Medicare Fundamentals: Part A and Part B

Over 47 million seniors age 65 and older, and people with certain disabilities and medical conditions, get their health care coverage through Medicare. While Medicare covers many health care services, it does not cover everything. Below is what you should know.

If you have Original, Fee-for-Service Medicare, the following applies to you:

Medicare Part A ("Hospital Insurance") does over: 

Inpatient care in a skilled nursing facility for a limited number of days, following a qualifying three-day minimum inpatient hospital stay for a related illness or injury

Home health services as ordered by a doctor (or other health care provider), including nursing care; physical, speech or occupational therapy; medical social services; home health aide services and medical supplies for use at home

Hospice care if you have a terminal illness with a life expectancy of 6 months or less, as certified by doctor, at home or facility where you reside. Limited coverage for stays in a hospice facility, hospital or skilled nursing facility for pain or symptom management

Services Medicare Part A does not cover include:

Custodial care or long-term care in a skilled nursing facility or nursing home. Custodial care includes non-skilled personal care, such as help with  bathing, dressing, eating, getting in and out of a bed or chair, or toileting.

Medicare does not pay for room and board costs or non-skilled personal(custodial) care in a nursing home, or long-term care or assisted living facility. It does cover Medicare-approved medical care and services, ordered and rendered by a Medicare-enrolled health care provider, such as a doctor or physical therapist, to the beneficiary who is a resident.                                                                            

    Services Medicare Part B ("Medical Insurance") does cover:         

• Doctors' visits, services and tests; outpatient care and services; some home health   services       not covered under Part A; Medicare-cove red durable medical equipment (DME), prosthetics, orthotics and supplies
• Medicare-covered services provided by non-physician health care providers, such as nurse practitioners, physician assistants, social workers, psychologists, physical therapists, and other
• Many preventive services and test
• Outpatient mental health care
• Kidney dialysis services and supplies
• Ambulance transport for medically-necessary services (limited)
• Chiropractic services (limited)
• Eyeglasses (limited to after-cataract surgery that implants an intraocular lens)
• Some prescription drugs (i.e. injections in doctor's office, certain oral cancer drugs
• Transplants and immunosuppressive drugs

Things that are not covered by Medicare, under either Parts A or B, include: routine dental care, dentures, hearing aids and exams for fitting hearing aids, cosmetic surgery and acupuncture.

For those who get coverage through a Medicare Advantage Plan (Medicare Part C), the story is a bit different. Medicare Advantage Plans are offered by Medicare-approved private insurers, and must cover all the services covered under Original Medicare, except hospice care, which continues to be covered by Original Fee-for­-Service Medicare even when a person is enrolled in a Medicare Advantage Plan.

These plans, which may charge a premium, deductible and co-insurance, may include extra benefits and services not covered under Original Fee-for- Service Medicare, such as dental and vision care, glasses, hearing aids and health and/or wellness programs. Most plans also include prescription drug coverage, available to those in OriginalMedicare under Part D.

 E-mail your Medicare questions to me at Ask Will at wwillbar@gmail.com

What's the Medicare Part D Late Enrollment Penalty?

The Medicare Enrollment Period Period will be here in less than ninety days. Take a moment now to consider the impact of the late enrollment period and specifically the penalty on your prescription drugs. 

The late enrollment penalty is an amount added to your Medicare Part D premium. 

You may owe a late enrollment penalty if, at any time after your initial enrollment period is over, there's a period of 63 or more days in a row when you don't have Part D or other creditable prescription drug coverage. 

You must learn how to avoid the late enrollment penalty. Please note, if you get Extra Help, you don't pay the late enrollment penalty.

How much is the Part D penalty?

The cost of the late enrollment penalty depends on how long you went without creditable prescription drug coverage. The late enrollment penalty is calculated by multiplying 1% of the "national base beneficiary premium" times the number of full, uncovered months you were eligible but didn't join a Medicare Prescription Drug Plan and went without other creditable prescription drug coverage. 

The final amount is rounded to the nearest $.10 and added to your monthly premium. The national base beneficiary premium may increase each year, so the penalty amount may also increase each year.

How will you know if you owe a penalty?

Your plan will tell you if you owe a penalty. After you join a Medicare drug plan, the plan will tell you if you owe a penalty, and what your premium will be. You may have to pay this penalty for as long as you have a Medicare drug plan. If you had to pay a Part D late enrollment penalty before you turned 65, the penalty will be waived once you reach 65.


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