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
In general Medicare Part A includes coverage for:
- Inpatient care in a hospital
Inpatient care implies admission to a hospital at your doctor’s order because you need inpatient hospital care to treat an injury or an 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 mention 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, it is mandatory to stay 3 days in 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 costs 0$.
- Home health care
This type of 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
In general, you don’t have to pay anything for Part A premium (if you or your spouse have paid for Medicare taxes while working for at least ten years). If you don’t have these terms fulfilled you can buy part A and costs for it in 2023 will be between $278 and $506 per month (costs are depending on how much of the time you or your spouse paid for Medicare taxes during your working period). A large cost for Medicare Part A is the deductible, which is the amount you have to pay for medical care out of pocket before the plan’s benefits begin. For 2023, the Medicare Part A deductible will be $1,600.
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
Part B covers services that are medically necessary to help you treat or diagnose your medical condition or illness.
- Clinical research
This may involve testing new treatments, diagnostic tests, surgical treatments, medicine
- Ambulance services
Implies transportation into a hospital, skilled nursing facility, or critical access hospital in case it is necessary for your health condition. It can also cover transportation by helicopter or airplane in urgent cases.
- Durable medical equipment
Medically necessary equipment prescribed by a doctor 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, mental health services help pay for depression screening, diagnostic tests, psychiatric evaluation, and medication management.
- Some prescriptions for drugs:
Drugs that are part of DME usage, 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
Besides your Annual wellness visit.
- 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, and hearing services
- Prescription for drugs coverage
- Hospital stays that last longer than 100 days
Part B cost
For most people, the cost of Medicare Part B premium for 2023 will be $164.90 per month. This rate is adjusted based on income. For high earners, the cost of Medicare Part B is based on your adjusted gross income (AGI) from your previous year’s taxes. For example, those earning more than $97,000 will pay higher premiums.
Besides the monthly premium, enrollees in Medicare Part B are also responsible for paying the deductible. For 2023, the Medicare Part B deductible will be $226, which means you would need to pay this amount before coinsurance benefits would kick in.
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.