What Is Original Medicare Part A And Part B

Is Original Medicare Enough?

 

Original Medicare (Parts A and B) is health insurance provided by the federal government. Part A covers inpatient hospital stays and Part B covers doctor visits and outpatient care.

 

People often choose additional insurance to cover items Parts A & B do not. Most important are prescription drug costs and the 20% coinsurance for medical care not covered by Original Medicare. Deductibles and copays for inpatient stays can also add up quickly. These items alone could burden you with significant annual costs. Even though you may currently be healthy, your future needs can change quickly.

 

We have plans to enhance your Original Medicare coverage, pay for the things it doesn’t cover, and help control your health care costs.

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What Does Original Medicare Cover?

 

Original Medicare is made up of Part A and Part B. Each covers different parts of your care.

 

Medicare Part A

 

 

Medicare Part B

 

Hospital Insurance

 

    Inpatient hospital stays

 

    Skilled nursing facility care

 

    Hospice care

 

    Some in-home care after a qualified inpatient stay

Medical Insurance

 

    Doctor visits

 

    Preventive care

 

    Outpatient services

 

    Medical supplies

 

    Tests and X-rays

Original Medicare Costs

 

Let’s look at how most people pay for Original Medicare.

 

Medicare Part A

 

Medicare Part B

 

$0

Monthly Premium For Most People

You may have to pay a premium for Part A, but most people don't. If you or your spouse made payroll contributions to Social Security for 10 years while you were working, you won’t have to pay premiums for Part A. If not, you'll have to pay a Part A monthly premium.

 

$164.90

Monthly Premium For Most People (2023)

The cost of Part B varies depending on your income. Social Security uses your tax information to find out what you should pay. Your Part B premium can be automatically deducted from your Social Security check each month.

 

Medicare Preventive Health

 

Original Medicare Part B includes many preventive health benefits. Take advantage of preventive care — it’s one of the best things you can do for your health. Regular checkups, tests, shots and screenings can protect you from disease or injury, or lead to early detection and treatment that is more effective. Original Medicare pays for many preventive health services, and some of our plans cover even more. Here’s a list of preventive services included with Medicare Part B (some limitations and/or exclusions may apply).

 

Shots

 

    COVID

 

    Flu

 

    Hepatitis B (for people at medium to high risk)

 

    Pneumococcal

 

Exams

 

    One-Time “Welcome to Medicare” preventive visit (within the first 12 months of having Part B)

 

    Yearly “Wellness” visits

 

Other Preventive Benefits

 

    Cardiovascular disease (intensive behavioral therapy)

 

    Diabetes self-management training

 

    Medical nutrition therapy (for people with diabetes or renal disease)

 

    Obesity (intensive behavioral therapy)

 

    Smoking and tobacco use cessation counseling

 

Screenings

 

    Abdominal aortic aneurysm (for people at risk)

 

    Alcohol misuse (screening and counseling)

 

    Bone mass measurement

 

    Breast cancer (mammograms)

 

    Cardiovascular disease

 

    Cervical and vaginal cancer

 

    Colorectal cancer

 

    Depression

 

    Diabetes (for people at risk)

 

    Glaucoma (for people at high risk)

 

    Hepatitis C (for certain ages and people at high risk)

 

    HIV (for people at increased risk)

 

    Pap test

 

    Prostate cancer

 

    Sexually transmitted infections (screening and counseling)

 

Does Original Medicare Cover Ambulance Services?

 

Original Medicare Part B covers ambulance transportation when you need to go to a hospital or skilled nursing facility for medically necessary treatment. Original Medicare may also pay for emergency transportation in an airplane or helicopter if you need rapid transportation to a hospital that ground transportation can’t provide.

What Is Not Covered By Original Medicare?

 

Though Original Medicare pays for many services, it doesn’t pay for everything. Medicare Advantage, Prescription Drug (Part D), Medicare Supplement Plans, and optional vision and dental plans are available for Medicare eligibles to help you with the things that aren’t covered.

Prescription Drugs

Most prescription drugs are not covered by Original Medicare, but a Prescription Drug (Part D) Plan can help you save money on your prescription drugs.

 

Most Medicare Advantage Plans include Prescription Drug (Part D) coverage.

Hospital Stay Limitations

Original Medicare Part A only fully covers your copays for the first 60 days in the hospital. After that your co-pays could be as high as $400 per day and you only have up to 150 lifetime days.

 

Medicare Advantage or Medicare Supplement plans can cover some or all of these costs.

20% Coinsurance For Doctor Visits

Original Medicare will only pay 80 percent of the cost of doctor visits.

 

With a Medicare Advantage plan, you will pay a small copay for doctor visits. For Medicare-covered services, Medicare Supplement plans can help cover some or all of the costs of doctor visits not covered by Original Medicare.

Vision, Dental, And Hearing

Original Medicare doesn’t cover regular vision exams, eyeglasses or contacts and it also doesn’t cover most dental care. But many of our Medicare Advantage plans offer vision, dental and hearing coverage.

 

 

 

Original Medicare vs. Medicare Advantage

 

Some of the benefits Medicare Advantage plans have that Original Medicare doesn’t include:

 

Prescription drug overage

 

Most Medicare Advantage plans include prescription drugs (Part D) coverage. While Medicare Part D provides only prescription drug coverage, Medicare Advantage plans can cover that and more.

 

Supplemental benefits

 

Many Medicare Advantage plans include allowances for Over-the-Counter (OTC) items, groceries, utilities, transportation and more. Note:  Supplemental benefits can vary based on where you live, the plan you chose, and whether you qualify to receive them. 

 

Dental care

 

Many Medicare Advantage plans offer dental coverage for things like routine checkups and exams, cleanings, dentures, and coverage for unplanned dental procedures like root canals and crowns.

 

Vision care

 

Eye health and vision coverage becomes more important as we age. Eye exams, glasses, and contacts are a part of many Medicare Advantage plans.

 

Hearing care

 

Original Medicare doesn't cover hearing aids, which can be expensive. Many Medicare Advantage plans provide hearing coverage that includes testing and medically required hearing aids.

 

Wellness and fitness

 

Medicare Advantage plans give you options for maintaining a healthy lifestyle. Many plans include access to gym memberships, senior fitness programs like SilverSneakers®, and coaching to improve overall well-being.

 

We offer Medicare Advantage, Prescription Drug (Part D), and Medicare Supplement plans in most areas of the country. Depending on the plan you choose, it may help you pay for some of what Medicare doesn’t cover for Medicare-approved services. Our Medicare Supplement plans also include value-added programs like SilverSneakers®.

 

And, in most states, one of our optional dental or vision packages can easily be purchased in addition to your Medicare Supplement or Medicare Advantage plan to complement your coverage. You receive allowances for the glasses or contacts you rely on and your checkups and eye exams will be covered.

How To Sign Up For Medicare

 

We can help you understand the rules about when and how to sign up for Original Medicare and the Medicare plans we offer such as Medicare Advantage, Prescription Drug (Part D), and Medicare Supplement on our Sign Up For Medicare page.

 

Get Help Paying For Original Medicare

 

If you need help paying for the costs of Original Medicare, like deductibles or premiums, there are many programs to help. You can also apply for a Medicare Savings Program to help cover the costs of Original Medicare. To find out if you qualify for one of these programs, visit Medicare.gov  or call your state’s Medicaid or local Social Security office. If you already have Medicaid or are enrolled in certain levels of the Medicare Savings Program, you may be eligible for a Dual Special Needs (D-SNP) plan. These plans are designed for people who have Medicare and Medicaid and have no premium, medical copays or deductibles.

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Read Our Other Medicare Articles

Original Medicare: Part A (Hospital Insurance) and Part B (Medical Insurance).

 

Anthem Blue Cross and Blue Shield is a Medicare Advantage plan with a Medicare contract. Anthem Blue Cross and Blue Shield is a D-SNP plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in Anthem Blue Cross and Blue Shield depends on contract renewal.

 

For Medicare Supplement only: Not connected with or endorsed by the U.S. government or the federal Medicare program.