Learn about Medicare Part A
Part A is the inpatient insurance of Medicare.
This means when you’re admitted to a hospital for medically necessary treatment, or you’re admitted to a skilled nursing facility, or a Medicare-approved hospice facility, Part A of Medicare pays your medically necessary bill – after you’ve paid your deductible. You don’t have to pay a monthly or annual premium for Part A of Medicare as long as you contributed to payroll taxes for ten consecutive years, or paid into payroll taxes for forty quarters during your life. Working all those years and paying into the separate hospital insurance fund, entitles you to Part A of Medicare at no additional premium. Individuals who are ineligible for premium-free Part A coverage can enroll voluntarily by paying a monthly premium, if they also enroll in Part B. This is called Medicare Buy-In. You’ll pay up to $407.00 per month. Penalties for late enrollment may apply.
Part A has deductibles. Each time you’re admitted into the hospital for a medically necessary reason, and the number of admitted days is less than sixty consecutive days, you will pay a Part A deductible of over $1,216.00. If you’re admitted into the hospital, then released and you remain out of the hospital for at least sixty consecutive days, and then need to be admitted for a previous or new condition, you’ll be billed a new deductible Part A charge.
What Services Does Part A Cover?
When you’re admitted to a hospital, Medicare Part A hospital insurance will cover the following for a limited time:
- A semiprivate room; or a private room if medically necessary
- All meals, including special, medically required diets
- Regular nursing services
- Special care units, such as intensive care and coronary care
- Drugs, medical supplies, and appliances furnished by the facility, such as casts, splints, wheelchair
- Hospital lab tests, x-rays, and radiation treatment billed by the hospital
- Operating and recovery room costs
- Blood transfusions (you pay for the first three pints of blood, unless you arrange to have them replaced by an outside donation of your blood to the hospital)
- Rehabilitation services, such as physical therapy, occupational therapy, and speech pathology, provided while you are in the hospital
Medicare Part A hospital insurance does not cover:
- Personal convenience items such as television, radio, or telephone
- Private duty nurses
- A private room when not medically necessary
Learn about Medicare Part B
Part B – The Outpatient Services
As I have pointed out previously, you can think of Part A as being the part of your policy that covers inpatient needs, whether in a hospital, skilled nursing facility, (SNF) or a hospice facility. Part B, then, covers just about everything else.
- Doctor visits come under Part B
- Having blood drawn is under Part B
- Going to physical therapy is under Part B
- Having same day surgery at an outpatient facility is covered under Part B
- The majority of your medical care will fall under Part B of Medicare
Part B covers two types of services – Medically necessary services and preventive services.
Medically necessary services are services or supplies needed to diagnose or treat your medical condition. The services must also be accepted standards of medical practice. Preventative services refer to health care to prevent illness (pneumonia for example),or to detect it at an early stage (cancer for example). Early prevention is when treatment is most likely to work best.
Some of the more common Preventative services under Medicare are:
- Having a blood test to check cholesterol and triglyceride levels is free of charge if done every five years.
- Having a bone density test –
- If prescribed by a physician and a person’s x-ray shows possible osteoporosis or a vertebral fracture.
- A person is diagnosed with hyperthyroidism.
- A person taking prednisone as a steroid treatment plan.
- A woman who is estrogen deficient or at risk for osteoporosis.
- A colonoscopy
- Covered every 2 yrs. If the individual is at high risk for colorectal cancer.
- Covered every 10 yrs. If the individual is at average risk for colorectal cancer.
- A Mammogram
- Prostate Cancer Screening
- Preventative Shots
- Hepatitis B
Durable Medical Equipment (DME) is covered under Part B. Some examples of supplies (but not limited to) needed to diagnose or treat your medical conditions are:
- Diabetic monitors
You can determine if your item, service, or supply is covered by Medicare by going to the Medicare.gov website:
Contact your Medicare health plan and speak to someone who can verify if an item is covered. You can also call Medicare at 800-633-4227. You can see the tremendous amount of coverage under Part B of Medicare. That’s why enrolling in Part B of Medicare is optional. Paying a monthly premium will cover you to pay 20% of the Medicare approved bill. Medicare will pay the other 80%.