Medicare is extremely complicate for many reasons.
When I first started learning Medicare I was overwhelmed with all the different alphabetical letters Medicare give and the different parts of Medicare.
While these letters get confusing, it’s important to know which letters cover what.
Not knowing this can lead to costly surprises.
Medicare Part A
This week let’s talk about the first part of Medicare. This is the part that covers your hospital visits and is called Medicare Part A.
Medicare Part A is the first part of Medicare you have when you join Medicare. 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 a hospital that requires an inpatient hospital stay, Medicare Part A will cover those services.
The key word in the sentence above is “inpatient”. Let me tell you why.
When Part A Doesn’t Cover the Hospital
The other day I was talking to my friend Megan.
Her mom is a teacher in Texas where she receives health insurance, but she is also on Medicare Part A. Over the holidays her mom had 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.
Her mom’s procedure and visit was classified as outpatient, so her Medicare Part A didn’t cover it. Instead her employer health insurance did.
Details Matter
Sometimes hospitals don’t categorize certain treatments as inpatient services, and instead categorize them 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 does and doesn’t cover .
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.
Part A provides great coverage, but please know when and where it can be used
Here’s to making Medicare easy!
