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Understanding Medicare Parts A and B Coverage

Medicare Part A and Part B form the foundation of Original Medicare, the federal health insurance program for people age 65 and older, some younger people with disabilities, and people with end-stage renal disease. A guide about these programs explains what each part covers and how they work together.

Part A covers hospital insurance. This includes inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. When you stay in a hospital as an inpatient, Part A helps pay for your room, meals, medications while hospitalized, and other hospital services and supplies. Part A does not cover outpatient services like visiting a doctor's office or getting lab work done at an outpatient clinic.

Part B covers medical insurance. This includes doctor visits, outpatient services, durable medical equipment like wheelchairs or oxygen, and other medical services and supplies. Part B typically covers preventive services with no cost-sharing, such as annual wellness visits, cancer screenings, and vaccinations. However, Part B requires a monthly premium that most people pay, along with a yearly deductible and co-insurance amounts for services used.

Together, Parts A and B create a two-part system. For example, if you have chest pain and go to an emergency room, Part A covers the hospital facility costs if you are admitted as an inpatient. Part B covers the emergency room physician's services. Understanding what each part covers helps you know what costs you might encounter.

A guide about these programs typically includes charts showing what services are covered, what costs you might owe, and how the two parts work together. This information helps people understand the basics of how Original Medicare functions and what to expect regarding coverage and costs.

Practical Takeaway: Knowing the difference between Part A hospital coverage and Part B medical coverage helps you understand what services you may need to pay for out-of-pocket and which services Medicare may help cover.

How Medicare Part A and B Enrollment Works

People become part of Medicare through enrollment, a process managed by the Social Security Administration and Centers for Medicare & Medicaid Services (CMS). A guide about this process explains when enrollment happens and what the different enrollment periods mean.

Most people become part of Medicare automatically when they turn 65. If you receive Social Security benefits before age 65, you are typically enrolled in Parts A and B automatically three months before you turn 65. If you do not receive Social Security yet, you must take action to enroll when you turn 65.

The Initial Enrollment Period spans seven months: three months before the month you turn 65, the month you turn 65, and three months after. During this time, you can enroll in Parts A and B without penalty. If you miss this window and do not have other health coverage, you may face a permanent penalty on your Part B premium for as long as you have Medicare.

After your Initial Enrollment Period ends, there is a General Enrollment Period from January 1 through March 31 each year. However, if you miss your Initial Enrollment Period and enroll during General Enrollment instead, your Part B coverage does not start until July 1 of that year, and you pay a penalty. This is why timing matters for enrollment.

People with employer health coverage through current work may be able to delay enrollment without penalty through Special Enrollment Periods. A guide typically explains these exceptions and situations where people might not need to enroll right at age 65.

The guide also covers enrollment for people under 65 who have disabilities or end-stage renal disease. These groups have different enrollment rules and timelines than people turning 65.

Practical Takeaway: Understanding your enrollment period and when coverage begins helps you plan your health insurance and avoid potential penalties or gaps in coverage.

Part A and B Costs You Should Know About

Original Medicare has several types of costs that beneficiaries may pay. A guide about costs breaks down these different expenses so people understand what they might owe for various services.

Part A has a deductible amount you pay each benefit period before Medicare starts paying for inpatient hospital care. In 2024, this deductible is $1,632 per benefit period. A benefit period begins when you enter a hospital and ends after you have not received inpatient hospital care or skilled nursing facility care for 60 consecutive days. You may have multiple benefit periods in a year if you have multiple hospital stays. For skilled nursing facility care within the same benefit period as a hospital stay, you pay coinsurance amounts ($408 per day in 2024) after the first 20 days.

Part B has a yearly deductible ($240 in 2024) that you pay before Medicare begins to pay its share. After you meet the deductible, you typically pay 20 percent of the cost for most doctor services, outpatient services, and durable medical equipment. Medicare pays the remaining 80 percent. However, some preventive services have no deductible or co-insurance.

Part B also requires a monthly premium payment. The standard premium in 2024 is $174.70 per month, though higher-income beneficiaries pay more through Income-Related Monthly Adjustment Amounts (IRMAA). Most people pay the Part B premium through deductions from their Social Security benefit check.

A guide typically includes a table showing these costs and how they apply to different scenarios. For example, if you have a hospital stay followed by skilled nursing facility care, the guide might walk through what you would owe at each stage. This concrete example approach helps people understand how costs add up.

The guide also mentions that these amounts change yearly, so amounts listed in guides are based on the year the guide was created. Current amounts should be verified with Medicare.gov.

Practical Takeaway: Reviewing the specific dollar amounts for deductibles, co-insurance, and premiums helps you budget for healthcare expenses and understand what percentage of costs you are responsible for when you use services.

What Is NOT Covered by Parts A and B

Understanding what Medicare does not cover is as important as knowing what it does cover. Many people are surprised to learn about coverage gaps, and a guide typically explains common exclusions and limitations.

Original Medicare does not cover dental care, vision care, or hearing aids. This means routine dental cleanings, tooth extractions, fillings, eyeglasses, hearing tests, and hearing devices are not covered by Parts A and B. Some Medicare Advantage plans include these benefits, but Original Medicare does not. People who need these services must pay out-of-pocket or purchase separate coverage.

Long-term care or custodial care is not covered. If you need help with daily activities like bathing, dressing, or eating in a nursing home or at home, and skilled medical care is not the main reason for the care, Medicare does not pay for it. This is different from skilled nursing facility care, which Medicare does cover for a limited time after a hospital stay.

Routine physical exams and related tests for screening purposes beyond what Medicare lists as covered preventive services are not included. For example, while Medicare covers an annual wellness visit, it does not cover routine physical exams that are not specifically listed in the preventive services benefit.

Experimental treatments and procedures not approved by Medicare are not covered. Medications and treatments that Medicare determines are experimental or investigational are excluded, even if your doctor recommends them. This can be a significant limitation for people seeking cutting-edge cancer treatments or other new therapies.

Travel outside the United States is another major exclusion. Medicare covers services received in the United States, Puerto Rico, U.S. Virgin Islands, Guam, and American Samoa. Care received in other countries is generally not covered, though there are limited exceptions for emergency services in specific border situations.

A comprehensive guide lists many more exclusions and explains the reasons behind them. It may also discuss supplemental insurance options and Medicare Advantage plans that offer different coverage for some of these services.

Practical Takeaway: Knowing what Medicare does not cover helps you plan for out-of-pocket expenses and consider whether supplemental insurance or alternative coverage options may be worth exploring.

How to Get Information About Medicare Programs

Getting accurate information about Medicare is essential for making decisions about your coverage. A guide about obtaining Medicare information describes several reliable resources for learning more about the programs.

Medicare.gov is the