Medicare Part A and B

Understand the Basic Coverage Provided



Medicare Part A and B coverage becomes available in most instances after a person turns 65. This is the best time to apply for Medicare and review your Medicare eligibility.

In most instances, Medicare Part A is available free of charge once you reach the age of 65. It is up to you to apply for Medicare. It is not an automatic event.

Although not a simple process, once you understand how to apply for Medicare, what each plan covers, and what your expenses will be, it becomes a little easier.

Medicare Part A and B Coverage

The basic coverage of Medicare Part A and B is intended to provide a limited amount of insurance at low or no cost. It is not intended to provide complete, total coverage of all of your insurance needs.

Part A Coverage and Cost

medicare part a and b, letter a

Medicare A is the standard Medicare coverage that is available to those over the age of 65 or those under 65 with certain disabilities, including those on Social Security Disability and those with certain medical conditions, such as end stage renal failure.

Part A covers basic hospitalizations, but there are conditions on this coverage. For example, a "covered hospital stay" has to be over 3 days. Benefits will not cover you if you are in the hospital for two days.

Since hospitals make more money off from private pay patients than they do off from Medicare patients, there are many more people getting discharged at 2 days then the 3 midnight requirement for Medicare to kick in.

Part A covers other benefits as well, but some of those come with certain conditions as well. For example, Part A will cover up to 100 days of inpatient skilled nursing facility coverage, provided that the following conditions are met: There must first be a qualifying hospital stay, the three midnight rule and it must be inpatient in the hospital, not one day in observation and 2 as inpatient.

Only the first 20 days are covered in full. From day 21 to 100, you will be responsible for a copay. You must also be receiving skilled care within the facility and that skilled care must be directly related to your diagnosis from your hospital qualifying stay.

Medicare Part A coverage also covers blood transfusions while you are in the hospital under a qualifying stay. Under certain circumstances, it will also cover some home health services, some medical equipment you may need at home and hospice benefits if you have a terminal condition and wish to utilize your Medicare Hospice Benefit.

Part A is usually premium free for those people that have worked a qualifying time period, usually 10 years, and that have paid Medicare taxes through their payroll. However, without a Medicare supplement plan , you will also be responsible for a yearly deductible of approximately $1132 (for 2011) and coinsurance for certain benefits as well.

For those that haven't worked a qualifying amount or whose spouse hasn't either, there is an option to buy into Medicare Part A Coverage. The highest cost for 2011 is reported by Medicare.gov to be around $450.00.

Part B Coverage and Cost

medicare part a and b, letter b

Medicare Part B covers basic physician services, including medically necessary doctor's appointments, ambulance services, many labs and test, some home health care services, preventative care, diabetic supplies and blood you may receive on an outpatient basis.

For a full and complete list of everything Medicare Part B covers, go to Medicare.gov.

Most people will pay a premium for their Part B Benefits, and it is subject to increases yearly. In 2011, there are two basic structures. Depending on your income, you will most likely be required to pay either $96.40 or $110.50. In some instances, you could pay a premium of $155.40.

If you are also receiving Social Security Benefits, you can elect to have your Part B Premium deductible from your check each month if that is easier for you.

Your deductible each year, the amount you have to pay before benefits kick in, is $162.00 for Part B. Once you have met the deductible, you will still have to pay 20% ( your coinsurance ) of all approved charges. Medicare Part B will cover the other 80% if it is an approved charge or service.






As you can see, Medicare Part A and B cover a wide variety of services, but not everything you may need. For additional coverage to help off set your out of pocket expenses, you may want to consider a Medigap policy. Medicare supplemental plans help offset the costs you may incur with traditional Medicare, including deductibles and coinsurance.

Due to the Health Care Reform Act, there may be additional changes in coverage and costs. Medicare.gov is the government's official website notifying you of changes to your costs and benefits.

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Amazon has a wide variety of resources that can help explain Medicare Part A and B, as well as Medicare Supplemental Insurance. Try putting the keywords "Medicare Benefits" or "Medicare" into the search box to the right and you will find a variety of products available to help you navigate this system.








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