What’s the Medicare A and B difference?

When it comes to healthcare in the United States, Medicare can be a life-saver. It’s a federal health insurance program that provides coverage to people over the age of 65, as well as to people with certain disabilities and those with End-Stage Renal Disease. However, Medicare has different parts, each covering different aspects of healthcare. Medicare Parts A and B are the two Original Medicare parts that provide coverage for hospital and medical services. In this article, we’ll discuss what Medicare Parts A and B cover and what their differences are.

What is Medicare Part A?

Medicare Part A is often called hospital insurance. It covers inpatient care in hospitals, skilled nursing facilities, hospices, and home health care services. Usually, Part A is premium-free, provided that you or your spouse worked and paid Medicare taxes for at least ten years. If you don’t meet this requirement, you’ll have to pay a premium for Part A.

What does Medicare Part A cover?

Medicare Part A covers the following services:

  • Hospital stays: Part A covers the cost of a semi-private room, meals, and general nursing care in a hospital. It also includes Medicare-approved services and supplies, such as lab tests, X-rays, and drugs that are necessary for your treatment.
  • Skilled nursing care: After a period of hospitalization, patients may need additional skilled nursing care in a skilled nursing facility. Medicare Part A covers skilled nursing care if it’s medically necessary and if the patient meets certain conditions.
  • Hospice care: Medicare Part A covers hospice care for people with terminal illnesses who have six months or less to live. This care can be provided in a hospice facility, a nursing home, or at home.
  • Home health care: Medicare Part A covers some home health services, such as skilled nursing care, home health aide services, and physical therapy. To be eligible, patients must be homebound, meaning that leaving their home is a major effort.

What does Medicare Part A not cover?

Medicare Part A doesn’t cover the following services:

  • Private duty nursing
  • Long-term care
  • Private rooms in hospitals
  • Most dental care, vision care, and hearing aids
  • Medical care outside of the United States

What is Medicare Part B?

Medicare Part B is often called medical insurance. It covers medical services and supplies that are necessary to diagnose or treat an illness or condition. Unlike Part A, Part B requires a monthly premium, which is based on your income.

What does Medicare Part B cover?

Medicare Part B covers the following services:

  • Doctor services: Part B covers visits to doctors, including specialists, and other health care providers who accept Medicare assignment.
  • Preventive care: Part B covers certain preventive services, such as flu shots, Pap tests, and mammograms.
  • Outpatient care: Part B covers outpatient care in hospitals and clinics, as well as urgent care centers and other outpatient medical services.
  • Durable medical equipment: Part B covers the cost of durable medical equipment, such as wheelchairs, walkers, and oxygen equipment.
  • Mental health care: Part B covers mental health care services, including therapy and outpatient mental health visits.

What does Medicare Part B not cover?

Medicare Part B doesn’t cover the following services:

  • Long-term care
  • Dental care (with some exceptions)
  • Vision care (with some exceptions)
  • Hearing aids and exams for fitting them (with some exceptions)
  • Acupuncture
  • Cosmetic surgery

What are the differences between Medicare Part A and Part B?

While both Medicare Part A and Part B provide coverage for healthcare services, they have some significant differences that people should be aware of.

Premiums

Medicare Part A is usually premium-free, as long as you or your spouse worked and paid Medicare taxes for at least ten years. If you don’t meet this requirement, you’ll have to pay a premium for Part A. Medicare Part B requires a monthly premium, which is based on your income.

Coverage

Medicare Part A covers hospital and skilled nursing facility stays, hospice care, and some home health care services. Medicare Part B covers medically necessary services and supplies, such as doctor visits, preventive care, and durable medical equipment.

Copayments and deductibles

Medicare Part A has a deductible, which is the amount you pay out-of-pocket before Medicare starts paying. For 2022, the Part A deductible is $1,548. Medicare Part B has a deductible of $233 for the year 2022. After you pay the deductible, you usually pay 20% of the Medicare-approved amount for most doctor services and outpatient care.

FAQs: What is the difference between Medicare A and B?

  • Do I need both Medicare Part A and Part B?

    Yes, most people need both Medicare Part A and Part B to get comprehensive healthcare coverage. They’re often referred to as Original Medicare.

  • Can I choose not to enroll in Medicare Part B?

    Yes, you can choose not to enroll in Medicare Part B. However, if you don’t have other healthcare coverage, such as through an employer or a spouse’s plan, you may face a penalty for not enrolling in Part B when you’re first eligible.

  • What is the difference between Medicare Parts A, B, C, and D?

    Medicare Part A covers hospital and skilled nursing facility stays, hospice care, and some home health care services. Medicare Part B covers medically necessary services and supplies, such as doctor visits, preventive care, and durable medical equipment. Medicare Part C (also called Medicare Advantage) is an alternative to Original Medicare, offered by private companies. It includes Parts A and B, and often extra benefits like vision, hearing, and dental care. Medicare Part D covers prescription drug coverage.

Conclusion

Medicare Parts A and B are the two Original Medicare parts that provide coverage for hospital and medical services. While both provide coverage for healthcare services, they have some significant differences, which people should be aware of when choosing their coverage. Medicare Part A is often called hospital insurance, and it covers inpatient care in hospitals, skilled nursing facilities, hospices, and home health care services. Medicare Part B, on the other hand, covers medically necessary services and supplies, such as doctor visits, preventive care, and durable medical equipment. Understanding the differences between the two parts can help people make informed decisions about their healthcare coverage.

References

– Medicare.gov. (n.d.). What’s Medicare? Retrieved December 14, 2021, from https://www.medicare.gov/what-medicare-covers/whats-medicare

– Medicare.gov. (n.d.). What’s Medicare Part A (Hospital Insurance)? Retrieved December 14, 2021, from https://www.medicare.gov/coverage/part-a

– Medicare.gov. (n.d.). What’s Medicare Part B (Medical Insurance)? Retrieved December 14, 2021, from https://www.medicare.gov/coverage/part-b

– Medicare.gov. (n.d.). What’s Medicare Advantage Plan (Part C)? Retrieved December 14, 2021, from https://www.medicare.gov/what-medicare-covers/whats-medicare-advantage-plan-part-c

– Medicare.gov. (n.d.). What’s Medicare Part D (Prescription drug coverage)? Retrieved December 14, 2021, from https://www.medicare.gov/drug-coverage-part-d

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