Original Medicare Part A and Part B

Introduction

Part A: Medicare Part A covers hospital-related expenses, including inpatient stays in a traditional hospital, skilled nursing facility, or hospice. It may also include coverage for home health care.

Part B: Medicare Part B covers expenses that are not considered hospital related. This can include some doctor visits and outpatient care, medical supplies, and preventive care services.

Medicare Part A

Most people become eligible to enroll in Medicare Part A when they turn 65. Individuals must enroll during specific enrollment windows. Having health insurance through an employer’s plan can impact enrollment timeframes. Part A is provided free for individuals and their spouses who worked and paid Medicare taxes for a minimum of 10 years. Those who are not eligible to receive free Part A may be eligible to buy it and pay premiums for coverage. Once eligible for Medicare, individuals will typically be enrolled automatically in Part A if they are receiving Social Security (SS) or Railroad Retirement Board (RRB) benefits. Those who are not receiving SS or RRB benefits, as well as those living in Puerto Rico, are not automatically enrolled.

How does Part A work?

Part A pays a portion of the costs for services associated with hospitalization. For example, these services include inpatient care, skilled nursing facilities, or hospice. Part A does not cover long-term care that is custodial in nature. There are limits to the amounts Medicare Part A will pay based on covered services and length of hospital stay. Medicare does cover inpatient care in a psychiatric hospital. However, coverage is capped at a maximum of 190 days per lifetime. Also. Medicare Part A will only cover care in a semi-private room, unless a private room is medically necessary.

Medicare Part B

Medicare Part B always requires the individual to pay a premium. Eligibility for Parts A and B tend to coincide. However, Part B eligibility will be impacted by whether or not a person is eligible for premium-free Part A. Enrollment in Part B is voluntary. Depending on a person’s eligibility, they may be enrolled in Part B automatically with the option to refuse it, or they may need to enroll on their own. Like Part A, enrollment can only happen during certain windows.

How does Part B work?

Part B covers a portion of the costs associated with medically necessary services to diagnose or treat a condition. It also includes some preventative care costs. For example, Part Be typically pays for an ambulance, durable medical equipment, certain health screenings, and some vaccines, including the flu shot and the COVID-19 vaccine. Most preventive services are provided at no cost. However, other services are typically subject to a deductible and 20% coinsurance. There is no limit on out-of-pocket costs.

We do not offer every plan available in your area. Currently we represent 12 organizations which offer 50 products in your area. Please contact Medicare.gov, 800-MEDICARE, or your local State Health Insurance Program to get information on all your options.