What is the difference between Medicare Part A and Part B?

Medicare Part A and Part B are frequently referred to as the Original Medicare and are both ran by the federal government. While plans under Medicare Part A provide hospital coverage, Medicare Part B plans offer outpatient medical care, like doctor’s visits. Instead of viewing the plans as an either-or, Medicare Part A and Part B are complementary pieces. Together, they provide comprehensive healthcare coverage inside and outside the hospital. To learn more about the key differences between Medicare Part A and Part B, continue reading the article.

What Is Medicare Part A?

Medicare Part A, also often called hospital insurance, covers:

  • Inpatient hospital care. Medicare Part A will only cover inpatient hospital care if you are admitted to a hospital following an official physician’s order and the hospital accepts Medicare. In some scenarios, the Utilization Review Committee of the hospital may need to approve your stay while you are in the hospital.

  • Skilled nursing facility care. Skilled nursing facility care is administered when skilled nursing or therapy staff treats, manages, observes, or evaluates your care. This can include the administration of medication and physical therapy.

  • Hospice care. To be eligible for hospice care, a hospice doctor and your physician must first certify that you are terminally ill or have a life expectancy of 6 months or less. Hospice care coverage includes all items and services necessary to relieve pain and manage symptoms, medical and social services, and grief counseling.

  • At-home health care. Although Medicare does not cover for 24-hour-a-day at-home health care, it covers intermittent skilled nursing care. Medicare Part A may cover eligible at-home services, such as physical therapy, injectible osteoporosis drugs, and speech-language pathology services.

  • Lab tests. If a lab test is ordered while you are receiving outpatient care at a hospital or skilled nursing facility, it is covered under Medicare Part A.

Who Is Eligible for Medicare Part A?

To qualify for Medicare Part A, you must be age 65 or older, have a disability as determined by a physician and receive Social Security benefits for at least 24 months, have end-stage renal disease, or have amyotrophic lateral sclerosis. Additionally, to be eligible for premium-free Medicare Part A, you must be entitled to receive Medicare contingent on your earnings or those of a spouse, parent, or child. To receive premium-free Medicare Part A, you must possess a specified number of quarters of coverage and apply for Social Security or Railroad Retirement Board Benefits.

What Is Medicare Part B?

Medicare Part B is known as medical insurance and generally covers services and supplies. Medicare Part B can be broken into two main categories: medically necessary services and preventive services. According to medicareinsuranceaz.com, medically necessary services and supplies are needed to diagnose or treat a medical condition. These services must meet the medically accepted practice standards. Preventive services refer to health care that prevents illness or detects it at an early stage. Preventive services identify illnesses when treatment is most likely to be its most effective. Services and supplies that are covered under Medicare Part B include:

  • Doctor’s visits

  • Ambulance services

  • Mental health services

  • Limited outpatient prescription drugs

  • Flu shots

  • Alcohol use counseling

  • Physical therapy

  • Diabetes screenings and supplies

Who Is Eligible for Medicare Part B?

The eligibility standards for Medicare Part B are contingent on whether you are eligible for premium-free Medicare Part A or whether you must pay a premium for Medicare Part A coverage. If you qualify for premium-free Medicare Part A, you can enroll in Medicare Part B. However, if you pay a premium for Medicare Part A, you must be age 65 or older, a United States resident, and be either a United States citizen or an alien who has been lawfully admitted for permanent residence and has resided in the United States for at least five consecutive years before the month you apply for Medicare.

The Takeaway

Medicare Part A, or hospital insurance, covers inpatient hospital care, while Medicare Part B is medical insurance that covers outpatient care. Since they both cover different services and supplies, they complement one another. Together, they offer comprehensive healthcare coverage inside and outside the hospital.

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