Medicare Part A
Otherwise known as hospital insurance, Part A covers inpatient hospital care, nursing care facilities, hospice care, and home health care.
How much does it cost, and who is eligible?
Those who qualify for Medicare also qualify for Part A. Part A is funded through federal payroll taxes paid into Social Security. As such, most beneficiaries covered under Part A do not have to pay a monthly premium. You or your spouse must have paid Medicare taxes for 10 years or 40 quarters to receive coverage at no cost.
However, those who do not qualify for free Part A insurance, and do qualify for Medicare, can still purchase it through licensed insurance agents like Elite Insurance.
What Does Part A Cover?
Inpatient hospital care is covered for all emergency care following admission to the hospital, up to 90 days per benefit period. It also provides 60 lifetime reserve days and 190 total days of coverage in approved psychiatric hospitals.
Skilled nursing care provides coverage for some services, medications, wound care, and tube feeding received at a skilled nursing facility (SNF). It also requires that the individual was first admitted to a hospital for a minimum of three days. Beneficiaries receive 100 days of SNF care per benefit period.
Home health care is usually covered under Medicare Part B. However, if you spent at least three days in the hospital within the past two weeks, Part A will cover you. Beneficiaries receive 100 days of home health care per benefit period.
Hospice care coverage has no restrictions on time and is covered if a provider deems it necessary.
Medicare Part B
Otherwise known as medical coverage, Part B covers medically necessary outpatient services, procedures, treatments, and preventative services.
How much does it cost, and who is eligible?
Unlike Part A, Part B requires a monthly premium. Part B is paid for by the federal government, monthly premiums, copays, and deductibles.
The premium is determined based on the beneficiary’s yearly gross income reported to the IRS. Those receiving social security benefits will find the premium automatically deducted from their Social Security benefit payment; those who do not will receive a bill. As for coinsurance, you are generally expected to pay 20% of the approved amount after the deductible.
During the Initial Enrollment Period, you are not required to enroll in Part B Medicare coverage. However, it is generally recommended as later enrollment can come with hefty fees.
What Does Part B Cover?
Doctor’s services covered by Part B includes treatment considered medically necessary.
Ambulance services are covered for any ambulance services needed during an emergency. For non-emergent care, ambulance services are covered if there is no alternative transportation.
Home health care coverage includes any services provided in the beneficiary’s residence.
Durable medical equipment used repeatedly and serves a medical purpose is covered under Part B. Examples include wheelchairs, hospital beds, crutches, and blood test strips.
Limited prescription drugs, such as cancer medications, immunosuppressants, dialysis medications, and antiemetic drugs, are covered under part B. Other, more common prescription drugs are covered under part D.
Some early-stage preventative services are covered under Part B. Examples include physical therapy, speech therapy, yearly health screenings, vaccines, and lab work.
Clinical research that is covered could involve diagnostic tests, surgical treatments, testing new treatments, and new medicine.
Mental health services covered include outpatient, inpatient, and partial hospitalization necessary for diagnosing and treating mental health issues.
What's Not Covered by Parts A & B?
As expected, Medicare Part A & B do not cover everything. In some cases, the services they do not cover will be covered by Parts C, D, and Supplements. However, a basic list of things that Medicare Parts A & B will not cover includes:
- Majority of Dental Care, including dentures
- Eye Exams
- Cosmetic surgery
- Massage Therapy
- Hearing aids and fitting exams
- Any care provided by an opt-out doctor
- Concierge Care
- Long-Term Care
- Out-of-Country Visits
