Part A (Hospital Insurance): Helps cover:
- Inpatient care in a hospital
- Skilled nursing facility care (inpatient care in a skilled nursing facility that’s not custodial or long-term care.)
- Hospice Care
- Blood
- Home health care (like rehabilitation services for physical therapy, speech-language pathology therapy, occupational therapy).
- Additional services as outlined by Medicare
Part B (Medical Insurance): Helps cover:
- Services from doctors and other health care providers
- Outpatient care
- Home health care
- Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
- Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)
- Many other tests and procedures, often including infusions and Chemotherapy
- Many chemotherapy drugs that are administered through your vein in an outpatient clinic or a doctor’s office.
- Outpatient surgeries.
- Mental health services, including services that are usually provided outside a hospital (like in a clinic, doctor’s office, or therapist’s office) and services provided in a hospital’s outpatient department.
- Nutritional counseling if you have diabetes or kidney disease.
- In some cases, a second opinion for surgery that isn’t an emergency, and a third opinion if the first and second opinions are different.
Medicare Part B requires a monthly premium that (in 2023) starts at $164.90 per month. Single people with adjusted gross incomes over $97,000 and married couples with AGIs over $194,000 pay higher premiums.
Click here to learn more about IRMAA.
Medicare Part B has a $226 deductible (in 2023). After that, you typically pay 20% of the Medicare-approved amount for the services and supplies.
What is the Medicare Part B penalty?
If you do not sign up for Medicare Part B at 65 and later decide you need it, you will likely pay a penalty of 10% of the premium for each 12-month period that you delayed (unless you had creditable coverage). You will pay this penalty for life, basically, since few people drop Medicare Part B once they have it.
What Parts A and B Don’t Cover.
The largest and most important item that Original Medicare does not cover is long-term custodial care. If your condition requires ongoing long-term personal care assistance, which may include residence in an assisted-living facility, Medicare will cover only Medicare approved medical costs but none of the cost of the long-term care facility or personnel providing custodial care.
Some other expenses that are not covered include routine dental or eye care, dentures, and hearing aids. Cosmetic procedures and services deemed to not be “Medically Necessary” also will generally not be covered under Original Medicare (or Part C plans).
Medicare Part C: Medicare Advantage Plans
Also known as Medicare Advantage, Part C is an alternative to traditional Medicare coverage. Coverage includes all Part A and Part B services, normally a prescription drug plan (Part D), and, depending on your choice of a Medicare Advantage plan, other possible benefits.
Part C plans are issued and administered by Medicare-approved private insurance companies.
Depending on the plan, you may or may not need to pay an additional premium for Part C.
You must continue to pay your Medicare Part B premium (and Part A premium, if applicable).
Click here to learn more about Medicare Advantage Plans.
Medicare Part D: Prescription Drugs Plans
Prescription drug coverage, known as Part D plans, are also administered by private insurance companies. Stand alone Part D plans are optional, but there are consequences for not enrolling in one when you are eligible. Part D coverage is also provided with Medicare Advantage plans (MAPD) which include a Prescription Drug coverage.