Understanding Original Medicare: What Parts A & B Actually Cover

Original Medicare consists of two main parts: Part A (Hospital Insurance) and Part B (Medical Insurance). Understanding what each part covers is crucial for making informed decisions about your healthcare coverage. Let’s break down each part in detail.

Medicare Part A: Hospital Insurance

What Part A Covers

Inpatient Hospital Care
- Semi-private rooms
- Meals
- General nursing
- Drugs administered during your stay
- Hospital services and supplies
Skilled Nursing Facility Care
- Semi-private room
- Meals
- Skilled nursing care
- Physical and occupational therapy
- Speech-language pathology services
- Medical social services
- Medications
- Medical supplies and equipment
Hospice Care
- Pain relief
- Symptom management
- Medical, nursing, and social services
- Drugs for pain relief and symptom management
- Durable medical equipment
- Aide and homemaker services
- Grief and loss counseling
Home Health Care
- Part-time skilled nursing care
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
- Part-time home health aide services
- Durable medical equipment

Part A Costs

Premium: Most people don’t pay a premium for Part A if they or their spouse paid Medicare taxes while working
Deductible: $1,632 (2024) for each benefit period
Coinsurance:
- Days 1-60: $0
- Days 61-90: $408 per day (2024)
- Days 91+: $816 per day (2024) for up to 60 lifetime reserve days

What Part A Doesn’t Cover

Private-duty nursing
Private room (unless medically necessary)
TV and phone in your room
Personal items (toiletries, etc.)
Long-term care
Most dental care
Eye exams for glasses
Dentures
Cosmetic surgery
Acupuncture
Hearing aids and exams

Medicare Part B: Medical Insurance

What Part B Covers

Doctor Services
- Office visits
- Outpatient care
- Preventive services
- Medical supplies
Preventive Services
- Annual wellness visits
- Screenings for:
  - Cancer
  - Heart disease
  - Diabetes
  - Depression
- Vaccinations (flu, pneumonia, COVID-19)
- Counseling services
Outpatient Care
- Ambulatory surgery center services
- Diagnostic tests
- X-rays and lab work
- Durable medical equipment
- Mental health services
- Limited outpatient prescription drugs

Part B Costs

Premium: $174.70 per month (2024) for most people
- Higher income earners may pay more
- Premiums can change annually
Deductible: $240 (2024)
Coinsurance: 20% of the Medicare-approved amount for most services

What Part B Doesn’t Cover

Most prescription drugs (covered under Part D)
Long-term care
Most dental care
Eye exams for glasses
Dentures
Cosmetic surgery
Acupuncture
Hearing aids and exams
Routine foot care

Important Considerations

Coverage Gaps

Original Medicare doesn’t cover everything. Common gaps include:

Prescription drugs (need Part D)
Dental care
Vision care
Hearing aids
Long-term care
International travel

Supplementing Your Coverage

To fill these gaps, you can consider:

Medicare Supplement Insurance (Medigap)
- Helps pay for out-of-pocket costs
- Must have both Part A and Part B
Medicare Part D
- Prescription drug coverage
- Available through private insurance companies
Medicare Advantage (Part C)
- Alternative to Original Medicare
- Often includes Part D coverage
- May include additional benefits

Need Help Understanding Your Options?

At MedStar Insurance Agency, we can help you:

Understand your coverage options
Compare plans in your area
Find the right combination of coverage
Navigate the enrollment process