Difference between Medicare Part A and Part B

May 30th, 2017     Medicare

Medicare is the federal health insurance program for people who are 65 or above, certain young people who have disabilities such as end stage renal disease. Medicare includes different parts that cover specific services like Part A covers hospital insurance, Part B covers medical insurance, Part C (issued by private insurers) covers services of both Part A and Part B (and sometimes Part-D), and Part D covers drug prescription services.

It is important to know the difference between Medicare Part A and Part B while enrolling for Medicare. Lets check them out.

Medicare Part A Medicare Part B
Coverage and Services Medicare Part A covers hospital insurance. Below are the services categorized as follows:

Hospital Care: This coverage includes benefits such as meals, semi-private room, general nursing, other hospital services and supplies, care in inpatient rehabilitation facilities and mental health care in a psychiatric hospital. To know the list of hospitals which are enrolled in Medicare and choose the best hospitals, you can refer to our website //www.medicarelist.com/hospitals/

Skilled Nursing Facility Care: This coverage includes semi-private room, meals, skilled nursing care, medical social services, physical therapy, speech-language therapy, medical equipment, Ambulance transportation and Dietary counseling. To know the list of nursing-homes (along with quality ratings) which are enrolled in Medicare, you can refer to our website //www.medicarelist.com/nursing-homes/

Hospice: This coverage provides services to people who are terminally ill and have less than 6 months to live. To get the services, doctor must certify that the patient is terminally ill. To know the list of hospice which are enrolled in Medicare, you can refer to our website //www.medicarelist.com/hospice-care/

Home Health Services: Face to face interaction with the doctor is necessary to avail home health services. Patient must be home-bound. To know the list of home health agencies which are enrolled in Medicare, you can refer to our website //www.medicarelist.com/home-healthcare/

Medicare Part B covers medical insurance. Below are the services categorized as follows:

Doctors’ Services: Medicare covers medically necessary doctor services. It also covers services given by other health care providers, like physician assistants, nurse practitioners, social workers, physical therapists, and psychologists.

Outpatient Medical and Surgical Services and Supplies: Medicare covers for approved procedures like X-rays, casts, or stitches.

Durable Medical Equipment: Medicare covers costs for items such as oxygen equipment and supplies, wheelchairs, walkers, and hospital beds for use in the home. Some items may be rented.

Home Health Services: Medicare covers medically necessary part time nursing care, physical therapy, speech-language pathology services and services for people with a continuing need for occupational therapy.

Other (including, but not limited to): Medicare covers for clinical laboratory services, diabetes supplies, kidney dialysis services and supplies, mental health care, limited outpatient prescription drugs, and other services. The costs varies with each service.

Preventative Services: Medicare covers many preventative services to help the person stay healthy.

To know the list of doctors , therapists and nurses who accept medicare, you can refer to our website //www.medicarelist.com/

Cost Part A Premiums.
Most people don’t pay any premium for Medicare Part A (individuals who paid medicare taxes for atleast 40 quarters). There is monthly premium for Medicare Part A for individuals who paid medicare taxes for less than 40 quarters. Check the premium prices at Medicare Part A Premium

Part A Deductibles.

  • Hospital care:
    Patient pays a $1,316 deductible and no coinsurance for days 1– 60 of each benefit period. For example, if the hospital bill for 7 days is $20,000, then the patient will pay $1,316 and the remaining amount will be paid by Medicare.

    Patient pays $329 per day for days 61– 90 of each benefit period. If the patient is hospitalized for 65 days, then he has to pay total of $2961 [$1,316 (deductible) + 5 x $329 ($1645 co-pay)]

    Patient pays $658 per “lifetime reserve day” after day 90 of each benefit period (up to 60 days over your lifetime).

  • Skilled Nursing Facility:

    Patient pays nothing for days 1-20 of each benefit period.

    Patient pays $164.50 per day for days 21-100 of each benefit period.

    patient pays all the costs after 100 days of benefit period.

    Home Health Care: Patient has to pay nothing for home health services in the original Medicare. For certain medical equipment like wheel chair or walker, he has to pay 20% of the amount and the rest 80% is covered by Medicare Part-B.

  • Hospice: Patient has to pay not more than $5 for each prescription drug and 5% for inpatient respite care. For example, if Medicare approved $150 per day for inpatient respite care, then he has to pay $7.50 per day.
Part B Premiums.

Each person pays a premium for Part B each month which depends on one’s income. The standard Part B premium amount in 2017 is $134.

If each person pays his/her Part B premium through his/her monthly Social Security benefit, he/she has to pay less ($109 on average).

Part B deductible and coinsurance.

A person has to pay $183 per year for his/her Part B deductible. After his/her deductible is met, he/she typically pays 20% of the approved amount of medicare for most doctor services, outpatient therapy and durable medical equipment.


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Medicare Part A (Hospital Insurance)

May 23rd, 2017     Medicare

Medicare is a health insurance program offered by the federal government for people who are 65 and above. Within Medicare, Part-A insurance covers the inpatient hospital care. Most people get Medicare Part A free of cost when they turn 65. Below are the services which come under Medicare Part A.

  • Hospital Care: This coverage includes benefits such as meals, semi-private room, general nursing, other hospital services and supplies, care in inpatient rehabilitation facilities and mental health care in a psychiatric hospital. To know the list of hospitals which are enrolled in Medicare, you can refer to our website //www.medicarelist.com/hospitals/
  • Skilled Nursing Facility Care: This coverage includes semi-private room, meals, skilled nursing care, medical social services, physical therapy, speech-language therapy, medical equipment, Ambulance transportation and Dietary counseling. To know the list of nursing-homes which are enrolled in Medicare, you can refer to our website //www.medicarelist.com/nursing-homes/
  • Hospice: This coverage provides services to people who are terminally ill and have less than 6 months to live. To get the services, doctor must certify that the patient is terminally ill. To know the list of hospice which are enrolled in Medicare, you can refer to our website //www.medicarelist.com/hospice-care/
  • Home Health Services: Face to face interaction with the doctor is necessary to avail home health services. Patient must be home-bound. To know the list of home health agencies which are enrolled in Medicare, you can refer to our website //www.medicarelist.com/home-healthcare/

Who are eligible for Medicare Part A?

People with the following criteria are eligible for Part A Medicare program.

  • People with the age 65 or above.
  • People who are disabled permanently.
  • People with the end stage renal disease.

Refer to our guide on Medicare Eligibility Requirement for in-depth eligibility requirments.

What is the cost of Medicare Part A?

Premium-Free

There is no monthly premium for Medicare Part A for individuals who paid their medicare taxes for atleast 40 quarters.

The eligibility for people at 65  is as follows:

  • People with retirement benefits from Social Security or Rail Road Retirement Board.
  • People who are eligible and yet to file for Social Security or Rail Road benefits.
  • People and their respective partners have medicare covered government employment.

The eligibility for people under 65 is as follows:

  • People who got disability benefits of Social Security or Rail Road Retirement Board  for 24 months.
  • People with end stage renal disease and meet certain requirements.

Premium

For the year 2017

  • People who paid taxes for less than 30 quarters have to pay $413 monthly.
  • People who paid taxes for 30-39 quarters have to pay $227 monthly.
  • People who paid taxes for 40 quarters or above avail free medicare coverage.

When to enroll for Medicare Part A?

  • Initial Enrollment Period (IEP): People can enroll 3 months before they turn 65 to get services from the day they turn 65. If they enroll during the month they turn 65, then they can avail services the next month. If they enroll in the last 3 months of this period, then they can avail services after 2 to 3  months they turn 65.
  • General Enrollment Period (GEP): People who did not sign up during Initial Enrollment Period can enroll during General Enrollment Period. It occurs every year from January 1 to March 31. If the person is not eligible for premium-free Part A and has not bought it in IEP, his/her monthly premium may go up 10%. He/She has to pay the higher premium for twice the number of years he/she did not signup for Part A.
  • Special Enrollment Period: Most of the people are not eligible for Special Enrollment Period. To be eligible, a person should have employer group health plan coverage based on his/her employment status. The SEP allows people to enroll for Medicare after IEP without needing to wait for GEP and there is no penalty as well.

How to apply for Medicare Part A?

  • Visit the social security website for online application.
  • Visit the nearest social security office for offline application.
  • Call Social Security at 1-800-772-1213
  • Call the R.R.B at 1-877-772-5772,  if you are a rail road employer.

How much does Medicare Part A pay?

Inpatient care:

Benefit Period in 2017 Pay
Days 1-60 $1316 deductible
Days 61-90 $329 per day
Days 91-150 $654 per day
(60 lifetime reserve days)
All days after 150 All Costs

Cost Working Examples

  1. Patient pays a $1,316 deductible and no coinsurance for days 1– 60 of each benefit period. For example, if the hospital bill for 7 days is $20,000, then the patient will pay $1,316 and the remaining amount will be paid by Medicare.
  2. Patient pays $329 per day for days 61– 90 of each benefit period. If the patient is hospitalized for 65 days, then he has to pay total of $2961 [$1,316 (deductible) + 5 x $329 ($1645 co-pay)]
  3. Patient pays $658 per “lifetime reserve day” after day 90 of each benefit period (up to 60 days over your lifetime).

Skilled Nursing Facility:

Benefit Period in 2017 Pay
Days 1-20 $0
Days 21-100 $164.50 per day
All days after 100 All Costs

Home Health Care: Patient has to pay nothing for home health services in the original Medicare. For certain medical equipment like wheel chair or walker, he has to pay 20% of the amount and the rest 80% is covered by Medicare Part-B.

Hospice: Patient has to pay not more than $5 for each prescription drug and 5% for inpatient respite care. For example, if Medicare approved $150 per day for inpatient respite care, then he has to pay $7.50 per day.


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.