Original Medicare (Parts A & B)
In this guide, we'll explain the key aspects of Medicare Parts A and B and help you navigate crucial information.
Medicare Part A, also known as hospital insurance, covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services. Here are some key points to understand about Part A:
- Hospital Stays: Part A helps cover the costs associated with inpatient hospital stays, including semiprivate rooms, meals, nursing services, and necessary hospital supplies.
- Skilled Nursing Facilities: If you require skilled nursing care or rehabilitation services in a skilled nursing facility, Medicare Part A can help cover those costs for a limited time.
- Hospice Care: Part A provides coverage for hospice care if you have a terminal illness and a life expectancy of six months or less. It includes medical and support services to manage pain and provide comfort.
- Home Health Care: Medicare Part A covers medically necessary home health care services when prescribed by a doctor, such as skilled nursing care, therapy, and assistance with activities of daily living.
Medicare Part A
Medicare Part B, also known as medical insurance, covers medical services and supplies necessary for the diagnosis or treatment of medical conditions. Here are some key points to understand about Part B:
- Doctor Visits: Part B covers visits to doctors, specialists, and other healthcare providers. It includes services like check-ups, preventive care, and medically necessary treatments.
- Outpatient Care: Part B covers services received in outpatient settings, such as outpatient surgeries, diagnostic tests, lab work, and durable medical equipment (e.g., wheelchairs, walkers, and oxygen equipment).
- Preventive Services: Medicare Part B provides coverage for preventive services like vaccinations, screenings, and counseling to help prevent or detect illnesses at an early stage.
- Ambulance Services: Part B covers emergency ambulance transportation to a hospital when other transportation options would be unsafe or unsuitable.
- Medical Supplies: Medicare Part B helps cover medically necessary supplies like insulin, diabetes testing supplies, and certain durable medical equipment.
Medicare Part B
The Initial Enrollment Period (IEP) is the seven-month period that starts three months before your 65th birthday month, includes your birthday month, and ends three months after your birthday month. It's typically the best time to enroll in Medicare Part B to avoid any late enrollment penalties. If you miss your IEP, you can enroll during the General Enrollment Period, which runs from January 1 to March 31 each year. However, late enrollment penalties may apply. Some individuals may qualify for Special Enrollment Periods (SEPs) that allow them to enroll in Medicare outside of the IEP or General Enrollment Period. SEPs are triggered by specific life events, such as retiring from a job with employer-provided healthcare coverage.
Learn more about enrollment for Parts A, B, C, D, and supplement plans here.
Enrollment
- Premiums: Most people do not pay a premium for Medicare Part A because they or their spouse paid Medicare taxes while working. However, there may be a premium for Part A if you haven't paid enough Medicare taxes.
- Part B Premium: Medicare Part B has a monthly premium, which is typically deducted from your Social Security benefits. The premium amount may vary based on your income.
- Deductibles and Coinsurance: Part A and Part B have deductibles and coinsurance that you are responsible for paying. These amounts can change annually, so it's important to review the current costs.
- Coverage Limitations: Medicare has certain limitations and exclusions. For example, it does not cover most prescription drugs, dental care, or long-term care. To cover these services, you may need additional insurance such as Medicare Part D (prescription drug coverage) or Medicare Supplement (Medigap) plans.
Understanding the basics of Medicare Parts A and B is essential for boomers to make informed decisions about their healthcare coverage. Part A provides coverage for hospital stays and certain types of care, while Part B covers doctor visits, outpatient services, and preventive care. Familiarize yourself with the enrollment periods, costs, and coverage limitations associated with each part. By understanding these key aspects, you can navigate the Medicare system more effectively and ensure you have the necessary coverage for your healthcare needs.