Medicare is a fantastic, comprehensive insurance program for seniors age 65 and over, but it can be overwhelming. With its various parts, gaps, supplements, limits and deductibles, it’s easy to become intimidated and confused when learning about it for the first time—or even for the fifth.
Two of the most important and basic aspects of Medicare are Part A and Part B. Today, let’s take a look at those two parts exclusively so that you can get a firm handle on what part they play in your healthcare.
Medicare Part A
Part A is the element of Medicare that handles hospitalization expenses. That sounds pretty limiting, but it’s really not. Part A covers inpatient care that is received in many different facilities including hospice and skilled nursing facilities. It may even provide some benefits for home healthcare.
One of the most confusing aspects of Part A is its definition of an inpatient. Many people believe that if they stay overnight in a hospital, that automatically means that they are an inpatient and therefore, Part A will cover their expenses. In reality, one is not considered an inpatient unless they have been formally admitted to the hospital through a doctor’s order. If a doctor hasn’t ordered your admittance,then you would be considered an outpatient,andPart A would not cover your expenses.
Another confusing element of Part A is found in the institutions that are covered. For example, if you are an inpatient at a hospital, rehabilitation facility or long-term care facility, Part A will generally cover expenses. However, if you are in a skilled nursing facility that provides custodial care,Part A may not provide coverage. If all that you need is nonmedical care, then Medicare itself would provide no coverage.
For those who qualify, Part A has no premiums. If you’re hospitalized for more than a year, you may be expected to pay the cost of that hospitalization. You may also be expected to pay deductibles for the plan.
The second most important piece of the Medicare puzzle is Part B, which is the medical insurance portion. Part B covers the expenses for regular doctor visits (either for preventive care or to treat a new or ongoing illness), outpatient care, medically necessary home health services and certain medical equipment.
When a service or supply is needed in order to diagnose or treat a medical condition, as long as it meets accepted standards of medical practice, it will be covered under Part B. Unlike Part A, Part B requires a premium payment each month. If you have a higher income, you may have to pay an added amount. In addition to that premium, you can expect to pay some coinsurance, which will generally amount to 20 percent of the expenses for a visit or procedure, based on the Medicare-approved dollar amount. There may also be copayments to pay for certain outpatient services.
Between Part A and Part B, Medicare has created a well-rounded, affordable form of comprehensive healthcare for seniors. Look for our future articles on supplementing Medicare A and B with a Medicare Supplement Policy.