- Medicare Basics
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Original Medicare
Table of Contents
Medicare in Simple Terms
Understanding Medicare Part A and Part B
Original Medicare is a federal health insurance program that was established in 1965 as part of the Social Security Act. It has since become an important component of the United States’ healthcare system by providing coverage to millions of Americans who are age 65 or older, as well as to younger individuals with certain disabilities or health conditions.
There are two main parts to Original Medicare: Medicare Part A and Medicare Part B.
Medicare Part A
Medicare Part A is often referred to as hospital insurance because it provides coverage for inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.
Inpatient hospital care includes hospitalization, intensive care, and critical access hospital care. Medicare Part A covers inpatient hospital care for up to 90 days per benefit period, with the option to extend coverage for up to 60 additional days with a higher coinsurance rate. After 150 days, Medicare coverage for inpatient hospital care ends, and beneficiaries are responsible for the full cost.
Skilled nursing facility care is covered by Medicare Part A if skilled nursing care is deemed necessary and certain requirements are met. To be eligible for skilled nursing facility care you must have a qualifying hospital stay of at least three days and require skilled care on a daily basis.
Hospice care is available for people who are terminally ill and have a life expectancy of six months or less. Medicare Part A covers hospice care services, including doctor and nursing services, medical equipment and supplies, and counseling.
Some home health care services are also covered by Medicare Part A. These include skilled nursing care, physical therapy, occupational therapy, speech language pathology services, and home health aide services.
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Medicare Part B
Medicare Part B, on the other hand, covers outpatient care, doctor visits, and other medical services. This includes preventive care, such as flu shots and mammograms, as well as diagnostic tests and medical equipment like wheelchairs and walkers.
Outpatient care includes medical services that do not require an overnight hospital stay. This can include office visits to doctors and other health care providers, ambulance services, and outpatient surgery.
Preventive care services are covered by Medicare Part B to help beneficiaries maintain their health and prevent illnesses. These services include wellness visits, flu shots, screenings for various health conditions, and other preventive services.
Diagnostic tests and medical equipment can include blood tests, x-rays, MRI and CT scans, and other diagnostic procedures. Durable medical equipment, such as wheelchairs, walkers, and hospital beds, are also covered by Medicare Part B.
To be eligible for Medicare, you must meet certain enrollment and eligibility requirements. Most people become eligible for Medicare when they turn 65, but some younger people with disabilities or health conditions may also be eligible.
Enrolling in Medicare is typically done during a designated enrollment period, which can vary depending on your circumstances. If you are approaching age 65, you may want to start thinking about enrolling in Medicare and determining which parts of the program are right for you.
The enrollment process for Medicare Part A and Part B is generally straightforward, but there are some important considerations to keep in mind. If you are already receiving Social Security benefits, you will be automatically enrolled in Medicare when you turn 65. If you are not receiving Social Security benefits, you will need to actively enroll in Medicare to receive coverage.
Understanding Medicare can be overwhelming, but it is an important part of planning for your health care needs as you age. Medicare Advisors Group is here to provide you confidence in understanding the complexities of Medicare and walk you through the enrollment process, ensuring you receive the coverage you need to maintain your health and well being.
By learning about Medicare Part A and Part B in simple terms, you can rest assured that you are making informed decisions and receiving the care you need to live your best life.
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