Turning 65 is a significant milestone, and with it comes the opportunity to enroll in
Medicare for the first time. Navigating the world of healthcare coverage can be daunting,
but understanding the basics of Traditional Medicare—Parts A and B—can help you make
informed decisions about your healthcare needs.
What is Traditional Medicare?
Traditional Medicare, also known as Original Medicare, is a federal health insurance
program primarily for individuals aged 65 and older. It consists of two main parts: Part A
and Part B.
Medicare Part A: Hospital Insurance
Medicare Part A is designed to cover inpatient hospital stays, skilled nursing facility care,
hospice care, and some home health care. Here’s what you need to know:
- Inpatient Hospital Stays: Part A covers the cost of a semi-private room, meals, general nursing, and other hospital services and supplies. It does not cover private-duty nursing, a television or telephone in your room, or personal care items like razors or slipper socks.
- Skilled Nursing Facility Care: If you require specialized nursing care after a hospital stay, Part A can cover up to 100 days in a skilled nursing facility, provided certain conditions are met.
- Hospice Care: Part A covers hospice care for individuals with a terminal illness, focusing on comfort and quality of life rather than curative treatment.
- Home Health Care: For those needing home-based medical services, Part A may cover limited home health care services.
Costs Associated with Part A:
- Premiums: Most people don’t pay a monthly premium for Part A if they or their spouse paid Medicare taxes while working.
- Deductibles and Coinsurance: You’ll pay a deductible for each benefit period, and coinsurance may apply after a certain number of days in the hospital or skilled nursing facility.
Medicare Part B: Medical Insurance
Medicare Part B covers outpatient care, doctor visits, preventive services, and some home
health care. Here’s a closer look:
- Doctor Visits and Outpatient Care: Part B covers medically necessary services like doctor visits, outpatient care, and other medical services that Part A doesn’t cover.
- Preventive Services: Part B includes coverage for preventive services like flu shots, screenings, and annual wellness visits to help you stay healthy and detect any issues early.
- Durable Medical Equipment (DME): Part B covers certain medical equipment, such as wheelchairs, walkers, and oxygen equipment.
Costs Associated with Part B:
- Premiums: Most people pay a standard monthly premium for Part B, which can vary based
- on your income.
- Deductibles and Coinsurance: After meeting the annual deductible, you typically pay 20% of
- the Medicare-approved amount for most doctor services, outpatient therapy, and durable
- medical equipment.
Enrolling in Medicare Parts A and B:
- Initial Enrollment Period (IEP): The IEP is a seven-month window that begins three months before your 65th birthday, includes your birthday month, and ends three months after. Enrolling during this period ensures you avoid late enrollment penalties.
- Automatic Enrollment: If you’re already receiving Social Security benefits, you may be automatically enrolled in Part A and Part B.
Making the Most of Your Medicare Coverage:
- Review Your Needs: Consider your healthcare needs and whether you might benefit from additional coverage, such as a Medicare Advantage Plan or a Medigap policy.
- Stay Informed: Medicare can be complex, so staying informed about your benefits and options is crucial.
At My Virtual Physician, we’re here to help you understand your Medicare options and
provide guidance to ensure you receive the best care possible. Welcome to this new chapter
of healthcare coverage!
Schedule your appointment with us today: BOOK HERE
