Medicare was born in 1965 including coverage for hospital (Part A) and physician services (Part B). It was a simpler time – no one could have imagined the complexity of modern medicine.

Part A

Inpatient Hospital Care

Once you are given a room and admitted with inpatient status at the hospital, all the care you receive is filed under Part A*.

• Covers up to 90 days in a general hospital (per benefit period)
  • Additional,
    • 60 lifetime reserve days
    • 190 lifetime days in a Medicare-cerified psychiatric hospital

Skilled Nursing Facility Care

Part A covers your room, board and certain services provided in a skilled nursing facility. Examples of this daily care include

• physical therapy
• tube feedings
• wound care
• intravenous injections that can only be given by a doctor or registered nurse.

Other Details

• Medicare covers up to 100 days each benefit period
• A patient must have spent at least three consecutive days in the hospital within 30 days of admission

Home Health Care

This is usually covered by Part B – unless you’ve spent at least three consecutive days as a hospital inpatient within 14 days of receiving home care. Up to 100 days of daily care are covered or an unlimited amount of intermittent care.

Hospice Care

To qualify for hospice care, your doctor and a hospice doctor must certify you are terminally ill, that is your life expectancy is six months or less.

How Much Does Part A Cost?

Part A has zero cost if you have worked at least 10 years in the United States paying Medicare payroll taxes. You can still purchase Part A with less time in the work force. Reach out for more information.

Gaps in Part A

• Part A has a deductible of $1,448 (in 2021) for each unique hospital admission
• Day 1-60 is covered at no charge (after deductible); days 61-90 at $352 a day; days 91-50 go up to $704
• Skilled nursing care is covered through day 20. Days 21-100 have a copay at $176

Part B

Most medical services we use throughout our life happen outside of an inpatient hospital stay. That’s Part B. Examples include physician visits, outpatient services, preventive services, and some home health visits. Lab work, physical therapy, and ambulance trips are also Part B.

For all that Part B covers, there is one giant hole: prescription drug coverage. See Medicare Part D.

How Much Does Part B Cost

Part B has a one-time calendar year deductible of $203 in 2021. After that, Part B is an 80/20 plan. This means Medicare Part B covers 80% of all costs while you are responsible for 20%.

Left alone, Part B opens a Medicare beneficiary up to significant exposure because that 20% has no cap. Typical group health plans have a MOOP, or Maximum Out of Pocket, to create a stop loss. With Original Medicare alone, there is no structured stop loss.

Medigap (Medicare Supplement) Plans

Original Medicare was groundbreaking health coverage in 1965. But with the ever-rising cost of modern medicine, Original Medicare leaves significant gaps.

This is why Medigap (also called Medicare Supplement) Plans were created in the 1980s. These plans cover the hospital deductible and cover the 20% left to you with Plan B.

I believe when on Original Medicare with a purchased Medigap policy, you will have the best medical health insurance in the world. After you pay your $203 deductible, every bill will simply get paid.

Reach out for more information on Medigap plans.

* Note: if you are never given inpatient status – even after spending one night in the hospital – your services are filed under Part B.

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