There are four main parts of Medicare: Part A, Part B, Part C, and Part D. Part A and Part B is referred to as “Original Medicare”. Part A (hospital insurance and inpatient services) and Part B (medical insurance/outpatient coverage). While Part A and Part B are the most common Medicare plans, Part C refers to Medicare Advantage plans, and Part D is a separate plan for prescription drug coverage. In any case, Part A and Part B are the most important, as they form the basis of all Medicare plans. If this doesn’t make sense, check out our page on what is Medicare.

There are a couple of important ways that Part A and Part B differ. First, they differ in the services and treatments covered. Part A is also usually free. Generally speaking, Part A covers the following: 

  • Inpatient hospital care
  • Skilled nursing facility care
  • Hospice care
  • Nursing home care
  • Certain home healthcare

As a result, Part A is often referred to as “inpatient coverage” or “hospital coverage.” Whenever you need to be admitted for overnight treatment in a qualifying facility, the treatment will likely fall under Part A Medicare.

What Is Not Covered Under Medicare Part A

Not every kind of inpatient treatment is covered under Part A. Here are a few examples of things that Part A does not cover:

  • A private room at an inpatient or nursing facility
  • Private nursing care
  • Amenities like television or personal phone access
  • Personal care items like shaving razors or slippers
  • The first three pints of blood (unless you have a Medigap policy)
  • The cost of skilled nursing facility care if you have not been properly enrolled in a hospital for at least three days (staying “under observation” does not count toward this tally)
  • Custodial care, such as dressing, feeding, or bathing, at a nursing home or assisted living facility

As you can see, it’s important to look at the details when it comes to Medicare. Oftentimes, you may think you’re covered for inpatient care, but you may need to pay for additional services like custodial care, blood, or a private room.

What Is Not Covered Under Medicare Part B

Part B is often referred to as “outpatient coverage,” as it covers many of the costs associated with more regular care you might receive at a clinic or hospital (without being admitted or staying overnight).

Just like Part A, there are various services that are not covered under Part B. To get a better understanding of Part B coverage, here are a few examples of things that Part B does not cover:

  • Home safety items like shower chairs or stairlifts, unless deemed medically necessary and prescribed by a physician
  • Treatments that are not deemed medically necessary
  • Vaccines
  • Nonprescription drugs
  • Long-term home health care

Part B does cover: 

  • Doctor’s office visits
  • Ambulance services
  • Durable Medical Equipment (DME) like wheelchairs and walkers
  • Mental health care
  • Outpatient surgery
  • Lab tests and bloodwork
  • Some preventative care like flu shots, cancer screenings, and nutritional therapy
  • Certain (short-term) home health care
  • Care received at a hospital while “under observation” (not officially admitted)

What Does Medicare Not Cover

There is more to Medicare than just Original Medicare (Parts A and B). However, generally speaking, here are a few common services that neither Part A nor Part B cover:

  • Prescription drugs (excluding those used during inpatient hospital treatments)
  • Long-term care
  • Dental care
  • Vision care
  • Hearing care
  • Wellness check-ups
  • Cosmetic surgery
  • Acupuncture
  • Routine foot care

Needless to say, figuring out what Medicare covers can get tricky. Fortunately, the more coverage you have, the less you have to worry about it. That said, Medicare is not free. Whether you opt for Original Medicare or shop for a Medicare Advantage plan, you will have to pay varying amounts for your plan and medical care. Next, let’s take a look at the differing costs between Part A and Part B.

If you or your spouse are 65 or older and have paid income taxes for at least 10 years (40 quarters), you qualify for premium-free Part A. If this sounds confusing, don’t worry. It’s easier to know if you qualify by confirming whether you qualify for Social Security. As soon as you qualify for Social Security benefits, you also qualify for premium-free Part A coverage.

However, if you choose to purchase a Part A plan and do not qualify for premium-free coverage, the standard monthly premium for Part A is $458 in 2020. It’s important to note that this number is subject to change every calendar year. Also, keep in mind that you can qualify for a reduced monthly premium, even if you don’t qualify for the zero-dollar premium. For older adults who have paid income taxes for more than 30 quarters but less than 40, the monthly premium for Part A is $252.

Whether or not you need to pay a premium for your Part A (most people do not), you will have to pay your annual deductible and coinsurances. The current deductible for Part A is $1,408. Just like the Part A premium, this number is subject to change every year. Most years, the Part A deductible increases by a small percentage to keep up with rising health care costs and inflation.

For Part A coverage, your coinsurance is calculated based on how many days you spend in inpatient care during a calendar year (or benefit period). Typically, you pay nothing for the first 60 days of inpatient care. For the next 30 days of inpatient care, you pay up to $352 per day. After that, you’re subject to $704 per day or the entirety of the cost for your inpatient care. 

Now, let’s look at the costs of Part B Medicare. The monthly premium for Part B is $144.60. However, this number may increase based on your income. If you make more than $87,000 (individual) or $174,000 (jointly), you will need to pay a monthly premium of $202.40 or more. The highest Part B premium (based on income) is $491.60. Again, keep in mind that these numbers are subject to change every calendar year.

In addition to monthly premiums, Part B also has a deductible and coinsurance. Fortunately, the figures are much more straightforward for Part B coverage. With Part B, the current annual deductible is $198. After you’ve paid your deductible, you will be expected to pay a coinsurance that is 20% of the total cost of all medical services covered by Part B.

If you have further questions about the difference between Part A and Part B, contact Time for 65’s licensed partnered agents today. Simply fill out this form or give us a call to see how we can help.