Medicare Coverage: The Benefits of Part A and Part B
A breakdown of what's covered, what isn't, and what to expect
Key Takeaways
Original Medicare is also known as Medicare Part A and Part B.
Medicare Part BMedicare Part B is the portion of Medicare that covers your medical expenses. Sometimes called "medical insurance," Part B helps pay for the Medicare-approved services you receive. covers medical care, such as doctor visits and outpatient therapy.
Medicare Part AMedicare Part A, also called "hospital insurance," covers the care you receive while admitted to the hospital, skilled nursing facility or other inpatient services. Medicare Part A is part of Original Medicare. covers hospital and facility costs.
What is Original Medicare Parts A and B?
Medicare was started in 1965 to provide medical insurance to people aged 65 and older. Medicare is a public health insurance program available in two ways: Original Medicare and Medicare Advantage Plan (Part C). The basics of Medicare coverage are Part A, Part B, Part C, and Part D.
The most popular plan is Original Medicare (Parts A and B), but there has been a steady rise in Medicare Advantage popularity. If you’re new to Medicare, your coverage options may seem complicated. Don’t worry. We have answers to common questions about Medicare.
If you or a loved one is looking into Medicare, we’ll walk through what’s covered.
Find a local Medicare plan that fits your needs
What Does Medicare Part A Cover?
The short answer is hospital insurance. Medicare Part A covers your costs for hospital visits [i]
or other facilities. For example, Part A will include your room charges for a hospital visit. Here are the services that are usually covered by your Part A plan:
- Inpatient care in a hospital
- Skilled nursing facility
- Nursing home care (when needed for short-term rehabilitation; not long-term)
- Some home health care
- Hospice care
A Note About Hospital Stays and Part A
The term “hospital insurance” can be misleading. Part A doesn’t cover all hospital services at the same rates. If a hospital admits you for care, usually an emergency visit, Medicare covers your stay.
What Does Medicare Part B Cover?
Medicare Part B coverage includes your doctor visits [i] and actual care. It’s the medical insurance portion of Medicare. This is also where you get the bulk of your benefits. Medicare Part B coverage includes:
- Medically necessary services
- Preventive services
- Ambulance services
- Outpatient care
- Mental health
- Durable Medical Equipment (DME)
Medicare Part B covers any visit to a healthcare provider that accepts medicare.
Part B Deductible and Coverage Limits
The Part B deductible,A deductible is an amount you pay out of pocket before your insurance company covers its portion of your medical bills. For example: If your deductible is $1,000, your insurance company will not cover any costs until you pay the first $1,000 yourself. may go up or down year-to-year. Once you reach the deductible amount, you pay only 20% of Medicare-approved services for the rest of your benefit year. Medicare pays 80% of costs after deductible.
For example: After your deductible is satisfied, a $100 doctor visit will cost you $20 (20%), and Medicare will pay $80.
Are you eligible for cost-saving Medicare subsidies?
What is NOT Covered by Part A and Part B?
If you need a service that isn’t covered by Original Medicare, you may need to pay out of pocket or consider Medicare Advantage. Examples of care that are not covered by Part A or Part B include:
- Long-term care
- Dental care
- Eyeglasses
- Dentures
- Cosmetic or plastic surgery
- Acupuncture
- Hearing aids
- Foot care
- Prescription drugs
What Else Might I Consider?
Prescription Drug Plan
Original Medicare (Parts A and B) does not include prescription drug coverage. Medicare Prescription Drug Plan (Part D) is a standalone plan that can be added to Original Medicare to cover prescription drugs.
Along with Part D, other plans are available to work alongside your Original Medicare or offer an alternative to Original Medicare altogether.
Medicare Supplement Insurance (Medigap)
Medicare Supplement Insurance (Medigap) has ten different plans, all of which offer different services designed to cover medical issues or costs not picked up by Part A or Part B.
PROS: many coverage options, different levels of protection
CONS: Comprehensive options like Plan C and Plan F are not available to individuals enrolling in Medicare for the first time in 2021.
Medicare Advantage
Also known as Medicare Part C, Medicare Advantage bundles Part A, Part B and Part D together and offers the coverage through private carriers.
PROS: Low monthly costs and deductibles
CONS: Copayments and co-insurance costs, a regional provider network
What extra benefits and savings do you qualify for?
FAQs
Can I Add to My Coverage at Any Time?
Medicare holds a open enrollment period each year from Oct. 15 to Dec. 7. During this time, you can enroll in a plan or change your current plan. If you want to add Medicare Supplement Insurance (Medigap) to cover any gaps in your coverage, you have six months after you turn 65 to enroll in Medigap coverage without going through a health evaluation.
How Do I Know if I’m Getting the Right Coverage?
A great place to start is making a list of all the medical services you need and thinking about which of those are fully covered, or if any medical services are a little too costly. Plan changes can make your coverage a better fit. If you need help, you can also speak to a GoHealth licensed insurance agent to evaluate your policy and find options.