Medicare
Parts A & B
Medicare A & B Costs and Coverages - 5min
Medicare A and B…
Medicare Parts A and B are often called Original Medicare. These are the two main parts of Medicare provided by the federal government.
Medicare can be a great starting point for your health coverage, but it does not cover everything. That is why it is important to understand what Parts A and B cover, what they cost, and where you may still have out-of-pocket expenses.
Most people become eligible for Medicare when they turn 65. Some individuals may qualify earlier due to disability, End-Stage Renal Disease, or ALS.
Whether you need to enroll in Medicare at age 65 depends on your situation. If you are still working or covered under an employer plan, your timing may depend on whether that coverage is considered creditable for Medicare purposes. Because every situation is different, HTA can help you review your personal Roadmap into Medicare.
What does Medicare Part A Cover?
Medicare Part A is your inpatient hospital coverage.
- Inpatient hospital stays
- Skilled nursing facility care after a qualifying hospital stay
- Hospice care
- Some home health care
What does Medicare Part B Cover?
Medicare Part B is your outpatient medical coverage.
Part B helps cover outpatient care and medically necessary services:
- Doctor visits
- Specialist visits
- Preventive services
- Diagnostic testing
- Outpatient surgery
- Emergency room services
- Hospital observation stays
- Chemotherapy and other outpatient treatments
- Durable medical equipment, when approved by Medicare
Does Medicare A and B pay 100% of my medical expenses?
No. Original Medicare does not cover 100% of your medical expenses.
Medicare Parts A and B provide strong baseline coverage, but you may still be responsible for:
- Deductibles
- Coinsurance
- Copays
- Services not covered by Medicare
- Costs above Medicare-approved amounts in certain situations
One of the most important things to understand is that Original Medicare does not have a maximum out-of-pocket limit. That means there is no built-in cap on what you could spend in a year if you only have Medicare Parts A and B.
This is one reason many people consider additional coverage, such as a Medicare Supplement, Medicare Advantage plan, and/or Part D prescription drug plan, depending on their needs.
Common services not generally covered by Medicare Parts A and B include:
- Most dental care
- Dentures
- Routine vision exams
- Most eyeglasses or contact lenses
- Hearing aids and exams for fitting hearing aids
- Routine foot care
- Cosmetic surgery
- Long-term custodial care
- Most care received outside the United States
View the Medicare Out of Pocket Costs here
There are also certain services that are not coverage by Medicare. See more information on what Medicare does not cover at medicare.gov
Enrolling at the Right Time Matters
It is important to enroll in Medicare at the right time for your situation.
Some people should enroll in Medicare when they first become eligible at age 65. Others may be able to delay Part B if they are still working and covered by qualifying employer coverage.
If you delay Medicare without having the right type of coverage, you could face late enrollment penalties. For Part B, Medicare generally charges an extra 10% for each full 12-month period you could have had Part B but did not enroll, unless you qualify for a Special Enrollment Period.
Not sure when you should enroll in Medicare?
Your Medicare timeline depends on your work status, employer coverage, spouse’s coverage, income, and personal health needs.
HTA can help you build your personalized Roadmap into Medicare so you know what to do, when to do it, and how to avoid unnecessary penalties.
Key Takeaways
- Medicare Parts A and B are the foundation of your Medicare coverage.
- Part A helps cover inpatient hospital care.
- Part B helps cover doctors, outpatient care, testing, preventive care, and other medical services.
- Original Medicare is valuable coverage, but it does not pay for everything and does not include a maximum out-of-pocket limit.
Visit the following pages for more information on plan options
Medicare Supplement Plan Options
Medicare Advantage Plan Options
Medicare Part D Prescription Plans