UNDERSTANDING MEDICARE PART A AND PART B

The Medicare program began in 1965, after generations of citizens and politicians worked to establish a national health care system for America’s older population. This benefit is often referred to as "Original Medicare" or "Part A" and "Part B".

Original Medicare is a fee-for-service plan, which means you can go to any doctor, supplier, hospital or other facility that is enrolled in and accepts Medicare, and is accepting new Medicare patients.

In 1972, Medicare became available to people with disabilities and people with End-Stage Renal Disease/kidney failure.

Original Medicare

Part A
Hospital Insurance

Part B
Medical Insurance

  • Hospital stays
  • Skilled nursing facility
  • Hospice care
  • Some home health care

Once you turn 65, you’re automatically enrolled in Medicare Part A. Most people don’t have to pay a premium for Part A because they, or their spouse, paid Medicare taxes while working.

  • Medical service
  • Outpatient care
  • Medical items

Medicare pays: 80% of approved charges
Beneficiary Pays: about 20% of approved charges

Part B is optional because you have to pay a monthly premium and satisfy a deductible before Medicare will pay benefits.

Part A

Part A is the hospital insurance portion of Medicare. This benefit covers inpatient care, hospital stays, care in a skilled nursing facility, hospice care and some home health care.

Once you turn 65, you are eligible to enroll in Medicare Part A. Those who are already collecting Social Security disability benefits are automatically enrolled in Part A. Initial enrollment period packages are sent to individuals 3 months before they turn 65 or during their 25th month of disability benefits. You do not have to be retired to enroll in Medicare Part A.

If you do not automatically get premium-free Part A, you may be able to buy it if you (or your spouse):

Are age 65 or older and entitled to (or are enrolling in) Part B to meet the citizenship and residency requirements.

Are under age 65 and are disabled but no longer get premium-free Part A because you returned to work.

Part B

Part B provides many of the medically necessary services not covered in Part A. this includes coverage such as medical (doctor) services, outpatient care and other medical items (diabetic test strips, nebulizers and wheelchairs). You’ll also benefit from some covered preventative services.

Part B is optional because you have to pay a monthly premium and satisfy a deductible before Medicare will pay benefits. The monthly premium is based on your income.

Note: In some cases, your monthly premium may be higher if you did not sign up for Part B when you became eligible.

Part A and Part B do not cover everything. You’ll have to pay out-of-pocket for certain procedures unless you purchase supplemental insurance from another carrier to cover the costs (Medigap). Even if Part A and Part B do cover a service or item, you generally have to pay deductibles, coinsurance, and copayments.

Help paying for Medicare:

Medicare provides financial assistance for people who have limited income and resources. If you feel you may qualify, we encourage you to learn about the process and its eligibility requirements by visiting www.socialsecurity.gov on the web, or by calling the Social Security Administration at 1-800-772-1213. (TTY/TDD users should call 1-800-325-0778).

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