Understanding Original Medicare (Part A and Part B)

Original Medicare is the foundational health insurance program provided by the federal government for eligible individuals. It consists of two main parts: Part A (Hospital Insurance) and Part B (Medical Insurance).

Medicare Part A: Hospital Insurance

Part A helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. Think of it as your "hospital insurance."

What Part A Covers:

• Inpatient hospital stays (semi-private rooms, meals, nursing services).
• Care in a skilled nursing facility (following a qualifying hospital stay).
• Hospice care for terminal illness.
• Home health care if you are homebound and need skilled care.

Part A Costs:

Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes while working. However, you will still be responsible for a deductible for each hospital benefit period and coinsurance for extended stays.

Medicare Part B: Medical Insurance

Part B helps cover medically necessary services and supplies, as well as preventive services. This includes outpatient care, doctor's visits, and medical equipment.

What Part B Covers:

• Doctor's visits and services.
• Outpatient hospital care.
• Durable medical equipment (like walkers and wheelchairs).
• Ambulance services.
• Preventive services (like flu shots and cancer screenings).
• Mental health services.

Part B Costs:

Most people pay a standard monthly premium for Part B. You will also be responsible for an annual deductible. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most covered services.

What Original Medicare Doesn't Cover

It's important to know that Original Medicare does not cover everything. Common gaps in coverage include:

• Most prescription drugs (this is covered by Part D).
• Long-term care (custodial care).
• Most dental care, eye exams for glasses, and hearing aids.
• Cosmetic surgery.

Because of these gaps and the 20% coinsurance, many people choose to get additional coverage through a Medicare Advantage plan or a Medigap policy.