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Original Medicare

Health care worker examining senior patient during a home visit.

Medicare Part A

Once you are eligible for Medicare, you can enjoy the benefits of Medicare Part A. This insurance covers the cost of inpatient care in hospitals and skilled nursing facilities (not long-term care). There is usually no monthly cost for Medicare Part A, as you paid to gain this insurance during your working years. If you did not pay Medicare taxes during working years, you can purchase Part A coverage.

Medicare Part A – How Does it Work?

When they reach the end of their years of employment, most people are eligible for Medicare. Medicare Part A is a critical part of this government health insurance plan and covers the following:
Inpatient care: If you are admitted to a hospital, Medicare Part A covers the cost for 90 days. You must meet your deductible before the benefits in coinsurance and copays can begin.
Skilled nursing facility care: Under Medicare Part A, you are covered for the costs of room, board, and many other services provided at a skilled nursing facility. To qualify, under Medicare rules, you must have spent three days consecutively in a hospital with a health condition that requires skilled nursing care. In addition, the coverage is limited to 100 days per benefit period.
Home health care: If you have a health condition that leaves you homebound, Medicare Part A covers the cost of in-home care for up to 100 days. To be eligible for these services, you must have spent at least three days in a hospital within 14 days needing in-home healthcare services.
Hospice care: For terminally ill people, Medicare Part A covers the cost of hospice care but requires a medical professional to certify the need for this type of care.

Medicare Part A and Added Costs

Medicare Part A does not cover the entire cost of your care, and you will need to cover some of it out-of-pocket, such as the deductible (which varies, plan to plan), coinsurance, and copayments for all eligible Medicare services.

Medicare Part B

Medicare Part B covers medically necessary services or supplies that your doctor needs to diagnose or treat a wide array of medical conditions. For example, doctor visits, outpatient medical services, and standard medical and preventative care that is not covered by Medicare Part A are covered by Part B. To maintain Medicare Part B, you must pay a monthly premium. Most medically necessary services are covered under Medicare Part B and many types of durable medical equipment.

Which Medical Services are Covered by Medicare Part B?

Part B covers many medical services, including health screenings, ambulance services, blood tests, bone density tests, cardiac treatments, lab services, implantable defibrillators, diabetes, other screenings, and a wide array of standard medical services.
Medicare Part B covers treatments your doctors deem medically necessary, including chemotherapy, dialysis, imaging tests, and transplants. However, Medicare Part B does not cover routine physical exams, prescription drug costs, dental care, vision care, hearing aids, or alternative medical services such as acupuncture.

Are You Eligible for Medicare Part B?

If you are 65 or older, disabled, or have end-stage renal disease, you are eligible for Medicare Part B. When you enroll in Medicare, you can enroll in Part B. If you do not enroll at that time, your premium will depend on your income. If you do not enroll when you first become eligible for Medicare, you may need to pay a late enrollment penalty. So it makes sense to purchase Medicare Part B when you first enroll in the program.

What Does Medicare Part B Cost?

Your price could be higher or lower based on the income reported on your tax return two years before your enrollment. You will also be responsible for your deductible, coinsurance (about 20 percent of the cost of medical services), and copays for some services, such as outpatient hospital visits. You may or may not be automatically enrolled in Medicare Part B. It is advised that you speak with a local insurance agent to help you navigate the entire Medicare process, as it can be challenging to understand your options without guidance.

*Disclaimer: This page has not been reviewed or endorsed by or any member of the Centers for Medicare & Medicaid Services (CMS).

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