Medicare wasn’t meant to be confusing, but it’s grown in complexity since it was first established. Original Medicare, still the program of choice for many seniors, consists of Part A and Part B benefits that work together but cover different services.
What is Medicare Part B?
Medicare Part A is hospital insurance. After the deductible, it helps pay for inpatient hospital bills, as well as hospice care and stays in skilled nursing or rehabilitation facilities. When you sign up for Medicare benefits, you’re automatically enrolled in part A. In most cases, it costs you nothing as long as you paid a certain amount of taxes while working.
Medicare Part B is medical insurance. It helps pay for outpatient medically necessary services, such as:
• Preventative care, including flu shots, annual physicals and health screenings
• Emergency room costs
• Medical transportation and telehealth services
• Blood tests
• Outpatient physical, occupational and speech therapy
• Diagnostics such as x-rays, CT scans and MRIs
• Inpatient and outpatient mental health services
• Participation in clinical research studies
• Smoking cessation programs
• Durable medical equipment (DME), including canes, walkers and diabetes supplies
• Medicines that must be administered by healthcare professionals but that don’t require hospitalization, such as chemotherapy infusions
What doesn’t Medicare Part B cover?
Part B plans don’t cover:
• Hospital care
• Most prescription drugs
• Routine dental and vision care
• Hearing aids
• Cosmetic surgery
• Custodial home health
• Nursing home care
• Services deemed experimental or not medically necessary
How does Medicare Part B work?
Medicare Part B is elective. Seniors who are still working can choose to keep their employer’s group health plan if it costs less or offers more benefits and delay Part B enrollment. Keep in mind that if you qualify for Part B, do not have other creditable coverage, and decide to delay enrolling, you may be subject to a late enrollment penalty when you decide to sign up for Part B later.
The standard Part B monthly premium starts at just $170.10 for 2022, and the deductible is only $233. Similar to commercial health insurance policies, most preventive care is covered in full. Other services are subject to a 20-percent co-insurance payment.
Are there alternatives to Original Medicare?
Once you sign up for Part A and Part B, you can choose to enroll in a Medicare Advantage plan, also known as Medicare Part C. Offered by private insurance companies, MA plans combine Medicare Part A and Part B benefits plus extras such as routine dental care and free eyeglasses. For some people, it’s a great value.
There are differences between Original Medicare and Medicare Advantage plans that could save you money depending on your needs and preferences. In an MA plan, your choice of doctors may be limited to in-network providers depending on the plan you choose, so compare the options available in your area. With Original Medicare, you can see any doctor that accepts assignment.
An important difference is that there is no out-of-pocket limit in Original Medicare. For seniors who frequently use their benefits due to a chronic condition or sudden illness or injury, the costs could add up. Medicare Supplement insurance, or Medigap plans, may help defray some expenses if you have Original Medicare. You can’t have a Medigap policy if you are enrolled in a Medicare Advantage plan.
Take time to compare your options using an online plan comparison tool. If you have questions or need help narrowing down your options, take advantage of the expertise of a licensed sales agent.