Medicare Part A vs. Medicare Part B: What’s the Difference?

Medicare Part A vs. Medicare Part B: What’s the Difference?

Medicare is a federally funded health insurance program that provides coverage to people 65 years of age and older, as well as those with specific disabilities or conditions. Medicare has several parts, each covering different types of healthcare services.

Medicare Part A

Medicare Part A is also known as “hospital insurance.” It covers inpatient hospital care, skilled nursing care, hospice care, and home health care. If you have worked and paid Medicare taxes for at least ten years, you are eligible for Medicare Part A at no cost. If you have not worked and paid Medicare taxes for at least ten years, you may still be able to get Medicare Part A, but you will have to pay a monthly premium.

Inpatient Hospital Care

This benefit covers the medical services a patient receives during an overnight stay in a hospital. Medicare Part A also covers care in critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals.

The inpatient care benefit covers various services, including semi-private rooms, meals, general nursing, drugs, and other hospital services and supplies. Some specific services covered by Medicare Part A include a semi-private room in the hospital, as well as meals and general nursing care.

Skilled Nursing Care

Skilled nursing care is another benefit of Medicare Part A, which covers care provided by professional nurses in a skilled nursing facility. This benefit is available to those who require daily skilled care that a family member or caregiver cannot provide.

To be eligible for this benefit, you must have had a three-day inpatient hospital stay, and your doctor must certify that you need skilled nursing care. The professional nursing care must be related to the condition you were treated for during your hospital stay. If you choose to go to a skilled nursing facility that is not your usual place of care, you can receive Medicare coverage for up to 100 days in one year.

Hospice Care If your doctor certifies that you are terminally ill and have less than six months to live, Medicare Part A may cover hospice care. Hospice care provides pain management and comfort at the end of life. It can be provided at home or in an institution like an assisted living facility or nursing home.

Home Health Care

Medicare Part A covers inpatient hospital care, skilled nursing care, hospice care, and home health care services. Specifically, Medicare Part A covers home health care services considered medically necessary for treating an illness or injury and provided by a Medicare-certified home health agency.

Medicare Part B

Medicare Part B is the other part of the Medicare program that provides outpatient and medical services coverage. It's also known as “medical insurance” and covers doctor services, outpatient care, preventive services, medical equipment and supplies, and home health services.

Doctor services covered by Medicare Part B include visits to a doctor's office and services provided by other healthcare professionals, such as nurse practitioners, physician assistants, and clinical psychologists. Medicare Part B also covers preventive services, such as flu shots, mammograms, and other screenings that can help detect health problems early.

Outpatient care covered by Medicare Part B includes services provided in an outpatient setting, such as an emergency room, outpatient surgery center, or ambulatory care center. This coverage also includes diagnostic tests, such as X-rays and laboratory tests.

Prescription drugs covered by Medicare Part B are considered medically necessary to treat diseases. These prescriptions can be issued by a physical therapist, chiropractor, nurse practitioner, physician assistant, or an internist. One of the problems with this part of the Medicare program is that it doesn't cover over-the-counter (OTC) drugs. The only OTC drugs covered by Medicare Part B are cough and cold medicines when you have a cough or cold.

To be eligible for Medicare Part B, you must be enrolled in Medicare Part A and be 65 years of age or older or have specific disabilities. You must also pay a monthly premium for Medicare Part B based on your income. The monthly premium amount depends on which coverage gap you fall into. This gap is sometimes referred to as the “donut hole.”

It's important to note that Medicare Part B does not cover all medical services or supplies. Some services, such as dental care, hearing aids, and eyeglasses, are not covered by Medicare Part B. If you need these services, you may purchase separate insurance or pay for them out of pocket.

Medicare Part A and Medicare Part B are two different parts of the Medicare program that cover different types of healthcare services. Medicare Part A covers inpatient hospital care, skilled nursing care, hospice care, and home health care. In contrast, Medicare Part B covers outpatient care, preventive services, medical equipment and supplies, and doctor services.

Understanding the differences between Medicare Part A and Medicare Part B is essential to make informed decisions about your healthcare coverage. If you are eligible for Medicare, enroll in Part A and Part B to ensure that you have comprehensive coverage for your healthcare needs.