Medicare

 Navigating the Foundation of Medicare: Parts A and B

Welcome to Rhonda Fisher Insurance, your trusted partner in navigating the complexities of Medicare. For many, the journey into Medicare begins with understanding its core components: Original Medicare, which is comprised of Part A (Hospital Insurance) and Part B (Medical Insurance). This foundational knowledge is crucial for making informed decisions about your health coverage, and we are here to guide you through every detail.

Medicare Part A: Your Hospital Insurance

Medicare Part A is the pillar of your inpatient care coverage. Think of it as your safety net for significant, facility-based medical events. For most Americans who have worked and paid Medicare taxes for at least 10 years, Part A is premium-free. This is a significant benefit, as it covers a wide range of essential services.

• Inpatient Hospital Stays: This includes care you receive when formally admitted to a hospital. Part A helps cover the costs of your room, meals, nursing care, and other services during your stay. There is a deductible for each benefit period, and coinsurance may apply for extended stays. It’s important to understand what a “benefit period” is—it begins the day you’re admitted and ends when you haven’t received inpatient care for 60 consecutive days.
• Skilled Nursing Facility (SNF) Care: Following a qualifying hospital stay, Part A can cover care in a skilled nursing facility. This is not for long-term care, but for short-term, medically necessary services like physical therapy or skilled nursing. There are limitations on the number of covered days, and coinsurance applies after the first 20 days.
• Hospice Care: If you have a terminal illness and choose to receive hospice care, Medicare Part A provides comprehensive coverage. This includes pain relief, symptom management, and support services for you and your family.
• Home Health Services: In specific circumstances, Part A can cover a limited number of home health visits for medically necessary services.

While Part A provides vital coverage, it’s not all-encompassing. It’s designed for acute, not chronic, care. Furthermore, it doesn’t cover things like long-term care, and it has deductibles and coinsurance that can lead to significant out-of-pocket costs. This is where the next piece of the puzzle, Part B, comes in.

Medicare Part B: Your Medical Insurance

Part B is the complement to Part A, covering your day-to-day medical needs. Unlike Part A, Part B has a standard monthly premium. This premium can be higher for individuals with higher incomes.

• Doctor’s Services: Part B covers medically necessary services and procedures performed by doctors and other healthcare providers, whether in an office, clinic, or hospital.
• Outpatient Care: This includes hospital outpatient services, emergency room visits, and outpatient surgery.
• Preventive Services: A key benefit of Part B is its coverage of preventive care, such as annual wellness visits, various health screenings, and immunizations. These services are often covered at 100% and are essential for maintaining your health.
• Durable Medical Equipment (DME): Part B helps pay for necessary medical equipment like wheelchairs, oxygen equipment, and hospital beds that are prescribed by a doctor for use in your home.

After you meet your annual Part B deductible, you typically pay a 20% coinsurance for most Medicare-approved services. This 20% can add up quickly, as there is no annual limit on your out-of-pocket spending with Original Medicare.

The Gaps in Original Medicare

Original Medicare is a powerful program, but it’s not without its “gaps.” It doesn’t cover everything, and the out-of-pocket costs can be unpredictable. Common expenses not covered include routine dental, vision, and hearing care, as well as prescription drugs. The lack of a cap on out-of-pocket spending is a primary reason many people seek additional coverage.

At Rhonda Fisher Insurance, we specialize in helping you understand these gaps and explore the solutions available to you. Whether it’s through a Medicare Supplement (Medigap) plan or a Medicare Advantage plan, our goal is to ensure you have comprehensive coverage that protects your health and your finances. Contact us today for a no-obligation consultation to discuss how Parts A and B work and what your next steps should be.