Original Medicare a federal health insurance program for Americans aged 65 and older and others with qualifying disabilities. It has two parts - Part A and Part B. Each part covers specific health care services.
Medicare Part A
Medicare Part A covers inpatient care and services. This is the care you receive when you are admitted to a hospital or skilled nursing facility. In general, Part A coverage provides for things such as a semi-private room, your hospital meals, lab tests and X-rays as an inpatient, operating room and recovery room services, drugs and medical equipment used while you’re in the hospital or skilled nursing facility, ICU care, skilled nursing services, hospice and more.
Part A does not cover personal care services in the hospital, such as help with eating, bathing or dressing or comfort items like a phone or TV.
Medicare Part A may charge a premium if you or your spouse did not work and pay Medicare taxes for 10 years. Otherwise, Part A will be premium-free. Part A also charges deductibles, copays and coinsurance.
When it comes to what you pay for Part A, coverage and costs are based on a “benefit period.” A benefit period begins the day you are admitted to a hospital or skilled nursing facility. It ends when you have been out of the hospital or facility for 60 days in a row. Part A charges a deductible for each benefit period. After that, Part A covers most costs for up to a 60-day inpatient stay. If you’re in the hospital for longer than 60 days, you may pay a larger share of the cost.
Note: One benefit period - and one deductible - may span two or more inpatient stays. If you're discharged from the hospital or skilled nursing facility and readmitted within 60 days, it’s still the same benefit period and covered under the same deductible. A new benefit period begins only after you’re out of the hospital for 60 days in a row.
Medicare Part B
Medicare Part B covers doctor services and outpatient care. Outpatient care includes services you receive in a doctor's office, a retail clinic, urgent care, or the emergency room. In general, Part B coverage includes things like doctor visits and services (even in the hospital), some preventative screenings and services, ambulance services, outpatient surgery services and mental health care, some durable medical equipment and medically necessary tests like X-rays, MRIs, CT scans and EKGs.
Medicare Part B charges a monthly premium based on your yearly income, as well as deductibles, copays and coinsurance. Medicare Part B doesn’t manage costs on benefit periods but as you use covered health services.
What does Original Medicare cover?
Check out the table below to see some of the things that Medicare Part and Part B cover.
|Medicare Part A - Hospital insurance
|Medicare Part B - Medical insurance
|A semi-private room and your hospital meals
|Skilled nursing services
|Ambulatory surgery center services
|Care on special units
|Outpatient medical services
|Drugs, medical supplies, and equipment used during your inpatient stay
|Some preventive care and screenings
|Lab tests, x-rays and exams
|Clinical labatory services
|Operating and recovery room services
|X-rays, MRIs, CT scans, EKGs and some other diagnostic tests
|Some blood transfusions
|Durable medical equipment for use at home
|Emergency room services
|Skilled home health care if you're homebound and only need part-time care
|Part-time, intermittent skilled nursing care and health aid services for the homebound
|Mental health care as an outpatient
How to get Medicare Parts A & B
There are two ways to get Medicare Part A and Part B.
The first is to only get Original Medicare (Parts A & B), which covers the above items and services. You can choose to add additional coverage at an added cost for things like prescription drugs (Part D) or out-of-pocket costs (Medicare supplement insurance). You get Original Medicare from the Social Security Administration.
The second option is to get a Medicare Advantage (Part C) plan that provides the Part A and Part B coverage as well as usually including Part D prescription drug coverage and extra benefits like vision, dental, hearing and fitness. You get Medicare Advantage plans from private insurance companies approved by Medicare.
Original Medicare provides a lot of coverage, but depending on your health and lifestyle needs, it may not be the right option. Consider what health care services you will want and then take some time to explore and learn about your coverage choices before enrolling.
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