Medicare Parts A and B (Sometimes Called "Original Medicare")
Medicare Parts A and B (sometimes called "Original Medicare") is the federal government's standard health plan. It works similarly to the health insurance you may get (or have gotten) through your employer, and provides two types of coverage:
- Part A helps with inpatient hospital costs.
- Part B helps with doctor's care and outpatient care.
If you choose Medicare Parts A and B, you can add a prescription drug plan (Part D) and Medicare Supplement Insurance to get benefits not provided by Parts A and B.
Medicare Part A helps cover:
- Inpatient care services in hospitals and critical access hospitals.
- Intermittent inpatient care in skilled nursing facilities.
- Hospice care and some home health care services (for those who meet certain eligibility requirements).
Medicare Part B helps cover:
- Doctor visits.
- Outpatient care, like preventive services.
- Some services not covered by Part A, such as physical or occupational therapy.
- Medically required home health care services, in some cases.
Are there limits to coverage?
Medicare Part A pays most of the costs of hospital stays lasting up to 60 days annually. Beyond that, you'll have to pay a daily copay for each day you remain in the hospital. If you're hospitalized more than 90 days, you should expect to pay for the majority, if not all, of your care.
Medicare Part B generally doesn't limit the number of covered medical services you can receive, as long as your care is medically necessary to treat an illness or condition. However, some services, like preventive care and screenings, may have limits.
What doctors can I see?
Because coverage is available everywhere in the United States, you can go to any doctor or hospital in the country that accepts Medicare. No referrals are needed, even if you see a specialist.
Care outside of the U.S. is generally not covered.
How much does it cost?
Medicare Part A
- Premium . For most people, the Part A monthly premium is free.
- Deductible . You must pay a deductible before Part A begins paying a share of your costs. If you have multiple hospital stays in one year, you may pay this deductible for each stay.
- Copays . You pay a daily copay after you've stayed a certain number of days in a facility. This includes hospital stays, skilled nursing care, and some parts of hospice care.
- Coinsurance . You'll pay a small coinsurance payment if you use inpatient respite care for hospice patients.
Medicare Part B
- Premium. You have to pay a monthly premium for Part B. Your monthly premium amount is determined by your yearly income.
- Deductible. You must pay a deductible before Part B begins paying a share of your costs.
- Copays. Outpatient hospital services have copays that range in price.
- Coinsurance. For example, after you pay your deductible, Part B may pay 80% and you would pay the remaining 20% as coinsurance for the cost of your care.
Original Medicare Parts A and B have no out-of-pocket limits, and an unexpected illness could result in significant costs.
How do I enroll in Medicare?
If you're receiving Social Security benefits when you become eligible for Medicare, you'll automatically be enrolled in Part A and Part B. If you don't want Part B coverage, you can opt out at your local Social Security office.
If you're not receiving Social Security benefits, but you're eligible for Medicare, you can enroll in Part A and Part B during your initial enrollment period at your local Social Security office.
You can't be denied coverage because of your medical history or pre-existing conditions.
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