Orginal Medicare Part A & B
What is Original Medicare?
Medicare is a healthcare insurance program funded by the government. It is offered to any United States citizen over 65, permanently disabled, or suffering from end-stage renal failure.
This health insurance is split into four parts: Part A, Part B, Part C, and Part D. Each part provides different coverage options tailored to your individual needs.
The first two parts, A and B, are known as Original Medicare. Many people enroll in Part A and B to get the most out of Medicare Coverage. This helps cover both inpatient and outpatient costs.
Part A
Medicare Part A covers inpatient hospital care, nursing care facilities, hospice care, and home health care. It is commonly referred to as hospital insurance. If you qualify for Medicare, you are qualified for Part A.
This coverage is free if you or your spouse have paid federal payroll taxes into Social Security for 10 years, or 40 quarters.
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 Golden Senior Benefits.
We'll help you get the most from your Medicare benefits.
At Golden Senior Benefits, we specialize in the senior market. We believe that you have the right to understand your options thoroughly. Our licensed Medicare insurance consultants are thoroughly educated in this ever-changing market, and ready to help you understand which health plan is best for your needs.
What does Part A cover?
Inpatient Hospital Care
Emergency care following admission to the hospital, or inpatient care, is covered under Part A for up to 90 days per benefit period. In approved psychiatric hospitals, Part A also provides 60 lifetime reserve days and 190 total days of coverage.
Skilled Nursing Care
If the individual was first admitted to the hospital for at least three days, Part A will cover certain services, medications, wound care, and tube feeding received at a skilled nursing facility (SNF). Beneficiaries receive 100 days of SNF care per benefit period.
Home Health Care
While Home Health care is usually covered under Part B, it will be covered under Part A if the individual spent at least three days in the hospital within the prior two weeks. Beneficiaries receive 100 days of home health care per benefit period.
Hospice Care
Hospice Care is covered under Part A if a provider deems it necessary, and there are no time restrictions.
Part B
Part B covers medically necessary outpatient services, procedures, treatments, and preventative services. It is also referred to as medical coverage.
The federal government, monthly premiums, copays, and deductibles pay for part B. The premium varies and is determined by the beneficiary’s yearly gross income reported to the IRS.
The premium will automatically be deducted from the beneficiary’s social security benefits payment, while those who do not receive Social Security benefits will receive a bill. After the deductible is met, the beneficiary is generally expected to pay 20% of the approved amount. Usually, beneficiaries opt for coinsurance, or Medigap, to pay the 20% rather than paying out of pocket.
While you are not required to enroll in Part B during the initial enrollment period, it is generally recommended as later enrollment can come with hefty fees.
What does Part B cover?
Doctor’s Services
Only treatment considered medically necessary is covered by Par B.
Ambulance Services
Emergency ambulance services are covered under Part B. For non-emergent care, ambulance services are covered if there is no alternative transportation.
Home Health Care
Any medical services provided in the beneficiary’s residence, except for those covered under Part A, are covered by Part B.
Durable Medical Equipment
Durable medical equipment that is used repeatedly and serves a medical purpose is covered under Part B. Examples include wheelchairs, hospital beds, crutches, and blood test strips.
Select Prescription Drugs
Select prescription drugs covered under Part B include cancer medications, immunosuppressants, dialysis medications, and antiemetic drugs. More common prescription drugs are covered under Part D.
Preventative Care
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
This could involve diagnostic tests, surgical treatments, testing new treatments, and new medicine.
Mental Health
Outpatient, inpatient, and partial hospitalization care necessary for diagnosing and treating mental health issues is covered under Part B.
What is not included in original Medicare coverage ?
By now, you may be wondering why you would need any additional insurance. It’s important to know that Parts A & B do not cover everything. In some cases, the services not covered will be covered by Parts C, D, and Supplements. However, an essential list of what Medicare Parts A & B does 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
How do you enroll?
You will usually automatically enroll in Part A of Medicare when receiving Social Security or Railroad Retirement benefits. You will also be allowed to enroll in or decline Part B.
For those who do not meet the requirements above, the easiest way to enroll is with an independent insurance agent. We will help you get the coverage that benefits you best. Because we partner with and sell policies of many insurance companies, we can provide options for you.
Golden Senior Benefits has years of experience in the senior market. We can assist you in determining what plan works best for your unique needs at the best price. Let our agents provide you with an insurance plan that fits your needs.
Medicare Supplements
Also known as Medigap, Medicare Supplements help pay the leftover 20% that Parts A and B don’t cover. They essentially "cover the gap".
Medicare Advantages
Also referred to as Part C, private insurance companies contracted with Medicare offer these plans. They provide all of your Part A and B benefits.
Prescription Drug Plans
Also known as Part D, this is an optional benefit that covers your prescription drugs. It is offered to everyone who has Medicare.