Medicare Plans

Medicare Part A

Coverage for hospital inpatient care

Depositphotos_7626676_originalMedicare Part A is hospital insurance that covers inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home healthcare. You must meet certain conditions to get these benefits.

How much does Medicare Part A cost?

Most people don’t have to pay a monthly premium for Part A because they or a spouse paid Medicare taxes while working. If you don’t get premium-free Part A, you may be able to buy it if:
  • You or your spouse aren’t entitled to Social Security, because you didn’t work or didn’t pay enough Medicare taxes while you worked and are age 65 or older
  • You are disabled but no longer get free Part A because you returned to work
If you have limited income and resources, your state may help you pay for Part A coverage.

What services does Medicare Part A cover?

Inpatient care in hospitals, including critical access hospitals and mental health centers
  • Semiprivate room and meals
  • General nursing
  • Other hospital services and supplies

Inpatient services not covered:

  • Private duty nursing
  • In-room televisions or telephones
  • Private rooms, unless medically necessary
Inpatient mental healthcare in a psychiatric facility is limited to 190 days in a lifetime. Skilled nursing facility care, following a related three-day inpatient hospital stay
  • Semiprivate room and meals
  • Skilled nursing and rehabilitative services
  • Other services and supplies

Home healthcare

Limited to reasonable and necessary part-time or intermittent skilled nursing care and home health aide services as well as physical therapy, occupational therapy, and speech-language pathology that are ordered by your doctor and provided by a Medicare-certified home health agency

Also covers:

  • Medical social services
  • Durable medical equipment, including wheelchairs, hospital beds, oxygen, and walkers
  • Medical supplies and other services
Hospice care for people with a terminal illness
  • Drugs and other treatments to relieve pain or other symptoms such as difficulty breathing
  • Medical, nursing and social support services from a Medicare-approved hospice
  • Other services not otherwise covered by Medicare, including grief counseling and pastoral care
Hospice care is usually given at home, which may include a nursing facility if this is your home. However, Medicare covers some short-term hospital and inpatient care given to a hospice patient so that the usual caregiver can rest, known as respite care. Blood – Pints of blood received at a hospital or skilled nursing facility during a covered stay

Medicare Part B

Coverage for doctors’ services and outpatient care

Medicare Part B helps cover your doctors’ services, outpatient hospital care and durable medical equipments as well as some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home healthcare.

How much does Medicare Part B coverage cost?

  • You pay the Medicare Part B premium each month – most often this is deducted from your Social Security check.
  • You also pay an annual Part B deductible before Medicare starts to pay its share
  • The Part B deductible and premium rates may change every year in January What does Medicare Part B cover?

Medical and other services

  • Doctors’ services, but not routine physical exams except for a “Welcome to Medicare” one-time physical exam within the first six months you have Part B
  • Outpatient medical and surgical services and supplies
  • Diagnostic tests
  • Ambulatory surgery center facility fees for approved procedures
  • Durable medical equipment, including wheelchairs, hospital beds, oxygen, and walkers
  • A second – and sometimes a third – surgical opinion for non-emergency surgery that isn’t an emergency (in some cases)
  • Outpatient mental healthcare
  • Outpatient occupational and physical therapy, including speech-language pathology

Clinical laboratory services

  • Blood tests
  • Urinalysis
  • Some screening tests and more

Home health care

  • Reasonable and necessary part-time or intermittent skilled nursing care and home health aide services
  • Physical therapy, occupational therapy, and speech-language pathology ordered by your doctor and provided by a Medicare-certified home health agency
  • When skilled nursing care or therapy services are being provided, home health aide services may also be covered if needed
  • Medical social services
  • Durable medical equipment, including wheelchairs, hospital beds, oxygen, and walkers
  • Medical supplies and other services

Outpatient hospital services

Hospital services and supplies received as an outpatient as part of a doctor’s care.

Blood

Pints of blood you receive as an outpatient or as part of a Part B-covered service.

Medicare Part B and Employer or Union Coverage

If you or your spouse work, and you have coverage through an employer, union or under COBRA, your Part B enrollment rights can be affected.