What Is the Difference Between Medicare Part A and Medicare Part B

As individuals approach age 65, they can feel like they are in a tangle trying to understand Medicare and all of the parts of each plan. This article will make Medicare Part A and Medicare Part B easy to understand.

Medicare Part A and Part B are part of the Original Medicare plan. Part A is your hospital insurance coverage. Medicare Part B is for your outpatient services such as doctor visits. With the two of them together, you will receive the help you need to pay for many of your healthcare costs. 

All of the parts of Medicare can be confusing. However, there is a significant difference in what each part pays. So let’s look at the differences and make it easier to understand. 

What is Medicare Part A?

Medicare Part A covers many aspects of your healthcare. You are eligible for Medicare Part A if you are 65 years or older, or you have a disability that a doctor verifies, and have received Social Security Income or benefits (SSI). You can also qualify for Medicare Part A if you have end-stage renal disease or have Lou Gehrig’s disease (ALS). 

What Does Medicare Part A Cover?

Medicare Part A is frequently called hospital coverage because it primarily covers hospitalization and things related to the hospital stay.

Services that Medicare Part A helps to pay for:

• Part A covers inpatient care in the hospital 
  • When the physician decides inpatient hospitalization is required to treat an illness or injury.
  • The hospital must accept Medicare as payment.
  • It does not cover observation-only admissions – though sometimes Medicare Part B will cover this type of stay.

• Part A covers a visit to a skilled nursing facility, but only if needed for a short period. This is not considered long-term care.
• It does cover a long-term care hospital stay, but only if you are admitted there directly from an acute care facility.
• Part A has limited home healthcare coverage immediately following a hospitalization. Homecare can be physical therapy (PT), occupational therapy (OT), or speech. Though sometimes, this falls under Medicare Part B.
• Hospice Care – Medicare Part A and the Medicare Advantage programs cover hospice care for all Medicare recipients. 

What Does Medicare Part A Cost?

Generally, there is no charge for Medicare Part A, although some people pay a monthly premium. There is no cost to receive this benefit if you or your spouse have worked for at least ten years and have paid Medicare taxes. The year is divided into quarters for Medicare purposes, and you must have paid Medicare taxes for forty quarters. If you did not work and pay Medicare taxes for forty quarters, you would pay a premium based on your income.

If you do not qualify for the premium-free Medicare Part A, you may be eligible for Medicare Part A with a premium due. As of 2022, you will either pay $274 or $499, depending on the time you or your spouse worked while paying Medicare taxes. Additionally, to buy Medicare Part A, you must purchase Medicare Part B.

There is also a deductible for all Medicare Part A recipients (premium-free or premium paid) that you would pay for each time you are hospitalized with a limited number of inpatient days. For the year 2022, you would pay $1556. The amount you pay could increase with extended inpatient stays.

What is Medicare Part B?

Medicare Part B is the other health insurance coverage service. This insurance covers what you would receive as an outpatient. Medicare Part B covers Durable Medical Equipment (DME), doctor visits, and other outpatient services. It sometimes covers prescriptions.

Services that Medicare Part B helps to pay:

• The services that you receive from doctors or other health providers such as a Nurse Practitioner (NP) or a Physician Assistant (PA)
• Outpatient Care – from an outpatient clinic or other outpatient care.
• Home health care such as physical, occupational, or speech therapy. It will also cover home nursing and sometimes nursing assistant. 
• Medical equipment that you could need, like wheelchairs, walkers, or hospital beds, only if a Medicare-approved DME provides it.
• Your preventative treatments could include health screenings, vaccines, and yearly wellness screens.

Medicare Part B does not cover dental, vision, or hearing aids; some Medicare Advantage programs provide these services.

What Does Medicare Part B Cost?

Medicare Part B has a monthly premium in 2022. The cost of a Part B plan is $170.10 each month. This number is increased for a higher-income individual. For example, if you made $91,000 on your tax return as an individual in 2022 or $182,000 as a joint return, you would pay more. 

This premium can change each year. The monthly premium is paid by a deduction from your social security check that you receive each month.

When Do I Enroll in Medicare Part A and B?

To initially enroll in these benefits, Medicare requires you to do so either three months before your 65^thbirthday month or three months after your birthday month. If you want to change your plan to the Original Medicare from an Advantage program, you must do so during open enrollment from January 1^st until March 31^st.

Navigating the parts of Medicare can be a daunting task. If you want more information on the different parts of Medicare, refer to the official Medicare website.