Medicare Parts A and B function differently from one another.
Original Medicare serves as the basis for coverage in Medicare Advantage plans.
Changes in Original Medicare plans are negligible for most Medicare beneficiaries.
In 1965 Original Medicare was formed by the federal government and currently serves for well over 6 million people just in California. While Medicare Part A and Part B cover entirely different services, they work alongside one another and are the backbone of coverage within Medicare. Learn more about the foundation of Original Medicare, its coverage, and the policies that go beyond Part A and Part B.
Medicare Part A Coverage
Medicare Part A will cover your inpatient hospital or nursing facility stay costs up to 90 days. It’s likely Part A coverage will be free if you or your spouse paid into Medicare via payroll taxes. Part A helps pay for the following:
- Inpatient hospital administered drugs
- Lab tests
- Part-time skilled nursing care
- End of life hospice care.
For more detailed Medicare Part A information visit Medicare Part A (Enrollment, Eligibility and Coverage Specifics).
Medicare Part B Coverage
Medicare Part B will cover outpatient service costs that are considered medically necessary along with preventative services. A monthly premium is required and varies depending on income level. Outpatient medical services may include the following:
- Doctor appointments
- Therapist services
- Preventative care
In addition, Part B may cover drugs that are not self-administered. These drugs would be given as part of a service in a doctor’s office and generally limited to drugs that are given by infusion or injection. Certain vaccines like flu shots, COVID-19, pneumococcal shots, hepatitis b shots, and other shots that aren’t directly related to the treatment of injury or illness.
For more detailed Medicare Part B information visit Medicare Part B (Enrollment, Eligibility, and Coverage Specifics).
Does the Original Medicare Coverage and Expense Change Each Year?
You should review your Medicare plan every year as plans can change, however, the change in coverage to your existing plan will likely be negligible. The bigger issue will be if your needs change and you will want to check if your existing plan has you covered or if you need to make an update. The other big variable that can change year to year are the costs you will pay in premiums, deductibles, and copayments or coinsurance. If an update does need to be made these changes can be done during open enrollment when ALL people with Medicare can make changes to their health or drug plans for the following year. Open Enrollment is October 15th and ends December 7th.
Is There Anything That Original Medicare May Not Cover?
The areas that Original Medicare does not cover can be addressed via coverage from Medigap or Medicare Advantage or Medicare Part D for outpatient prescriptions.
Below is a list of items Original Medicare does not cover:
- Long-term care
- Most dental care and dentures
- Hearing and eye exams
- Routine foot care
- Cosmetic surgery
- Outpatient prescriptions which may be covered by Medicare Part D.
What Medicare Coverage do People Typically Choose?
Individuals that are 65 and receiving Social Security checks are automatically enrolled in Medicare Part A and B through the Social Security Administration. The following provides information on qualifying individuals in 2016:
- 71% of individuals qualifying for Medicare for the first time were enrolled in Original Medicare coverage.
- 29% selected Medicare Advantage.
- Medicare Advantage enrollment appears to be growing in popularity and Medicare Advantage is projected to make up 50% of the beneficiaries by 2025.
Coverage between the two Medicare plans is obviously a big determinate and those enrollment adoption percentages between the Original Medicare and Medicare Advantage plans can fluctuate depending on state or disability. Therefore, having a good understanding of Medicare Original coverage should take the guesswork out of your Medicare coverage selection decisions.