What does Part A Cover?
Part A covers the hospitalization part of Medicare, but what does that actually mean? Part A does not cover everything that happens at the hospital. Many things, such as out patient surgery, are NOT covered by Part A. The best way to remember what Part A covers is to remember, "A is for Admission". If you are admitted into the hospital, it is Part A. If you are also admitted into hospice, it is Part A. If you are admitted into Skilled Nursing Care (after a 3 day hospital admission), it is covered by Part A. If you are admitted into Home Health Care, it is covered by Part A, under certain conditions.
Does Part A have a deductible?
In 2019, the deductible for a hospital admission is $1,364. This is paid for each new hospitalization if it is a different event and 60 days has gone by. There is no deductible for a skilled nursing facility as a three day hospitalization is required prior to being admitted into a skilled nursing facility.
Does Part A have a co-payment?
There is no co-payment nor co-insurance for the first 60 days of hospitalization. For days 61 to 90 of a hospitalization, you will pay a $341 daily co-payment. There is no co-payment nor co-insurance for the first 20 days of skilled nursing care. For days 21 to days 100 of skilled nursing care, you will pay a $170.50 daily co-payment.
What happens after 90 days in the hospital?
Once you have been in the hospital for 90 days, your normal Medicare Part A benefit runs out. You have a 60 day lifetime bank that you can pull from. If you have to use any of these 60 "lifetime reserve" days you will pay a $682 per day co-pay for 2019.
What happens after 100 days of skilled nursing care?
If you are still in skilled nursing care on day 101, you will be responsible for 100% of the cost.
Who is qualified for Part A?
Any US citizen or anyone that has legal residency in the US, and has worked 40 quarters or has a spouse that has worked 40 quarters is qualified for Medicare Part A. Anyone who has been on SSI disability for 24 months will qualify for Medicare Part A on their 25th month. Anyone with end stage renal disease or Lou Gehrig's disease (ALS) also qualifies for Medicare Part A.
What does Part B cover?
Part B covers
- Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
- Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
Are there any Part B deductibles or co-payments?
There is an annual deductible for Part B. A deductible with an amount you pay, to the healthcare provider, for services before Medicare starts paying. For 2019, that deductible is $185. This means you will pay your provider for the first $185 of covered services for 2019.
After the deductible is met, you will pay 20% of the assignment. An assignment is the amount Medicare agrees to pay for a covered service. For example, if the assignment for a Medicare covered procedure is $1000, you will owe the provider $200 for the Medicare Part B co-payment.
Do I have to take Part B?
Taking Part B is considered voluntary. However, if you do not take Part B when you first become eligible, and then decide to add it at a future date, you may have to pay for penalty for the rest of the time you have Part B. You have six months around your 65th birthday to decide whether you want to take Part B. If you have creditable coverage through your or your spouse's current employer you may not get the penalty. It is very important to understand that this has to be the current employer. You or your spouse must be actively working there. Retirement plans to do not prevent Part B penalties. The penalty is 10% per year for every year you were eligible, but did not take Part B.
Why is there a Part B premium?
Your whole working life, you have been paying for Medicare, right? So why is there a premium for Part B? The 1.45% of your income that you have been paying is for Part A. You get Part A automatically if you have paid for it by working 40 quarters. Since not everyone takes Part B, it is not a tax to your income. You pay for it only if you decide to take it.
What preventative services are covered by Part B?
- Abdominal aortic aneurysm screening
- Alcohol misuse screenings & counseling
- Bone mass measurements (bone density)
- Cardiovascular disease screenings
- Cardiovascular disease (behavioral therapy)
- Cervical & vaginal cancer screening
- Colorectal cancer screenings
- Depression screenings
- Diabetes screenings
- Diabetes self-management training
- Glaucoma tests
- Hepatitis B Virus (HBV) infection screening
- Hepatitis C screening test
- HIV screening
- Lung cancer screening
- Mammograms (screening)
- Nutrition therapy services
- Obesity screenings & counseling
- One-time “Welcome to Medicare” preventive visit
- Prostate cancer screenings
- Sexually transmitted infections screening & counseling
- Tobacco use cessation counseling
- Yearly "Wellness" visit
What is Part B "excess"?
Medical providers can accept Medicare payments and not accept Medicare assignments. An assignment is the amount that Medicare has stated that they will pay for any given service. If a Medical provider accepts Medicare but not Medicare assignments, Medicare still only pays 80% of the assigned amount. You, the patient, are then responsible for the difference between the amount the provider billed and the assignment, even if that is over the 20%.