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:

1. Medicare Supplement Insurance (Medigap)

   • Helps pay for out-of-pocket costs
   • Must have both Part A and Part B

2. Medicare Part D

   • Prescription drug coverage
   • Available through private insurance companies

3. 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

Contact us today to learn more about how we can help you make the most of your Medicare coverage.