What Is Medicare Part A?
Medicare Part A covers several aspects of healthcare that may include the following:
- Short-term care in a skilled nursing facility
- Limited home healthcare
- Hospice care
- Inpatient care at a hospital
Medicare Part A Eligibility
Medicare Part A eligibility, you must meet one of the following criteria:
- Be age 65 or older
- Have a disability as determined by a doctor and receive Social Security benefits for at least 24 months
- Have end stage renal disease
- Have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease
What Does Part A Cost?
Most individuals eligible for Medicare do not incur costs for Part A, provided they or their spouse have contributed to Medicare taxes for a minimum of 40 quarters, which equates to roughly 10 years of work. This means that many retirees can access hospital insurance without additional premiums, making healthcare more affordable during their retirement years.
For those who have not worked the required 40 quarters, there is still an option to enroll in Medicare Part A by paying a monthly premium. This flexibility allows individuals who may not have a long work history to still benefit from essential hospital coverage, ensuring that more people have access to necessary medical services.
It’s important to understand that Medicare’s coverage can vary based on your hospital status. If a doctor classifies you as an inpatient, Medicare Part A will cover your stay; however, if you are placed “under observation” without formal admission, coverage may not apply. Additionally, Medicare Part A does not cover certain hospital expenses, such as the first three pints of blood, private nursing care, or private room accommodations, although it typically covers a semiprivate room unless only private rooms are available.
What is Medicare Part B?
Medicare Part B pays for physician services, outpatient hospital care, and home health care that Part A does not pay for. It also covers:
- Diagnostic and laboratory tests, such as X-rays and blood work
- Medical equipment, such as wheelchairs and hospital beds
- Orthotics (devices that support joints) and prosthetics (artificial body parts)
- Mental health care
- Ambulance services
- Preventive services
- Doctors’ visits
- Outpatient therapy
Medicare Part B Eligibility
- Be age 65 or older and a U.S. citizen.
- Legally and permanently resided in the United States for at least 5 years in a row.
What Does Part B Cost?
The monthly premium for Medicare Part B is influenced by your enrollment timing and income level. For those receiving benefits from Social Security, the Railroad Retirement Board, or the Office of Personnel Management, the Medicare deductible will be automatically deducted from your benefits before they are disbursed. In 2025, the annual deductible for Medicare Part B is set at $257. It’s important to enroll during your designated enrollment period, typically around your 65th birthday, as failing to do so may result in a late enrollment penalty that adds to your monthly premium.
After meeting your deductible, you will generally be responsible for 20% of the costs for Medicare-approved services, while Medicare covers the remaining 80%. Be aware that if your healthcare provider does not accept the Medicare-approved amount for a service, you may incur additional out-of-pocket expenses beyond the standard co-payment.
What’s Not Covered by Medicare Part A & B
Medicare Part A and Part B do not include coverage for certain essential services, such as prescription medications, routine dental, vision, or hearing care, long-term custodial care, and medical treatment received outside the United States. This means that beneficiaries may need to seek additional plans to ensure comprehensive health coverage.
To address these coverage gaps, individuals can explore options like Medicare Part D, which specifically focuses on prescription drug coverage, as well as Medicare Supplement Plans (Medigap) that help cover out-of-pocket costs not included in Original Medicare. Additionally, Medicare Advantage Plans (Part C) offer an alternative way to receive Medicare benefits, often bundling various services into one plan.
Medicare Part A & B Enrollment
If you or someone you care about is planning to enroll in Medicare soon or is considering switching plans, it’s crucial to be aware of the following key deadlines:
- Initial Enrollment Period: This period spans three months before your 65th birthday, includes the month of your birthday, and extends for three months after. It’s essential to enroll during this time to avoid potential penalties and ensure you have coverage when you need it.
- General Enrollment Period: If you missed your initial enrollment, you can sign up for Medicare Part B from January 1 to March 31 each year. This is your opportunity to enroll without facing late enrollment penalties, but coverage will not begin until July 1 of that year.
- Open Enrollment Period: From October 15 to December 7, you can make changes to your Medicare Advantage and Part D prescription drug plans. This is the time to review your current coverage and make adjustments based on your health needs and budget for the upcoming year.
Timely enrollment is essential for keeping your healthcare costs manageable. To enroll in Medicare Part A and/or B, reach out to the Social Security Administration either online or by calling 1-800-772-1213 (TTY 1-800-325-0778) during the appropriate enrollment period.
If you’re feeling uncertain about which Medicare plan best suits your needs, consider scheduling a free consultation with one of our licensed Medicare agents. They can provide personalized assistance in evaluating your Medicare requirements, guide you through the enrollment process for Medicare Part A and/or B, and help you explore options for Medicare Advantage (Part C), prescription drug coverage (Part D), or any necessary Medigap plans. Remember, Medicare plan options and costs can change annually, so staying informed is key.
Resources
- “What’s the Difference between Medicare Part a and Part B?” Healthline, 30 Nov. 2021, www.healthline.com/health/medicare/medicare-part-a-vs-b#enrollment.
- “What’s the Difference between Medicare Parts a and B?” Ncoa.org, 8 Jan. 2025, www.ncoa.org/article/what-is-original-medicare-parts-a-and-b/.