Original Medicare (Part A)
WHAT IS MEDICARE PART A?
Medicare Part A is your hospital coverage. It provides you with affordable inpatient care. So what’s the definition of inpatient?
Here at Boomer Benefits, we tell our clients to think of it as “room and board” in the hospital. It’s going to cover a semi-private room with a bed for you, and all your regular meals while you are there. It will cover medications furnished to you by the hospital and any necessary lab services or medical supplies.
You may get your inpatient care at an acute care hospital, a critical access hospital, an inpatient mental healthcare hospital or at an inpatient rehabilitation facility.
What Does Medicare Part A Cover?
In addition to Medicare hospitalization coverage, Medicare Part A also covers post-hospital skilled nursing and short-term post-hospital home health care, as long as it is medically necessary. Part A covers hospice services which may include palliative care, DME, counseling, and social services. Medicare hospice coverage also provides short-term respite care for caregivers to have a rest.
Part A also provides for some home health care services received in the hospital or immediately following an inpatient stay. This includes skilled nursing care, medical social services, and physical therapy. Home health aid services are generally only covered when skilled nursing is also occurring.
Medicare does NOT cover long-term care, such as extended stays in a nursing home. Individuals can consider purchasing long-term care insurance if this is something they want to plan for.
There are some things that you might think would fall under Part A but sometimes fall under Part B, such as outpatient surgeries. When it comes to determining if something is inpatient vs outpatient, it’s always a good idea to consult your Licensed insurance broker for guidance. However, in general, what is covered by Part A is generally hospital-related for immediate or acute care of an injury or illness.
Original Medicare (Part B)
WHAT IS MEDICARE PART B?
What is Medicare Part B? What does Medicare Part B cover? Many people think of it as medical coverage, but it actually covers things both in and out of the hospital. Think of Part B coverage as any care administered by physicians.
What Does Medicare Part B Cover?
Medicare Part B coverage provides you access to a variety of outpatient medical services. Part B covers preventive care including flu shots, colonoscopies, mammograms and more. It covers ordinary outpatient things like doctor’s visits, lab testing, home health care, ambulance rides, and some chiropractic care too.
However, Medicare Part B also covers services that sometimes occur in the hospital. This includes things like physician’s services, radiation or chemotherapy for cancer, surgeries, diagnostic imaging, medical equipment, and even dialysis for failing kidneys. Part B will also pay for drugs administered in a clinical setting, such as osteoporosis injections, infused drugs, antigens, and insulin that is used with an insulin pump.
Otherwise, outpatient drugs fall under Part D.
Part B is optional, but if Medicare is your primary coverage, you definitely need Part B. You also cannot get Medigap supplemental coverage without it.
Part B DOES NOT cover hospital expenses covered by Part A. It also does not cover cosmetic procedures, routine dental, vision or hearing, or routine foot care. It also does not cover drugs that you pick up yourself at a retail pharmacy. For those you will need a Part D drug plan. In general, Part B doesn’t cover things that are not reasonable and necessary. Your doctor usually will know the rules for what is covered and what isn’t.