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Original Medicare

What is Original Medicare and What Does it Cover?

Original Medicare (also called traditional Medicare) is individual insurance provided by the federal government. It includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).

Part A

Helps pay for hospital stays and inpatient care.

Part B

Helps pay for doctor visits and outpatient care.

A Medicare card graphic

Medicare Part A - Hospital Insurance

Medicare Part A (hospital insurance) is one of two parts that make up Original Medicare. Part A covers hospital stays and most of the services you receive as an inpatient in a hospital or skilled nursing facility. Costs may not be covered by Part A if you are in the hospital for observation.

What Does Medicare Part A Cover?

Medicare Part A covers the hospital charges and most of the services you receive when you're in the hospital.

What is Covered by Medicare Part A?

Hospital stays and inpatient care, including:

 

  • A semi-private room

  • Hospital meals

  • Skilled nursing services

  • Care in special units, like intensive care

  • Drugs, medical supplies and medical equipment used during an inpatient stay

  • Lab tests, X-rays and medical equipment used as an inpatient

  • Operating room and recovery room services

  • Some blood transfusions in a hospital or skilled nursing facility

  • Inpatient or outpatient rehabilitation services after a qualified inpatient stay

  • Part-time, skilled care for the homebound

  • Hospice care for the terminally ill, including medication to manage symptoms and control pain

What is Not Covered by Medicare Part A?

  • Personal expenses while hospitalized, like a TV or phone service

  • Most care outside of the United States

  • Custodial care (care that helps with daily life activities, like eating and bathing)

  • Long-term care

  • Days spent in a psychiatric hospital beyond certain set limits

  • Hospital stays beyond certain set limits

How Much Does Medicare Part A Cost?

Will You Pay the Medicare Part A Premium?

Medicare Part A costs will vary person-to-person, but for most people, Medicare Part A is premium-free. It still has a deductible, which you pay per benefit period, and it also requires copays for covered services in the hospital, a skilled nursing facility or for hospice.  The costs for Medicare Part A can change each year. Below are the Part A costs as of January 1, 2024.

Most people don’t pay the Medicare Part A premium. You do not pay for Part A if you or your spouse worked and paid Medicare taxes for at least 10 years. If you or your spouse did not, then you will have a Part A premium to pay each month. As of 2024, the Part A premium can cost up to $505 per month.

Medicare Part A 2024 deductible and copays

Medicare Part A has a deductible that is charged per benefit period. For 2024, this deductible amount is $1,632.

  • A benefit period starts on the day when you enter a hospital or skilled nursing facility for care and ends when you have been out for 60 consecutive days. During this time, you may be in the hospital more than once.

  • There is no limit to how many benefit periods you can have. Medicare will cover all of them.

  • Each benefit period charges the $1,632 Part A deductible.

Medicare Part A also has copays for when you’re in the hospital, in a skilled nursing facility or in hospice. The copays and rules work differently for each.

Hospital Copays For Medicare Part A

Hospital copays are determined by the number of days you’re in the hospital, and when you exceed 90 days, you begin to use your lifetime reserve days. These are a set number of covered hospital days you can use if you’re in the hospital for more than 90 days in a single benefit period. You have 60 lifetime reserve days, and once you use them, they’re gone.

Number of Days in the Hospital

Days 1 - 60

Days 61 - 90

Days 91 and beyond

Part A Hospital Copay

$0

$408.00 per day

$816 per day up to 60 lifetime reserve days

Medicare Part A copays for a skilled nursing facility

For a skilled nursing facility, Medicare Part A charges copays per benefit period – similar to the Part A deductible—and by the number of days you spend in the facility receiving care. Below is a breakdown of the 2024 copay amounts for skilled nursing facility care.

Number of Days in skilled nursing facility (SNF)

Days 1 - 20

Days 21 - 100

Days 101  and beyond

Part A SNF Copay

$0

$204.00 per day

You pay all costs

Hospice copays for Medicare Part A

For hospice care, Part A copays exist for medications for pain and symptom management, durable medical equipment used in the home and for respite care. The costs for each for 2024 are below:

Hospice Service or Item

Medications for pain and symptom management

Durable medical equipment used at home

Respite care

Part A Hospice Copay

Up to $5 per prescription

20% of the cost

5% of the Medicare-approved amount

Medicare Part B - Medical Insurance

Medicare Part B (medical insurance) is the other half of Original Medicare. Part B covers care you receive in a clinic or hospital as an outpatient including most doctor services you receive as an inpatient, doctor visits, most routine and emergency medical services and some preventive care. The list below shows examples of some of the items and services Part B covers.

What Does Medicare Part B Cover?

Medicare Part B covers doctor visits and most routine and emergency medical services. It also covers some preventive care, like flu shots.

What is Covered by Medicare Part B?

  • Doctor visits, including when you are in the hospital

  • An annual wellness visit and preventive services, like flu shots and mammograms

  • Clinical laboratory services, like blood and urine tests

  • X-rays, MRIs, CT scans, EKGs and some other diagnostic tests

  • Some health programs, like smoking cessation, obesity counseling and cardiac rehab

  • Physical therapy, occupational therapy and speech-language pathology services

  • Diabetes screenings, diabetes education and certain diabetes supplies

  • Mental health care

  • Durable medical equipment for use at home, like wheelchairs and walkers

  • Ambulatory surgery center services

  • Ambulance and emergency room services

  • Skilled nursing care and health aide services for the homebound on a part -time or intermittent basis

What is Not Covered by Medicare Part B?

  • Eye exams, eyeglasses or contact lenses

  • Hearing tests or hearing aids

  • Dental exams, cleanings, X-rays or routine dental care

  • Acupuncture

  • Most prescription drugs

  • Long-term care (also called custodial care)

  • Cosmetic surgery

  • Routine foot care

How much does Medicare Part B cost?

Medicare Part B shares some costs with you when you see the doctor or use other medical services. Part B has a monthly premium that is either deducted from your monthly Social Security benefits check or that you pay directly to Medicare. The amount you pay can vary depending on your tax reported income from two years prior.
 

Below you'll see the different costs that may apply. Costs shown are for 2024.

Part B Premium

  • Per month:  $174.70 to $594 in 2024, depending on income

Part B Deductible

  • Per year:  $240.00 in 2024

Part B coninsurance

  • Most medical services:  20% of the Medicare-approved amount  

  • Durable medical equipment:  20% of the Medicare-approved amount

  • Outpatient mental health care:  20% of the Medicare-approved amount

How Medicare Part B Cost Sharing Works

You will pay the Medicare Part B premium and share part of costs with Medicare for covered Part B health care services. Medicare Part B pays 80% of the cost for most outpatient care and services, and you pay 20%.
 

For 2024, the standard monthly Part B premium is $174.70. 

You'll pay the standard amount if:

 

  • You enroll for the first time in 2024.

  • You aren't receiving Social Security benefits.

  •  Your premiums are billed directly to you.

  • You have Medicare and Medicaid, and Medicaid pays your premiums.

 

Your Part B premium may be less than the standard amount if you enrolled in Part B in 2022 or earlier and your premium payments are deducted from your Social Security check.
 

Your premium may be more than the standard amount based on your income. You will pay an income‑related monthly adjustment amount (IRMAA) if your reported income was above $103,000 for individuals or $206,000 for couples in 2024. Visit Medicare.gov to learn more about IRMAA. 
 

And while Medicare will share your Part B health care costs with you, there is something called "Medicare assignment" that's important to understand.
 

Doctors and providers who accept Medicare assignment agree to take what Medicare pays—the Medicare-approved amount—as payment in full. Medicare reduces the approved amount it pays for doctors who don't accept Medicare assignment. Doctors who don't accept Medicare assignment may charge more than the Medicare-approved amount. You may have to pay the additional cost, which is called "excess charges."

 

Medicare Part B covers doctor visits, lab tests, preventive screenings and other outpatient health care services. Part B costs include a monthly premium, an annual deductible and coinsurance for most services.

Medicare rules and regulations can be confusing.  We recommend giving a Medicare Advisor like us at Health & Life Solutions, Inc. a call to make sure you get all of your questions answered.  Give us a call at 217-290-1768.

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