Medicare Part A & Part B (Original Medicare)

Understanding Medicare can feel like trying to read a map with half the roads missing. That’s where I come in.

What is Medicare Part A?

Medicare Part A is your hospital coverage. It helps pay for:

• Inpatient hospital stays

• Skilled nursing facility care (short-term, after a hospital stay)

• Hospice care

• Some home health services

Most people don’t pay a monthly premium for Part A if they’ve worked and paid Medicare taxes long enough.

What is Medicare Part B?

Medicare Part B is your medical coverage. It covers things like:

• Doctor visits

• Preventive services (annual wellness visits, screenings, vaccines)

• Outpatient care

• Lab work, X-rays, and diagnostic services

• Durable medical equipment (like walkers or wheelchairs)

Part B does have a monthly premium, which can vary based on income.

What’s the Catch?

While Parts A & B cover a lot, they don’t cover everything. You’ll still have:

• Deductibles

• Coinsurance (typically 20% for Part B services)

• No built-in prescription drug coverage

• No cap on out-of-pocket costs

That’s why many people choose additional coverage like Medicare Supplement plans or Medicare Advantage plans.

What are the costs?

So the costs for Original Medicare without additional coverage are broken into Premiums, Deductibles, and Co-pays/Co-insurance!

Premiums for Part A:

Part A for most people is $0 (because they or a spouse paid Medicare taxes long enough while working — generally at least 10 years/40 quarters). If you get Medicare earlier than age 65, you won’t pay a Part A premium. This is sometimes called “premium-free Part A.”

Costs for Part A:

• Inpatient Hospitalization: You pay a $1,736 deductible, which covers you for 60 pays, after that it’s $434/day for days 61-90. Then $868/day for days 91-150. So for a 90-day hospitalization, your costs are over $14,000.

• Skilled Nursing facility: You pay $0/day for days 1-20, after that you pay $217/day for days 21-100 (that’s over $16,000).

• Home health care, and Hospice: These services are generally a $0 co-pay.

• There are other specific co-pays/co-insurance that may come up for certain services or specific situations.

Premiums for Part B:

Part B for most people is $202.90 each month (or higher depending on your income). The amount can change each year. You’ll pay the premium each month, even if you don’t get any Part B-covered services. Some people receiving Medicaid (MaineCare) may get there part B premium paid for them by the state. You might pay a monthly penalty if you don’t sign up for Part B when you’re first eligible for Medicare (usually when you turn 65). You’ll pay the penalty for as long as you have Part B. The penalty goes up the longer you wait to sign up.

Yearly deductible for Part B:

$283 before Original Medicare starts to pay. You pay this deductible once each year.

After the deductible:

Generally Medicare pays 80%, and you are responsible for 20% with no yearly cap on those costs. I had one client who had “neck surgery" on Original Medicare (no extra coverage beyond A/B) and she ran up a bill of $75,000 in one year after Medicare paid.