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Differences in Medicare Part A & B | Medicare Part B Overview and Common Questions

Original Medicare is Medicare that is administered directly by the federal government. It is fee-for-service coverage, which means you can go to any doctor or hospital you choose, as long as they accept Medicare, and the government will pay for any services or required testing.

You have to pay is your coinsurance and deductible. Original Medicare is made up of Part A and Part B. Part A is your hospital coverage while Part B is your medical coverage that covers doctor’s visits and other outpatient services.

Differences Between Part A and Part B Medicare Image result for hospital visits illustration

Medicare is complicated and the specifics of it change quite often. There are tons of questions you may be asking, such as is there a difference between Medicare part A and Medicare part B? If there is a difference, what is it? Does Medicare cover in-home care and ambulance and transportation services? It is hard to know immediately where to find doctors who take Medicare, but the following rundown should answer these questions and provide you with the information needed to figure out what medicare option is best for your needs. In addition, payment methods, and costs of different types and tiers of Medicare are discussed below. A brief and factual, but information dense run down should answer many of the frequently asked questions about differences between Medicare part A and Medicare part B coverage.

Differences in Cost

Premiums- Medicare part A is given to most people for free, provided they meet certain requirements. If you are older than 65 and are currently receiving social security benefits or certain other entitlement program benefits, Medicare part A will be free. Medicare part B, however, is not free. A premium of $135.50 is charged for part B, however, if you have a higher income than this premium could be more. If you are wondering is Medicare part B deducted from social security, the answer is no, as this premium is paid out of pocket.

Deductibles- In 2019, the Part A deductible is $1,364 per benefit season or period. The part B deductible, however, is $185 yearly, in 2019.

Coinsurance– This one is a bit more complex. For Medicare part A, after a 60 day stays in the hospital, for whatever reasons, between $341 and $682 will be charged per day, for every day after 60. With part B, 20% of Medicare-approved costs are usually paid, although since the variation is so big, you often won’t know the amount of coverage give until an actual bill is received.

Differences in CoverageImage result for Medicaid Spend-Down Program illustration

Is Medicare part B optional or mandatory? This is a tricky question. Technically, it is optional, however, the differences in coverage between the two make it likely that both will be necessary depending on individual health needs. If you have been asking is Medicare part B optional or mandatory, consider the following realms of coverage and decide. Medicare Part A Covers hospital rooms and meals, general nursing, prescription drugs are given in hospital only, skilled nursing facility care, hospice care, and in-home care. Medicare part B, however, covers completely different things. For instance, doctor visits for primary care doctors as well as specialist visits, some vaccines and flu shots, mental health assessment and treatment, annual physicals, medical equipment like walkers and wheelchairs, ambulance and transportation services, various therapies like speech and physical, and some preventative exams. Is Medicare part B optional or mandatory? It will depend on what you need.

Differences Between Medicare A and B

The differences between Medicare A and B may still be foggy and that is okay. Anyone over the age of 65, even those with chronic diseases, are eligible for Medicare. You must also be a U.S. citizen or permanent legal resident that has been living in the United States for at least five continuous years. The eligibility for both parts of Medicare have these requirements. You may even have been enrolled automatically if you meet the two following requirements:

  • If, while still under 65 years of age, you received at least 4 months of social security benefits or benefits of another qualifying entitlement program.
  • Or, regardless of age, if you have been receiving disability benefits for longer than 24 months (note: these 24 months do not have to be continuous, they can be considered if cumulative over your adult life)

Finding a Doctor

Is my doctor in my network? Where to find doctors who take Medicare? These may be questions that you are having while trying to assess your Medicare coverage. There are two main ways to assess whether or not your doctor is in the Medicare network and if not – to find nearby doctors in your area. The easiest and fastest way is to call your doctor and simply ask if they are registered in the Medicare network. The second way is to use the tool of the government website page for Medicare. This will not only tell you whether or not your doctor is in your network but also all eligible doctors in your area for both primary care and specialized fields. Hopefully, this answers the question of where to find doctors who take Medicare? These tools can help with finding other services that qualify for Medicare coverage. For instance, if you are looking for professionals to provide in-home care, the government Medicare resources can help you find qualified individuals. The same goes for various methods of ambulance and transportation services, which offer more flexibility in service that many don’t realize.

Payment

There are a variety of costs for different Medicare plans and a number of different ways to pay for Medicare and Medicare-related costs. You may be asking is Medicare part B deducted from social security benefits? The answer to that is always no. While there are several different methods of payment, none of them will be deductions from entitlement payments directly. Is Medicare part B deducted from social security, no, but some Medicare members use social security payments to pay medical and Medicare bills, however, this is not required. For low-income individuals, Medicare may be free or significantly lowered in cost. Otherwise, the deductibles and premiums depend highly on the plan that you actually have and the services that you actually use. Depending on your state, Medicare membership may also qualify you for bill assistance for services that aren’t covered by your Medicare plan. These vary based on the state of residence, however, so call your state office to see if you are eligible.

Medicare Premiums

The standard monthly premium for Medicare Part B is $134. However, many people are charged less than this amount, depending on their social security benefits. Most people who pay the full premium do not receive social security benefits are receiving Medicare for the first time, or have income above a certain threshold. Most people do not pay a premium for Medicare Part A (Hospital Services).

Medicare Part B Deductible and Co-Insurance

As doctor’s services are covered under Part B, you’ll have to meet your deductible before the government will pay for any services. The current Part B annual deductible is $183. Once your deductible has been met, you will be responsible for 20% of charges doctor’s visits and any other outpatient care services you receive. This 20% is called co-insurance.

Non-Participating Doctors

The 20% co-insurance charge applies to doctors who participate in the Medicare program. However, there are some doctors, known as non-participating doctors, who only occasionally see Medicare patients. If you go to a non-participating doctor, you’ll have to pay an additional charge over your 20% co-insurance, which can be up to 15% (for a total of 35% of all services). However, some states limit the additional percentage that non-participating doctors can charge. For more information about these charges, contact your State’s Health Insurance Assistance Program.

Opt-Out

Some doctors don’t work with Medicare at all, and in the event that you want to go to one of these doctors, you’ll have to sign a contract acknowledging that you are responsible for the full cost of treatment. This mostly happens with certain specialists, such as psychiatrists.

Medical Supplies

If the doctor deems it medically necessary, Medicare Part B will pay for your medical supplies, subject to your 20% co-insurance payment, as long as the equipment provider is approved by Medicare.

Ambulance and Transportation Services

Medicare Part B will also pay for ambulance services in an emergency. However, in non-emergency cases, the services must be medically necessary. In general, the patient must be unable to walk or sit in a wheelchair for coverage to apply.

Outpatient Services

Medicare Part B covers outpatient services, but they need to be authorized by your doctor as medically necessary. Services covered included physical therapy, occupational therapy, and speech therapy. Chiropractic services are even covered when approved by your doctor as being medically necessary. In addition, outpatient mental health services are also covered.Image result for out patient illustration

In-Home Care

In-home nursing and physical therapy services are also covered under Medicare Part B.

Prescription Drugs

As a general rule, Medicare Part B doesn’t cover prescription drugs, as Medicare’s prescription benefit is under Part D. However, certain anti-cancer drugs, which are not normally self-administered by the patient, are covered by Medicare Part B.

Conclusion

As a Medicare beneficiary, it’s important that you know your benefits and your rights. You can get more information at Medicare.gov. In addition, you can call Medicare’s national hotline at 1-800-MEDICARE.