolling in Part B if they or their spouse are still working and they have health coverage through their employer. It’s worth noting that if you don’t sign up for Part B when you’re first eligible and you don’t have other coverage, you may have to pay a late enrollment penalty for as long as you have Medicare if you decide to enroll later.

How do I enroll in Medicare Part A and Part B?

The enrollment process for Medicare Part A and Part B is facilitated through Social Security. You have several options for how you can apply. One of the easiest ways is to apply online at the Social Security website. If you prefer to apply in person, you can visit your local Social Security office. Alternatively, you can call Social Security at 1-800-772-1213. If you’ve worked at a railroad, you can sign up for Medicare through the Railroad Retirement Board.

Can I have other forms of insurance along with Medicare Part A and Part B?

Yes — it’s not only possible, but also quite common to have other insurance along with Original Medicare (Part A and B). This could include a Medigap (Medicare Supplement) policy, which helps pay some of the Medicare-approved healthcare costs not covered by Original Medicare. You might also have coverage through an employer or union, or through Medicaid if you meet the eligibility requirements. However, the way these different forms of coverage work with Medicare can be complex, and it’s recommended to talk with a representative from your other insurance to understand exactly how your coverage coordinates.

Are prescription drugs covered under Medicare Part A and Part B?

While Medicare Part A and Part B offer substantial health coverage, they typically do not cover prescription drugs that you take at home. If you require medication, you can add a standalone Part D plan, which specifically helps cover prescription drugs. However, it’s important to note that certain drugs are covered under Part B if they are administered to you in a hospital or an outpatient setting. Examples of these might include certain vaccines or injections.

Are dental and vision services covered under Medicare Part A and Part B?

Original Medicare, which includes Parts A and B, does not generally cover routine dental or vision care. That means services like routine check-ups, eyeglasses, and dentures are not typically covered. However, in certain situations, Part A may cover emergency or complicated dental procedures. Similarly, Part B may cover certain preventive or diagnostic eye exams and medical eye procedures, such as cataract surgery.

Is it possible to switch from a Medicare Advantage Plan back to Original Medicare (Part A & B)?

Yes, you certainly can switch from a Medicare Advantage Plan back to Original Medicare during certain enrollment periods. The Annual Election Period, which runs from October 15 to December 7 each year, allows you to make several changes, including switching from a Medicare Advantage Plan back to Original Medicare. Additionally, there is the Medicare Advantage Open Enrollment Period, from January 1 to March 31, during which you can switch from your Medicare Advantage Plan to Original Medicare.