SENIORS

Medicare Basics

Learn about the building blocks of medicare: Part A, B, and Prescription Drug coverage.

Schedule a Free Consultation

By submitting this form you are requesting a solicitation for insurance.

Fundamentals of Medicare

Medicare consists of many parts, you may or may not need every part of medicare to build your complete coverage. Follow us on this journey as we explain the building blocks of Medicare. The basics of Medicare include Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Watch this brief video to get a better understanding of how these parts work together.

What is Medicare Part A?

Medicare Part A covers Medicare inpatient care, including care received while in a hospital, a skilled nursing facility, and, in limited circumstances, at home.

Most people are automatically eligible for Medicare Part A at age 65 if they’re already collecting retirement benefits from the Social Security Administration or the Railroad Retirement Board. You may qualify for Medicare Part A before 65 if you have a disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS). You must be either a United States citizen or a legal permanent resident of at least five continuous years.

Medicare Part A Coverage

In general, Part A covers:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care (as long as custodial care isn’t the only care you need)
  • Hospice
  • Home health services

It is important to note that Part A does NOT cover Long Term Care. We recommend that people who also want Long Term Care (LTC) coverage research various types of policies separate from Medicare.

Medicare Part A Eligibility

You are eligible for Medicare Part A if:

  • You are age 65 or older and a U.S. citizen or permanent legal resident of at least five years in a row
  • You are already receiving retirement benefits
  • You are disabled and receiving disability benefits
  • You have end-stage renal disease (ESRD)
  • You have amyotrophic lateral sclerosis (Lou Gehrig’s disease or ALS)

Most beneficiaries do not pay a premium for Medicare Part A if they have worked at least 10 years (or 40 quarters) and paid Medicare taxes during that time. Individuals who aren’t eligible for premium-free Medicare Part A can still enroll in Part A and pay a premium. Beneficiaries who delay enrollment after they first become eligible for Medicare Part A may be subject to a late enrollment penalty once they sign up.

Medicare Part A Costs

If you only have Original Medicare, you may incur these costs by not also having a medicare supplement plan:

 

Type of Cost Sharing 2022
Part A Deductible
Inpatient Hospital Deductible 1-60 days
$1,556
Daily Coinsurance from 61-90 days $389 per day
Daily Coinsurance for lifetime reserve days from 91-150 days $778 per day
Skilled Nursing Facility Coinsurance from 21st-100 day $194.50 per day

Tip

If you are currently on your employer’s health plan, you may be able to pair Medicare Part A with your health plan and have it as either primary or secondary coverage.

What is Medicare Part B?

Original Medicare consists of two parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Medicare Part A covers Medicare inpatient care, including care received while in a hospital, a skilled nursing facility, and, in limited circumstances, at home. Most people are automatically eligible for Medicare Part A at age 65 if they’re already collecting retirement benefits from the Social Security Administration or the Railroad Retirement Board. You may qualify for Medicare Part A before 65 if you have a disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS). You must be either a United States citizen or a legal permanent resident of at least five continuous years.

What does Medicare Part B Cover?

Medicare Part B helps pay for many common types of health care:
  • Doctors’ services.
  • Durable medical equipment (DME) if your doctor certifies you need it, and you buy or rent it from a Medicare-certifiedMedicare-certified means offering services at a level of quality approved by Medicare. Medicare will not pay for services received from a health care provider that is not Medicare-certified. supplierA supplier is a person or business from whom you can buy medical equipment, like a walker or wheelchair. See also Provider and Durable Medical Equipment (DME)..
  • Ambulance services if your health requires ambulance transport and you are traveling to or from certain locations.
  • Many preventive care services.
  • Outpatient physical, speech, and occupational therapy services provided by a Medicare-certified physical, speech, or occupational therapist.
  • Chiropractic care when manipulation of the spine is medically necessary to fix a subluxation of the spine. A subluxation is when one or more of the bones of the spine move out of position.
  • Outpatient mental health services.
  • Home health services if you need skilled nursing or therapy services.
  • X-rays and lab tests.
  • Select prescriptionA prescription is an order for a health care service or drug written by a qualified health care professional. drugs, such as immunosuppressant drugs, some anti-cancer drugs, some anti-emetic drugs, some dialysis drugs, and physician-administered drugs that persons do not usually administer themselves.
It is important to note that Medicare does not cover all health care services.

Who is Eligible for Medicare Part B?

In general, you are eligible for Medicare Part B if:
  • You are age 65 or older and a U.S. citizen or permanent legal resident of at least five years in a row
  • You are already receiving retirement benefits
  • You are disabled and receiving disability benefits
  • You have end-stage renal disease (ESRD)
  • You have amyotrophic lateral sclerosis (Lou Gehrig’s disease or ALS)
Most beneficiaries pay a premium for Medicare Part B if they have worked at least 10 years (or 40 quarters) and paid Medicare taxes during that time. Beneficiaries who delay enrollment after they first become eligible for Medicare Part B may be subject to a late enrollment penalty once they sign up.

Tip

The transition from Employer Group Health Insurance may take some time to prepare. Speak with a licensed agent to find out your options and the expected time to receive Part B.

Medicare Part B Premium

One reason someone may hold off on not taking Part B initially is because of the monthly cost associated in accepting coverage. If someone is enrolled in employer group health coverage, it may not make sense to also pay a monthly premium to take Part B.

The premium is determined by what income you or your household receives. The more taxable income you receive, the more you will pay. In 2022, the monthly premium most people will pay is $170.10/month.

If you believe that you’re paying too much for Part B, check out this article to learn how to appeal your Part B premium.

Frequently Asked Questions
Does my preferred hospital accept Part A of Medicare?
Hospitals must adhere to certain safety and health regulations to participate with Medicare. The Medicare.gov website contains a useful Hospital Locator Tool, which allows you to enter your city, state, or zip code to find a list of hospitals in your area that accept Medicare.
Will I experience out-of-pocket costs with Part A?
Under Original Medicare coverage, you are responsible for your Part A deductible and coinsurance, even if your hospital accepts Medicare assignment, there is no cap on your out-of-pocket expenses. If you’re enrolled into a Medicare Supplement plan, these costs may be covered by the insurance carrier completely or partially. It is important to note that if you have only original medicare, there is no limit on out-of-pocket costs.
Does my doctor accept Part B?

To find a doctor that accepts Medicare payments, you may want to visit the Centers for Medicare and Medicaid Services’ Physician Compare. You can search by entering a health care professional’s last name or group practice name, a medical specialty, a medical condition, a body part, or an organ system. This tool will provide you with a list of professionals or group practices in the specialty and geographic area you specify, along with detailed profiles, maps, and driving directions.

What is the Medicare Part B late-enrollment penalty?
If a person does not enroll in Medicare Part B when first eligible, and they do not have other credible health coverageGenerally referred as health insurance just as good or better than Medicare., they will incur a late-enrollment penalty if they later choose to enroll in Medicare Part B. This is also true if someone has Medicare Part B, but then drops their Part B coverage, and then later decides to sign up again for coverage. Remember that, if a person does not enroll in Medicare Part A and/or Medicare Part B when they were first eligible, and they were not eligible for a Special Enrollment Period, they can only elect Medicare Part A or Medicare Part B during the General Enrollment Period that starts January 1st and continues through March 31 of each year. The Medicare Part B late-enrollment penalty is 10% of the current Medicare Part B premium (for instance, the 2019 Medicare Part B premium is $134) for every 12-month period that the person delayed enrolling in Medicare Part B after they were first eligible or dropped Part B and were without Medicare Part B coverage when they were eligible.

Speak with a Medicare Expert

Our team can help you get onto Part B and ensure you are not missing any forms.