Original Medicare Part A & Part B

Hospital Insurance (Medicare Part A) – This Medicare segment covers hospitalization expenses, encompassing stays in conventional hospitals, skilled nursing facilities, or hospice care. It extends to include home health care services as well.

Medical Insurance (Medicare Part B) – Distinct from hospital-related costs, this part covers a broader spectrum of medical expenses. It encompasses doctor consultations, outpatient treatment, medical supplies, and preventive health services.

Medicare Part A Overview

Eligibility for Medicare Part A kicks in for most individuals upon age 65. There are specific periods during which one must sign up, and being covered under an employer’s health plan may influence the timing of enrollment. Part A is free for individuals and their spouses who have contributed to Medicare taxes for at least ten years. Those who don’t qualify for free Part A have the option to purchase it, thereby incurring premium costs. Generally, individuals receiving Social Security or Railroad Retirement Board benefits are automatically signed up for Part A. However, this automatic enrollment doesn’t apply to non-beneficiaries or residents of Puerto Rico.

How does Part A work?

Part A contributes towards hospital-related expenses, covering services like inpatient care in hospitals, skilled nursing facilities, and hospice care, but not long-term custodial care. Coverage limits are imposed based on the type of service and duration of hospital stays. While inpatient psychiatric hospital care is included, it’s capped at 190 lifetime days. Part A typically covers semi-private rooms, with private rooms covered only if deemed medically necessary.

Medicare Part B Overview

Unlike Part A, Part B necessitates a monthly premium from all enrollees. Eligibility for both Part A and B usually aligns, but having premium-free Part A affects eligibility for Part B. Enrollment in Part B is optional and may occur automatically for some, who then have the choice to opt out or may require manual enrollment during designated periods.

How does Part B work?

Part B financially supports a share of the costs for essential services needed for diagnosis or treatment and some preventive services. This includes but is not limited to, ambulance services, durable medical equipment, certain health screenings, and vaccinations such as those for influenza and COVID-19. While most preventive services are free, others may involve a deductible and a 20% coinsurance, with no ceiling on out-of-pocket expenditures.