The Basics
Medicare Parts A and B are considered Original Medicare. Part A pays toward inpatient hospital care, inpatient skilled care and skilled care in your home. Part B pays toward doctor visits and other outpatient care.
It is important to note that Original Medicare (Parts A and B) does not cover everything. Original Medicare helps you get basic health care coverage, but you do have some out of pocket costs.
Some of the elements Original Medicare (Parts A and B) does not cover are:
- Vision
- Hearing
- Dental
- Prescription drugs
Medicare Part A (Hospital Coverage) Details
Medicare Part A helps cover the cost of:
- Inpatient hospital stays
- Skilled nursing facility visits after a hospital stay
- Hospice care
- Home healthcare visits for the homebound
If you made payroll contributions to Medicare for 40 quarters or 10 years you will not pay a premium for Part A. If you did not make those contributions you may be charged a premium.
The Part A inpatient hospital coverage for 2023 has a $1,600 deductible. Copayments depend on the length of your stay, and differ for hospitals and skilled nursing facilities.
Hospice care and home healthcare visits may not require a copayment if you use a Medicare-approved agency or facility.
Medicare Part B (Doctor Visits) Details
Medicare Part B helps to cover the cost of medical expenses such as:
- Doctor visits
- Lab tests
- X-rays/Radiology
- Surgery
- Durable medical equipment
Some coverage is limited under Medicare Part B. For example, vision services for routine eye exams for prescribing glasses and not covered. Other services such as treating glaucoma, cataracts, or macular degeneration are usually covered.
With Medicare Part B coverage, you can generally see any doctor who accepts Medicare. In most cases, for people new to Medicare, the premium for Medicare part B is $164.90 per month in 2023 and it will be deducted from your Social Security check. If you are not collecting Social Security, you will be billed quarterly for the premium. For those with higher incomes the Part B premium may be higher.
Medicare Part B has a calendar year deductible of $226. Once you meet that deductible Medicare will pay 80% of the Medicare approved amount and you are responsible for 20%. It is important to remember that the 20% has no out-of-pocket maximum.
You are also responsible for Part B excess charges. If a doctor does not accept the Medicare approved amount as full payment, they may charge up to 15% more
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