Medicare Coverage: The Benefits of Part A and Part B

Medicare was started in 1965 to provide medical insurance to people age 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 you through what’s covered.

The short answer is hospital insurance. Medicare Part A covers your costs for hospital visits 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.

Medicare Part B coverage includes your doctor visits 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.

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

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.

Medicare Advantage

Also known as Medicare Part C, Medicare Advantage typically bundles Part A, Part B and Part D together and offers  coverage through private carriers.