All About Medicare Part A: What You Need To Know About This Basic Benefit
Medicare Advantage vs. Supplement: Which is Right for You?
The two core elements of Medicare, Part A and Part B, work together to provide health coverage after you turn 65. Neither, however, provides full coverage and can still leave you vulnerable to copays and unexpected expenses. That’s why a Medicare Advantage or Medicare Supplement policy is an important step you shouldn’t ignore when enrolling.
First, let’s look at some of the basics of each.
What is Medicare Part A?
Medicare Part A is hospital insurance. It covers inpatient care in hospitals and skilled nursing facilities. Part A can pay for some home health care and hospice care, as well as inpatient care in a religious, non-medical health care institution. When you enroll in Medicare for the first time through the Social Security Administration, you are enrolled in Part A and Part B.
You qualify for Part A at no cost if:
- You are a U.S. citizen, or a permanent legal resident who has lived in the U.S for five continuous years
- You receive, or are eligible to receive, Social Security benefits, or
- Your spouse, living or deceased (including a divorced spouse) receives, or is eligible to receive, Social Security benefits, or
- You, or your spouse, worked long enough in a government job through which you paid Medicare taxes (10 years)
- You are the dependent parent of a fully insured deceased child
In general you need to be age 65 to qualify for Medicare, but there are exceptions: if you’ve been receiving Social Security Disability Insurance for 24 months or have permanent kidney failure, for example.
What is Medicare Part B?
Part B is pretty much everything else. Part B covers doctor visits; outpatient care; home health services; durable medical equipment; mental health services; some but not all outpatient prescription drugs; and other medical services. Part B also covers many preventative services.
If you’re eligible for Part A, you can enroll in Part B for a monthly premium.
What are Medicare Advantage and Medicare Supplement?
If you are enrolled in parts A and B and receive benefits directly from the government, you have Original Medicare. At this point you can buy a Medicare Supplement (Medigap) policy from a private insurance company. This will cover some but not all of the expenses Original Medicare doesn’t, such as copayments, coinsurance and deductibles.
You can also choose to receive your benefits from a Medicare Advantage organization or other Medicare-approved private company. Many Medicare Advantage plans provide extra coverage beyond Original Medicare and can reduce out-of-pocket expenses, including Part D coverage (prescription drug coverage).
Why buy Medicare Supplement Insurance?
Medicare Supplement, or Medigap, programs do just that. They supplement the costs incurred from Original Medicare.
“Original Medicare Parts A and B offer nationwide access to any doctor or hospital that accepts Medicare, but it lacks an out-of-pocket maximum and doesn’t cover prescription drugs or routine dental, vision, or hearing care” said Dr. Shernell Surratt-Gary, D.O. of Aura Wellness in Louisville. “Original Medicare can be paired with a Medicare Supplement like the Medigap plan to help pay for the deductibles and coinsurance gaps, to give you predictable and minimal out-of-pocket costs when you receive care.”
Medicare Supplement vs. Medicare Advantage
A Medicare Supplement plan (Part C) bundles Part A and Part B and often comes with additional benefits.
“When people ask me about Medicare Supplement versus Medicare Advantage, I explain it this way: Medicare Supplement charges you a monthly premium whether you use it or not, and you still need to buy separate Part D prescription coverage,” said Amber Allen, Senior Marketing Director at AmeriLife. “Most Medicare Advantage plans work differently—they often have zero monthly premiums, and you only pay when you actually use services through copays. Most also include those ancillary benefits like dental, vision, and hearing built right in.
“The trade-off with Medicare Advantage is that you are generally limited to a specific network of providers and may need prior authorizations or referrals for services, with variable copays and an annual out-of-pocket cost limit.”
Making a decision
The best choice to make is one made after examining your own medical needs, finances and lifestyle. “Health insurance is something you really want to make an informed decision about, Allen, said. “These are all government-supported plans, which means there are real benefits available—you want to make sure you’re taking full advantage of what’s offered.”
