Medicare Part A & B

Original Medicare consists of two main parts which include Part A and Part B. Part A includes basic inpatient coverage during the hospital stays.

Medicare part A coverage

In general Medicare Part A includes coverage for:

  • Inpatient care in hospital: when you are admitted to the hospital at your doctor’s order because you need inpatient hospital care to treat injury or illness. It covers semi-private rooms,  meals, general nursing, drugs (including methadone), and other hospital supplies that are needed for inpatient care. Also, it’s important to know that inpatient mental health care is limited to 190 days during your lifetime. However, it also implies acute care and critical access to hospitals, inpatient rehabilitation, and psychiatric facilities as well as long-term stay in the hospital 
  • Skilled nursing facilities care: for this kind of care you must stay 3 days in the  inpatient hospital care because treatment is related to skilled nursing or therapy services. It also includes meals, semi-private rooms, occupational therapy (helps with daily activities such as dressing or bathing), physical therapy, ambulance services, skilled nursing care
  • Hospice care: you get this kind of care if your doctor confirms that you are terminally ill ( with a life expectance of a minimum of 6 months) if you accept palliative care, and if you choose hospice care rather than treating your terminal illness in the hospital. Hospice care cost 0$.
  • Home health care: is usually covered under Part B of Original Medicare but in some cases, it’s covered under Part A ( if you have spent at least 3 days in a row in an inpatient hospital care after you were treated for at least two weeks at home)

 

What Medicare part A doesn't cover?

Medicare Part A doesn’t cover:

  • Private nursing
  • Private rooms
  • Items for personal care (razors, slippers, or such )
  • TV or phone (if there are separate charges for this)

Medicare Part A costs

Usually, you don’t have to pay anything for Part A premium (if you or your husband paid for Medicare taxes while working at least ten years). If you don’t have these terms fulfilled you can buy part A but costs for it in 2022 are from 274$ to 499$  (costs are depending on how much of the time you or your spouse paid for Medicare taxes during your working period. If you choose to buy part A you also have to enroll in Part B and pay Part A and Part B  monthly premiums.

Also, you may have to pay part A deductible if you used a 60-day stay in the hospital per year. Medicare Part A covers only 60 days of hospital stays so if you need inpatient hospital care longer than 60 days you’ll have to pay the deductible.  From 61-90 days costs are 389$ per day, and longer than that is 778$ per day.

When am I eligible to enroll?

The best time to enroll in Medicare Part A is three months before you turn 65. Also, you have to be a U.S. citizen or have a permanent residence for a minimum of five years.  Notice that you can pay a late enrollment penalty if you aren’t eligible for a free premium and don’t buy Part A when you become eligible for it. For, example if you are eligible for Part and you didn’t sign up in time you will have to pay a higher monthly premium for twice the number of years you didn’t enroll.

Medicare part B coverage

Part B covers services that are medically necessary to help you treat or diagnose your medical condition or illness.

That includes:

  • Clinical research: may involve testing new treatments, diagnostic tests, surgical treatments, medicine
  • Ambulance services: it covers in case sit is necessary for your health condition to be transported into a hospital, skilled nursing facility, or critical access hospital. It also can cover transportation by helicopter or airplane in urgent cases.
  • Durable medical equipment: if your doctor prescribes this equipment as medically necessary like blood sugar meters and test strips, canes, commode chairs, CPAP devices, hospital beds, wheelchairs, nebulizers, oxygen equipment, infusion pumps, walkers, etc. 
  • Mental health services: outpatient, inpatient, and partial hospitalization. For example, it helps pay for depression screening, diagnostic tests, psychiatric evaluation, medication management 
  • Some prescriptions for drugs: drugs that are part of DME usage (infusion pump or nebulizer), some antigens, injectable osteoporosis drugs, drugs for helping with clotting factors if you have hemophilia, injections of erythropoietin or oral drugs if you have ERSD and injectable and infused drugs 
  • Doctor visits
  • Preventive care services: vaccines, cancer screenings per year, lab work

What isn’t covered under Part B

Original Medicare which includes part B doesn’t cover for:

  • Dental
  • Vision
  • Hearing
  • Prescription for drugs coverage
  • Hospital stays more than 100 days

Part B cost

When you enroll in Medicare Part B you must pay for Part B premium costs. In 2022, this cost is approximately 170$ dollars per month. However,  if you have a higher income you will pay a higher premium cost. This cost is determined by IRMAA which determines your premium cost according to the amount of your annual income. 

Furthermore, your  Part B coverage also includes paying for deductible once a year and 20% of coinsurance which is 233$ in 2022. Once you reach your annual deductible Medicare covers 80% of your expenses.

Part B enrollment

Most people enroll in Part A and part B at the same time. You are eligible to enroll in the Initial Enrollment period which begins 3 months before your 65th birthday and ends three months after your 65th birthday. If you don’t enroll during the Initial Time Period you may have to pay the late enrollment penalty.

However, if you have Social Security benefits already you’ll be enrolled in Part B automatically, but if you don’t you’ll need to do it by yourself. 

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