When it comes to Medicare, there are so many parts, and I know that it can get confusing. In this blog post, I want to make sure you know exactly what you need for your unique situation.
First, there are two 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 referred to as 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 Medicare Part A to get Medicare Part B.
Medicare Part B is also referred to as 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.
That is a simplified breakdown of Medicare Part A and Medicare Part B. While the summary above sounds very clear, the reality is these parts are not always black and white.
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.
Based on what I shared earlier, this makes sense, 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 were classified as an outpatient service, so her Medicare Part A didn’t cover it, and instead, her employer health insurance did.
Sometimes hospitals do not categorize specific treatments as inpatient services, and instead, classify 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 classified as outpatient, Medicare Part B (not Part A) will cover your services.
This incident ended up costing her mom much more money because of the deductible on her employer health plan versus the deductible she would have paid through Part A.
I share this with you because it’s essential 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.
To easily make the right Medicare decision you can CLICK HERE to sign up for our Medicare Enrollment Concierge.
