There are so many parts of Medicare that it gets confusing. I want to make the parts of Medicare clear so you know exactly what you need and for which situation.
There are 2 primary parts of Medicare: Medicare Part A and Medicare Part B.
Medicare Part A
Medicare Part A is the first part of Medicare you join. You must have Part A to get any of the other parts of Medicare.
Medicare Part A is often called hospital insurance. It’s the part of Medicare that will cover your inpatient hospital visits, hospice care, home health services, skilled nursing facility care and nursing home care (as long as custodial care isn’t the only care you need).
If you go to the hospital for surgery, or if you are at the hospital that requires an inpatient hospital stay, Medicare Part A will cover those services.
There are specific rules on what Medicare Part A will and won’t cover so if you are expecting an inpatient hospital stay I recommend you understand the basic coverage guidelines.
Medicare Part B
Most people will primarily use Medicare Part B. You must have Part A to get Part B.
Medicare Part B is also called hospital insurance. It covers most medically necessary doctors’ services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health care, and some home health and ambulance services.
These are the basics parts of Medicare. While the summary above sounds very clear, the reality is these parts are not always black and white.
Take my friend’s mom for example.
The other day I was talking to my friend Megan. Megan’s mom is a teacher in Texas where she receives health insurance, but she is also on Medicare Part A.
Over the holidays her mom went to the hospital to have her gallbladder removed. Since the procedure was done in the hospital and included an overnight stay, they assumed that Medicare Part A would cover the treatment.
This make sense based on what I shared earlier, however, just because you stay in the hospital doesn’t mean Medicare Part A will cover the treatment.
This is where it gets complicated.
Megan’s mom procedure and visit was classified as outpatient, so her Medicare Part A didn’t cover it, and instead her employer health insurance did.
Sometimes hospitals do not categorize certain treatments as inpatient services, and instead categorize it as outpatient. This means that even though you have a procedure done in the hospital and you spend the night, the visit may be outpatient depending on how the hospital categorizes the stay. If it’s categorized as outpatient, Medicare Part B (not Part A) would cover your services.
This slight change ended up costing her mom much more money because of the deductible on her employer health plan verses the deductible she would have paid through Part A.
I share this with you because it’s important to understand what Part A and Part B cover.
It’s also important to understand the gray areas in Medicare.
If you are going to the hospital for a planned procedure, ask your doctor and nurse if your procedure will be classified as inpatient or outpatient so you can prepare. It may not be what you expect.
