Understanding Original Medicare: What Part A and Part B Cover

Medicare, a federally funded health insurance program, plays an instrumental role in providing healthcare coverage for U.S. citizens aged 65 and older, as well as certain younger individuals with disabilities and specific health conditions. Original Medicare, which is the traditional fee-for-service program offered directly through the federal government, is composed of two main parts: Part A and Part B. Understanding what each of these parts covers can help beneficiaries make informed decisions about their healthcare needs.

Medicare Part A: Hospital Insurance

1. Inpatient Care in Hospitals: Part A covers the costs associated with a hospital stay, including semi-private rooms, meals, general nursing, and certain hospital services. Note that it does not cover private nursing or private rooms, unless medically necessary.
2. Skilled Nursing Facility (SNF) Care: After a qualifying hospital stay, Medicare Part A can cover skilled nursing care, physical therapy, and certain other services. However, it does not cover long-term or custodial care.
3. Hospice Care: For individuals with a terminal illness, Part A covers hospice care, which includes pain relief, symptom management, social services, and certain prescription drugs for symptom control or pain relief.
4. Home Health Care: Part A may cover home health services like intermittent skilled nursing care, physical therapy, and speech-language pathology services, if deemed medically necessary and prescribed by a doctor.
5. Blood Transfusions: Part A covers blood transfusions received as an inpatient.

Costs Associated with Part A

While many people do not pay a monthly premium for Part A due to sufficient work history, there are out-of-pocket costs like deductibles, coinsurance, and copayments. These can change annually and are important to keep in mind when planning healthcare expenses.

Medicare Part B: Medical Insurance

1. Outpatient Care: Part B covers doctor visits, outpatient procedures, preventive services, and mental health care.
2. Home Health Care: Similar to Part A, Part B may cover necessary home health services.
3. Durable Medical Equipment (DME): Items such as wheelchairs, walkers, and oxygen equipment are covered under Part B.
4. Preventive Services: This includes screenings, vaccinations, and annual wellness visits. Part B emphasizes preventive care to help beneficiaries manage and detect conditions early.
5. Ambulance Services: Part B may cover emergency ground ambulance transportation when quick transportation is crucial to your health.
6. Clinical Research: Part B helps cover the costs of participating in qualifying clinical research studies.
7. Limited Prescription Drugs: Part B covers certain drugs like injections you get in a doctor’s office, certain oral cancer drugs, and drugs used with some types of durable medical equipment.

Costs Associated with Part B

Part B comes with a monthly premium, which may vary based on income. Additionally, beneficiaries are responsible for a yearly deductible and typically 20% of the Medicare-approved amount for most doctor services after the deductible is met.

Conclusion

While Original Medicare provides extensive coverage, it’s important to note that it does not cover everything. Prescription drugs (unless under specific conditions), routine dental care, eyeglasses, and hearing aids are some of the services not included. Beneficiaries may choose to supplement their coverage with additional policies such as Medicare Advantage (Part C), Prescription Drug Plans (Part D), or Medigap to fill these gaps.