If you’re approaching your 65th birthday and you are or will be getting Social Security benefits, you probably have questions about the Medicare program and what is covered under Medicare Part A and Part B. This guide will give you the basics about your eligibility for Medicare, explain the differences between Medicare Part A and B, and help you understand your options for getting your benefits.
How can I determine my eligibility for Medicare?
According to the Department of Health and Human Services (HHS), you are eligible for Medicare if you are age 65 or over, or under age 65 with a qualifying disability or disease. You may also qualify for Medicare at any age if you have end-stage renal disease requiring dialysis or a kidney transplant, or amyotrophic lateral sclerosis (also known as ALS or Lou Gehrig’s disease). There are two parts to the program: Medicare Part A and Part B. If you have a qualifying work history, you generally won’t pay a premium for your Part A benefits. Most people will, however, pay a monthly premium for Part B.
You can check your eligibility for Medicare and find out how much your premium will be with the Medicare Eligibility Calculator.
What is Medicare Part A?
The easiest way to understand Medicare Part A is to think of it as the part of Medicare that pays for your care when you are admitted to a hospital or skilled nursing facility. Medicare Part A is often called your hospital insurance. It also helps pay for some home health services and hospice care.
If you’re wondering what Medicare Part A is going to cost out-of-pocket, that’s a little more complex. You will have to pay a deductible for each benefit period, plus a coinsurance amount for each day you are an inpatient in the hospital or approved nursing facility. You can have several benefit periods in a single calendar year.
If you are concerned about your out-of-pocket costs with Medicare, you can enroll in a Medicare Supplement Plan to help cover your medical bills. There are several different plans to choose from; each covers different parts of your Medicare Part A and Part B costs.
What is Medicare Part B?
Simply put, Medicare Part B covers your doctors’ fees and outpatient medical expenses, including laboratory and diagnostic imaging tests, physical therapy, and durable medical equipment.
When you’re considering what is Medicare Part B cost-sharing, there are a few things to keep in mind. In addition to your monthly premium, you will have an annual deductible plus a coinsurance amount, generally 20% of the Medicare allowable charge, for your care. In some cases, you will pay a copayment, for certain outpatient services.
What is not covered under Medicare Part A and B?
Medicare Part A and Part B don’t pay for everything. In most cases, there is no coverage for prescription drugs you take at home. If you get medication in the hospital, Medicare will generally pay for it.
If you want coverage for prescription drugs, you’ll need to enroll in a Medicare Part D Prescription Drug Plan. There are several different ways to get Part D coverage, but in most cases, you’ll pay an additional monthly premium plus a copayment for each prescription you fill.
Medicare Part A and Part B also doesn’t cover custodial care in a long-term care facility if that is the only type of care you need. It doesn’t cover routine hearing, vision, or dental care, and there are no benefits for cosmetic services.
Are there any alternatives to Original Medicare Part A and Part B?
About a third of all Medicare beneficiaries choose to get their benefits through a Medicare Advantage plan. Also known as Medicare Part C, Medicare Advantage includes all the same benefits as Medicare Part A and Part B, but many also include Part D coverage for prescription drugs, so you get all of your Medicare benefits in a single plan.
In addition, some plans offer extra benefits for things Medicare Part A and Part B won’t cover, such as routine vision and dental care, prescription eyewear, and even the Silver Sneakers gym membership and fitness program.
You’ll need to continue to pay your Part B premium, plus any additional premium required by your plan, if you choose Medicare Advantage. You can’t combine Medicare Advantage with a Medicare Supplement Plan. Unlike Medicare Part A and Part B, there is an annual out-of-pocket maximum with Medicare Advantage plans.
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