MEDICARE PART A AND PART B MAY NOT BE ENOUGH
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Medicare Part A and Part B

Medicare Part A and Part B is the insurance program offered by the federal government.

Sometimes referred to as "Original Medicare," Medicare Part A and Part B provides eligible individuals with coverage at the hospital and doctor’s office. To be eligible, you must be 65 years of age or older, or you may also qualify if you are under 65 and have a disability. You can enroll in Medicare Part A and Part B through the government or by visiting Ssa.gov, which is the federal government’s social security website.

Medicare Part A and Part B benefits are comprised of two parts: 1) Medicare Part A, which is for hospital coverage, and 2) Medicare Part B, for doctor visits.

Medicare Part A: Coverage and Costs

Medicare Part A covers inpatient hospital care, limited home health services, limited skilled nursing care facility services, and hospice care.

There are no monthly premiums for Medicare Part A if you paid taxes for at least 10 years. If you did not pay taxes, you will likely have to pay as much as $413 per month as of 2017.

Inpatient Hospital Care

Inpatient hospital care includes coverage for a room, nursing services, medications, medical supplies, and meals that are necessary for your treatment. You can receive inpatient hospital care at the following types of facilities:

  • Emergency or Critical Care.
  • Mental Health.
  • Rehabilitation.
  • Long Term Care.

For inpatient hospitalization, you will be responsible for paying a deductible of $1,316 as of 2017. If your stay extends beyond 60 days, you will owe $329 per day for days 61-90, and $658 per day from day 91-150. You may be responsible for all costs after day 151.

Home Health Services

If your doctor has ordered home health care, and it is medically necessary, the following expenses should be covered by Medicare Part A:

  • Skilled nursing care (part-time or intermittent).
  • Physical therapy.
  • Occupational therapy.
  • Speech pathology.
  • Medical social services.
  • Durable medical equipment (80% of cost).

You will not be covered for 24-hour home health care unless it is medically necessary.

Skilled Nursing Facility Care

If your doctor recommends you transfer from inpatient hospital care to a Medicare-certified skilled nursing facility, Medicare Part A will cover the following expenses:

  • Semi-private room.
  • Skilled nursing services.
  • Rehabilitation services.
  • Medications while in the care of the skilled nursing facility.
  • Medical supplies and equipment while in the care of the skilled nursing facility.
  • Meals and dietary counseling.
  • Medical social services.

Long-term medical or personal care is not covered if that is the only type of care you need.

Hospice Care

If you have been diagnosed with a terminal illness, you may be eligible for hospice care, which will usually be provided in your home. To be eligible you must be (1) enrolled in Medicare Part A, (2) have been diagnosed by a doctor with a terminal illness with six months or less to live, and (3) agree to no longer receive medical treatment for your terminal illness.

The hospice care must be provided by a Medicare-approved hospice care provider and may include coverage for:

  • Doctor services.
  • Nursing care.
  • Social services.
  • Medical supplies.
  • Pain relief medications.
  • Homemaker services.
  • Hospice aide services.
  • Physical and occupational therapy.
  • Dietician services.
  • Short-term inpatient hospital care, as medically necessary.

You have the right to discontinue hospice care if you decide to seek additional treatment for a terminal illness at any time.

Medicare Part B: Coverage and Costs

Medicare Part B covers visits to your doctor, preventative health screenings, blood tests, medical equipment and supplies, outpatient hospital care, and more.

You will pay a monthly premium for Part B benefits, as well as a small annual deductible and doctor visit co-pays.

Medicare Part B monthly premiums are based on income. Generally speaking, the higher your income, the higher your premium. The income tiers are as follows:

Income: Individual Tax Return

Income: Married Filing Jointly

Income: Married Filing Separately

Annual Part B Premium

$85,000 or less

$170,000 or less

$85,000 or less

$134

$85,001-$107,000

$170,001-$214,000

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$187.50

$107,001-$160,000

$214,001-$320,000

---

$267.90

$160,001-$214,000

$320,001-$428,000

$85,001-$129,000

$348.30

$214,000+

$428,000+

$129,000+

$428.60

Please note that if you are already receiving Social Security or Railroad Retirement Board benefits, your monthly premium will automatically be deducted from these payments once you are enrolled in Medicare Part A and Medicare Part B.

The out-of-pocket costs for Medicare Part B include an annual deductible of $183 in 2017. The insurance will cover 80% of outpatient and doctor visit costs, meaning you may be responsible for the remaining 20% out-of-pocket, or the coinsurance.

Gaps in Medicare Part A and Part B Coverage

Due to the lack of maximum out-of-pocket limits as well as the Part B coinsurance, many people seek to close the "gap" in Medicare Part A and Part B coverage with Private Medicare Insurance.

Additionally, Medicare Part A and Part B does not cover the following:

  • Prescription drugs (unless hospitalized).
  • Most dental care and dentures.
  • Eye exams and contacts/eyeglasses.
  • Hearing aids and exams.
  • Long-term care.
  • Foreign travel health care.

To cover the items that Medicare Part A and Part B does not cover, in addition to getting help for out-of-pocket costs, many people opt to purchase a Medigap, Medicare Advantage, or a Part D options.

To get additional Medicare coverage, please submit your zip code to begin the process.

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