Medicare Coverage: The Benefits of Part A and Part B
Key Takeaways
- Original Medicare is also known as Medicare Part A and Part B.
- Medicare Part BMedicare Part B is medical insurance that covers Medicare-approved services — such as medically necessary treatment and preventive services — and certain other costs, like durable medical equipment. Medicare Part B is part of Original Medicare. covers medical care, such as doctor visits and outpatient therapy.
- Medicare Part AMedicare Part A is hospital insurance, which covers the care you receive while admitted to a hospital, skilled nursing facility, or other inpatient facility. Medicare Part A is part of Original Medicare. covers hospital and facility costs.
What Is Original Medicare Parts A and B?
Original Medicare, also known as Medicare Parts A and B, is a public health insurance program started in 1965 to cover people age 65 and older and later expanded to people with certain disabilities.
If you’re enrolled in Original Medicare, you have options for enrolling in additional coverage through private insurance carriers, such as a Medicare Supplement plan and a Medicare Part D prescription drug plan. You may also choose to switch to a Medicare Advantage plan, sometimes called Medicare Part C.
When you’re new to Medicare, your coverage options may seem complicated. Don’t worry. We have answers to common questions about Medicare.
Still have questions? GoHealth has the answers you need.
What Does Medicare Part A Cover?
Medicare Part A is hospital insurance, which can cover inpatient care in a:
- Hospital
- Skilled nursing facility
- Nursing home care (when needed for short-term rehabilitation; not long-term)
- Psychiatric hospital
- Some home health care
- Hospice care
Your care is covered if you’re admitted to a facility that accepts Medicare after receiving an official doctor’s order saying you need inpatient treatment.
After the costs for a hospital stay exceed the Part A deductibleA deductible is an amount you pay out of pocket before your insurance company covers its portion of your medical bills. For example: If your deductible is $1,000, your insurance company will not cover any costs until you pay the first $1,000 yourself. (which is determined each year by the federal government), Medicare pays your costs for the first 60 days. For longer stays, you will pay a set amount each day.
What Does Medicare Part B Cover?
Medicare Part B is medical insurance that covers your doctor visits and other services. When you go to a healthcare provider who accepts Medicare, your Part B coverage includes:
- Medically necessary services
- Preventive services
- Ambulance services
- Outpatient care
- Mental health
- Durable medical equipment (DME)
Part B Deductible and Coverage Limits
The Part B deductible may go up or down year-to-year. Once you reach the deductible amount, you’re charged a copayment or coinsurance for the rest of your benefit year, usually 20% of the Medicare-approved amount for most services.
Find the Medicare Advantage plan that meets your needs.
What Is NOT Covered by Part A and Part B?
If you need a service that isn’t covered by Original Medicare, you may need to pay out of pocket or consider a Medicare Advantage plan with additional benefits. Examples of care that are not covered by Part A or Part B include:
- Long-term care
- Dental care
- Eyeglasses
- Dentures
- Cosmetic or plastic surgery
- Acupuncture
- Hearing aids
- Foot care
- Prescription drugs
What Else Might I Consider?
Prescription Drug Plan
Original Medicare (Parts A and B) does not cover most prescription drugs. You can add a Medicare prescription drug plan (Medicare Part D) from a private insurance carrier to cover prescription drugs.
Medicare Supplement Insurance (Medigap)
Private insurance carriers offer Medicare Supplement Insurance (Medigap) plans to cover out-of-pocket costs not picked up by Part A or Part B. In most states, you have many coverage options, which offer different levels of protection.
Medicare Advantage
Also known as Medicare Part C, Medicare Advantage plans are offered by private insurance carriers. They substitute for Original Medicare and must at least match the coverage provided by Part A and Part B.
Medicare Advantage plans typically include Part D prescription drug coverage and may offer other benefits such as dental, hearing, and vision. Every plan has an out-of-pocket maximum that limits how much you’ll spend on covered services in a year.
Most Medicare Advantage plans have a provider network. To get the most out of your coverage, you’ll need to see healthcare providers and visit pharmacies that are included in that network.
FAQs
Can I add to my coverage at any time?
How do I know if I’m getting the right coverage?
Your Ideal Medicare Plan is out there.
Sources
- Emergency department services. CMS.gov.
- What Part B covers. CMS.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.