Choosing between Medicare Part A and Part B can be difficult if you don’t know what is or isn’t covered by either plan.
As with everything we choose in life, the question we always ask ourselves is “what are the advantages of this over the other?”
By answering this question, we have the information needed as a prerequisite to making a decision. The same rule applies when deciding between Part A and Part B.
If you have an idea of Medicare Part A and Part B, then you are aware of what Medicare is all about. If not, then let us begin by describing Medicare. Medicare in simplified times is health insurance given by the Federal government to specific people in the population including people above 65 years of age. There is a different kind of Medicare plans in which Part A and Part B are included.
Medicare Part A
Think of Medicare Part A as a hospital coverage. It covers some reasonable inpatient expenses like:
- A semi-private room where a private room has not deemed a necessity
- Food and drinks
- General nursing
- Inpatient drug treatment
- Any other related inpatient costs and expenses
- Any costs related to care given in a Skilled Nursing Facility
- Costs associated with care in a Long-term care hospital
- Hospice care
- Costs from part-time home health care
You might assume that all these benefits are inclusive in your Part A plan but that is not the case. What is either covered or not depends on the perceived medical necessity? Therefore, the best thing to do in order to find out the specific things covered in your situation is to contact your health care provider.
The cost of Medicare Part A
Medicare Part A is kind of free for many people. Why kind of? Because some people will qualify for premium-free Medicare Part A while other won’t.
So, who does qualify for free Part A?
- A person who is 65 years or older and is eligible to receive retirement benefits from either Social Security or Railroad Retirement Board
- A person who is 65 years and above who either personally had or the spouse had Medicare-covered government employment.
- A person below 65 years who has been receiving disability benefits for at least 24 months from either Social Security of the Railroad Retirement Board
- A person below 65 years who meets certain requirements and has End-Stage Renal Disease
- A person below 65 years who has Amyotrophic Lateral Sclerosis (ALS) and has been receiving social disability because of the condition
In case you don’t fall under any of these categories, you will have to pay $422 or even less per month.
What does it take to be automatically enrolled to Medicare Plan A?
- If 4 months prior to turning 65 you have been receiving benefits from Social Security or the Railroad Board
- If you have ALS
- If you’re receiving Social Security disability or disability benefits from the Railroad Board
Anyone who else who doesn’t have these requirements will have to apply online at the Social Security’s website or through the mail.
The disadvantage of the Original Medicare Part A is that it does not cover:
- Long-term care
- Dental expenses
- Routine eye, vision and hearing exams
- Foot care
- Cosmetic surgeries
- Prescriptions drugs at the local pharmacy
- Medically unnecessary services
Medicare Part B Plan
Think of Medicare Part B i was reading this as coverage of outpatient expenses like:
- The services and supplies for diagnosis and treatment of your medical condition
- Emergency transportation services
- Clinical research studies
- Preventative measures like screening, shots etc.
- Durable medical equipment which is medically necessary
- Mental healthcare services not covered by Part A
This list is not exhaustive enough because any outpatient service recommended by your doctor as necessary is covered under Medicare Part B. The determination of whether something is covered or not depends on its medical necessity. If it is not necessary, then it will not be covered.
The cost of Medicare Part B
Part B is not free like Part A. however, the cost is very affordable and there is often a standardized premium. Nevertheless, people who receive a gross income that exceeds a certain amount will have to pay a little more. The annual premium for Part B is $134. So with Part B, some pay less while others pay more.
In order to be automatically enrolled in Original Medicare Part B, you must either:
- Be getting benefits from Social Security or the Railroad Board 4 months before you turn 65 years
- Have ALS
- Be receiving Social Security disability or disability benefits from Railroad Board for at least 24 months
Similar to Part A, those who do not automatically qualify will have to apply either online at the Social Security Administration’s website or through the mail.
The Medicare Part A and Part B have specific enrollment dates that anyone interested in the plans must comply with or stand to pay a late enrollment penalty. Only people who qualify for a Special Enrollment Period are exempted from paying the enrollment penalty.
There are particular items that are not covered by the Original Medicare Part B like:
- Long-term care
- Dental expenses
- Routine eye, vision and hearing checkups
- Foot care
- Cosmetic surgeries and procedures
- Prescription drugs that are picked from the local drug store
- Any other services that the doctor may decide to be medically unnecessary
The areas not covered are quite similar for both Medicare Plan A and Plan B. in order to be absolutely sure of what will or will not be covered in your plan, you will need to ask your healthcare provider.
The Medicare Part A and Part B are good plans for anyone who qualifies.
They make life much easier for anyone who needs health insurance.
For those eligible, they no longer have to be worried about how they will cover their medical expenses. When the opportunity presents itself, do not fail to take advantage of the benefits of these plans as provided for by the Federal Government.
You don’t stand to lose anything. As a matter of fact, you stand to gain everything.