When you qualify for Medicare, usually it's Medicare Part A and Part B that you're first enrolled. Original Medicare consists of two components: Medicare Part A and Part B. If you get admitted to a hospital, Medicare Part A will help pay your costs. Medicare Part B may help pay for doctor visits, preventive services, lab tests, medical equipment and supplies, and more.
What's the Difference Between Medicare Part A and Medicare Part B?
In this Senior Affair article, we explain what you should expect from Medicare in 2021. We break down the differences between Medicare Part A and Medicare Part B.
What is Medicare Part A?
Medicare Part A is hospital insurance. Part A usually covers your inpatient hospital stays, skilled nursing care, hospice care, and limited home health-care services. You'll typically pay a deductible and coinsurance and copayments.
Do you have to pay a Part A Premium?
Many people don't pay a monthly premium for Medicare Part A. For example, if you worked at least ten years (40 quarters) while paying taxes, you don't pay a premium for Part A. If you worked for fewer than 30 quarters, you generally pay $471 per month in 2021. If you worked more than 30 but fewer than 40 quarters, your premium is $259 per month in 2021.
What is Medicare Part B?
Medicare Part B is medical insurance. It generally covers services and items such as:
- Doctor office visits
- Preventive services, such as specific tests and screenings
- Flu shots
- Pneumococcal shots
- Mental health care (outpatient)
- Alcohol use counseling
- Physical therapy
- Diabetes screenings, supplies, and self-management therapy
- Durable medical equipment, such as wheelchairs
This list is not complete. Part B could still cover many other services and items, but specific coverage rules apply. For example, providers must accept Medicare assignment (a payment agreement with Medicare), and certain items and services must be medically necessary.
Under Part B, in most cases, you will pay 20% of the Medicare-approved amount for each item or service. A deductible may also apply.
Do you have to pay a Part B premium?
Your Part B premium may be the “standard” amount or $148.50 in 2021.
If your income is above a certain amount (based on your income tax returns two years ago), you might pay a higher Part B premium.
Can you ever get both Part A and Part B coverage at the same time?
When you're an inpatient in a hospital, it's possible to get Part A and Part B coverage simultaneously. For example, while Part A generally covers medically necessary surgery and certain hospital costs, Part B may cover doctor visits while you're an inpatient.
Did you know that there's another way to get your Part A and Part B coverage? A Medicare Advantage plan delivers these benefits, and often more. Most Medicare Advantage plans include prescription drug coverage. Learn more about Medicare Advantage plans. You must pay your Medicare Part B premium when you have a Medicare Advantage plan, as well as any premium the plan might charge.
This information is not a complete description of the benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and copayments/coinsurance may change on January 1 of each year.