What Is the Difference Between Medicare Part A and Part B?
Last Updated : 02/14/2022 5 min read
“Medicare Part A and Part B” – you may have heard about these “parts” of Medicare. But what are Medicare Part A and Part B? Here’s a quick and clear summary of what Medicare Part A and Part B are.
Original Medicare: Part A and Part B
Medicare Part A and Part B make up the federal program known as Original Medicare. How do you qualify for Medicare?
- If you’re eligible for Medicare Part A and Part B, you might be enrolled automatically.
- If you’re getting Social Security (or Railroad Retirement Board) benefits when you turn 65, you’re typically enrolled without having to do anything.
- If you’re under 65 and get disability benefits, you may be enrolled in Medicare Part A and Part B automatically.
Be aware, though, that sometimes you’re not automatically enrolled, and you have to take steps to enroll in Medicare. For example:
- If you have end-stage renal disease (ESRD), you might qualify for Medicare before you’re 65, but you have to sign up through Social Security.
- If you live in Puerto Rico, even if you’re automatically enrolled in Medicare Part A, you need to enroll manually in Medicare Part B.
- If you delayed enrollment in Medicare Part A and/or Part B beyond your Medicare Initial Enrollment Period, you need to enroll manually.
This might not be a complete list of occasions when you have to enroll manually.
What is Medicare Part A?
Medicare Part A is hospital insurance. It may cover your care in certain situations, such as:
- You’re admitted to a hospital or mental hospital as an inpatient.
- You’re admitted to a skilled nursing facility and meet certain conditions.
- You qualify for hospice care.
- Your doctor orders home health care for you and you meet the Medicare criteria. Medicare Part A may cover part-time home health care for a limited time.
Even when Medicare Part A covers your care:
- You may have to pay a deductible amount and/or coinsurance or copayment.
- There may be some services you get in a hospital or other setting that Medicare doesn’t cover.
- It’s possible that your Part A coverage will run out – for example, if you stay in the hospital for more than 90 days in a row, you might have to pay all costs.
- Medicare typically won’t pay for a private room or non-medical items such as toiletries (like a razor) or a television in your room.
What is Medicare Part B?
Medicare Part B is medical insurance. It may cover a wide range of items and services. Here’s a partial list of what Part B may cover:
- Doctor visits
- Preventive services, like annual checkups and flu shots
- Medical Supplies and durable medical equipment, such as walkers and wheelchairs
- Certain lab tests and screenings
- Diabetes care, such as screenings, supplies, and a prevention program
- Chemotherapy
- Physical and occupational therapy
A Part B deductible and/or coinsurance or copayments may apply.
What do Medicare Part A and Part B have in common?
Medicare Part A and Part B share some characteristics, such as:
- Both are parts of the government-run Original Medicare program.
- Both may cover different hospital services and items.
- Both may cover mental health care (Part A may cover inpatient care, and Part B may cover outpatient services).
- Both may cover home health care.
- Both have annual deductibles, as well as coinsurance or copayments, that may apply to certain services.
- Both have monthly premiums, although many people don’t have to pay the Part A premium (see below).
How are Medicare Part A and Part B different?
Although both Medicare Part A and Part B have monthly premiums, whether you’re likely to pay a premium – and how much – depends on the “part” of Medicare.
Most people don’t have to pay a monthly premium for Medicare Part A.
- If you’ve worked and paid Medicare taxes for at least 10 years (40 quarters), you typically don’t pay a premium.
- If you worked 30-39 quarters, you’ll generally pay $240 in 2019.
- If you worked fewer than 30 quarters, you’ll generally pay $437 in 2019.
On the other hand, most people do pay a monthly premium for Medicare Part B. The standard premium in 2022 is $170.10, but you may pay more if your income is above a certain level. If you have a low income or no income, in some cases Medicaid might pay your Part B premium.
Can you get insurance to help cover Part A and Part B expenses?
As you’ve seen in this article, Medicare Part A and Part B generally come with out-of-pocket costs for you to pay. Did you know that you might be able to buy a Medicare Supplement insurance plan to help cover those expenses? There are up to 10 standardized Medicare Supplement plans available in most states. Learn more about Medicare Supplement insurance.
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What is a Medicare Advantage plan?
If you currently are enrolled in Original Medicare, Part A and Part B, you can choose to enroll in Medicare Part C, more commonly known as Medicare Advantage. Medicare Advantage plans are offered by private health insurance companies to provide and coordinate Medicare Part A and Part B benefits (hospital and medical) for beneficiaries. Learn more about Medicare Advantage plans.
You might wonder why a beneficiary would choose to enroll in a Medicare Advantage plan. A Medicare Advantage plan is required to cover everything that Original Medicare covers (except for hospice care), including emergency and urgent care. Hospice care is covered by Original Medicare, and hospice benefits continue to be covered by Original Medicare even if you have a Medicare Advantage plan. But, there can be some differences between Original Medicare and a Medicare Advantage plan. Those differences can be in how much you pay out of your own pocket when you receive health care. For example, you might have lower copayments and coinsurance or a smaller deductible.Tip
Medicare Advantage offers at least the same coverage as Original Medicare, and may offer additional benefits. It may be one way of adding coverage for routine vision, or dental services, dentures, and more. Some Medicare Advantage plans have a $0 premium. However, regardless of how much you pay for a Medicare Advantage plan, you must continue pay your Medicare Part B premium.
There can also be differences in the coverage you receive. Some Medicare Advantage plans include routine vision, routine dental, and/or wellness programs. Many plans also include prescription drug coverage; those plans are called Medicare Advantage Prescription Drug plans (MAPD).
Do be aware that you would remain enrolled in Original Medicare even if you enroll into a Medicare Advantage plan, and you must continue paying your Medicare Part B premiums. However, if you enroll into a Medicare Advantage plan, you will not be allowed to obtain a Medicare Supplement insurance plan (Medigap).
Eligibility for Medicare Advantage plans
Medicare Advantage plan eligibility is based on your eligibility for Original Medicare, Part A and Part B (except if you have ESRD). Generally, if you have Medicare Part A and Part B, you are eligible for Medicare Part C. However, you must live in the service area for the Medicare Advantage plan that you’re considering.
If you have other health insurance coverage, for example through an employer or union, ask your plan administrator about that plan’s rules before you enroll in a Medicare Advantage plan. In some cases, you may lose your other coverage if you enroll in the Medicare Advantage plan and you may be unable to get it back if you change your mind later.
Enrollment in Medicare Advantage plans
You may only enroll in a Medicare Advantage plan during specified election periods:
Initial Coverage Election Period: You can enroll into a Medicare Advantage plan or Medicare Advantage Prescription Drug plan when you first become eligible for Medicare. Your Initial Coverage Election Period (ICEP), is a seven-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you are under age 65 and you receive Social Security disability, you qualify for Medicare in the 25th month after you begin receiving your Social Security benefits. If you fall into this category, you may enroll into a Medicare Advantage plan 3 months before your month of eligibility, during the month of eligibility, and 3 months after the month of eligibility. For example, if your Medicare Part A and Part B coverage begins in May, your Medicare Advantage plan ICEP is February through August.
Annual Election Period: The Annual Election Period (AEP), also called Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage, is October 15 through December 7 every year. The plan coverage you choose during the AEP begins on January 1 of the next year. It allows Medicare beneficiaries to add, change, or drop their current coverage. You can use this period to enroll into a Medicare Advantage or Medicare Prescription Drug Plan or switch plans. If you’re already enrolled into a Medicare plan, you can use this period to disenroll from your plan.
Medicare Advantage Open Enrollment Period (OEP): If, after enrolling in a Medicare Advantage plan, you change your mind, you can switch back to Original Medicare from January 1 through March 31. If you would be losing prescription coverage as a result of the switch, you can also enroll into a stand-alone Medicare Part D Prescription Drug Plan during this time, if you wish.
Special Election Period: Generally, once you enroll into a Medicare Advantage plan, you stay enrolled in the plan until the next Annual Election Period (AEP) opens. However, there are some life events that might qualify you for a Special Election Period (SEP) during other times of the year, so you can make a change to your Medicare Advantage coverage. Some examples of these life events include (but aren’t limited to):
- Moving outside your Medicare Advantage plan’s service area
- Qualifying for Extra Help (a program to help you pay for prescription drugs)
- Moving into an institution (such as a nursing home)
Find out more, contact MWA’s licensed insurance agents. We have the knowledge to answer your Medicare plan questions.
