What do Medicare Parts A and B cost and cover?

What do Medicare Parts A and B cost and cover?

 Medicare Parts A and B, known collectively as Original Medicare, provide essential health coverage but come with specific costs and coverage limitations. Here’s a breakdown of what each part costs and covers:

Medicare Part A (Hospital Insurance)

Coverage:

• Inpatient Hospital Stays: Covers costs for hospital stays, including semi-private rooms, meals, general nursing, and other hospital services and supplies.
• Skilled Nursing Facility (SNF) Care: Covers care in a skilled nursing facility, but only after a qualifying hospital stay.
• Hospice Care: Provides coverage for hospice services for terminally ill patients who choose to receive care in a home or hospice facility.
• Home Health Care: Covers certain home health services, such as skilled nursing care and physical therapy, if prescribed by a doctor.

Costs:

• Premium: Most people don’t pay a premium for Part A if they or their spouse have paid Medicare taxes while working for at least 40 quarters (10 years). If you don’t meet this requirement, you may have to pay a premium, which can vary.
• Deductibles and Coinsurance: For 2024:
  • Hospital Deductible: $1,676 per benefit period. You pay this amount before Medicare starts to pay.
  • Hospital Coinsurance: $0 for the first 60 days; $419 per day for days 61-90; $838 per day for days 91 and beyond (up to 60 lifetime reserve days).
  • Skilled Nursing Facility Coinsurance: $0 for the first 20 days; $209 per day for days 21-100; all costs for days 101 and beyond.

Medicare Part B (Medical Insurance)

Coverage:

• Outpatient Services: Includes doctor visits, outpatient hospital care, and other services provided outside of a hospital setting.
• Preventive Services: Covers a range of preventive services, including vaccines, screenings, and yearly wellness visits.
• Home Health Services: Covers some home health services, but typically only if you meet certain conditions and if the care is prescribed by a doctor.
• Durable Medical Equipment: Includes items like wheelchairs and walkers, if prescribed by a doctor.

Costs:

• Premium: For 2024, the standard monthly premium is $174.00, though it can be higher based on income. Income-based adjustments (Income-Related Monthly Adjustment Amount or IRMAA) apply if your income exceeds certain thresholds.
• Deductible: $240 for 2024. You must pay this amount before Medicare starts covering your costs.
• Coinsurance: After the deductible, you typically pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment. There is no cap on these costs, so out-of-pocket expenses can add up.

Additional Points:

• Coverage Gaps: Neither Part A nor Part B covers everything. For example, they generally do not cover long-term care (nursing home care), most dental care, eye exams for glasses, or hearing aids.
• Medigap and Medicare Advantage: To help cover some of the costs not covered by Original Medicare, consider additional options like Medigap (Medicare Supplement Insurance) or Medicare Advantage (Part C), which may offer more comprehensive coverage.

Understanding these costs and what’s covered can help you make informed decisions about additional coverage and manage your healthcare expenses effectively.