Top Medicare Part A and B Coverage: What You Need to Know [2024]

What are Medicare Parts A and B, and how do they work? Medicare Parts A and B comprise what is known as Original Medicare. Once you are eligible for the federal health insurance program and enroll, Part A will be your hospital insurance, and Part B will be your medical insurance.

What services are included in Medicare Parts A and B, and are they expensive? Medicare offers limited coverage for hospital and medical services and has out-of-pocket costs. However, the amount of money you will pay depends on a few factors, like the Medicare taxes you pay while working.

Read on to know more about Medicare Parts A and B, including what they do and don’t cover. And if you want to find Medicare-participating health insurance providers in your area, you can enter your ZIP code into our free quote tool above.

What is covered by Medicare Parts A and B?

Medicare Part A often includes inpatient hospital services, while Part B covers limited inpatient and outpatient medical care.

Specifically, Medicare Part A covers the following hospital services:

• Inpatient care in a hospital
• Hospice care
• Home health care
• Care at a skilled nursing facility
• Nursing home care

Medicare Part B covers the following:

• Ambulance services
• Clinical research
• Durable medical equipment
• Some mental health services
• Some outpatient prescription drugs

Medicare Parts A and B will occasionally cover emergency dental surgery if it’s related to your inpatient hospital care or related medical care.

Read on for more information about the other services listed above.

Inpatient Care

To receive inpatient care in a hospital, you must be admitted on a doctor’s order. Medicare will cover things like semi-private rooms, meals, general nursing care, drugs you need as an inpatient, plus supplies.

Hospice Care

To receive hospice care, a hospice doctor and your physician (if you have one) must certify that you are terminally ill, meaning that you have six months or fewer to live. Covered services include medical care and spiritual and grief counseling. (For more information, read our “Will health insurance pay for hospice?“).

Home Care

Medicare covers intermittent home health care. You must be under doctor supervision, need qualified services, and be homebound. Part A will cover some of the cost, while some services fall under Part B coverage.

Covered home care services include physical therapy, occupational therapy, speech-language pathology, and part-time nursing care.

Nursing Home Care/Care at a Skilled Nursing Facility (SNF)

Generally, a three-day inpatient stay qualifies you for skilled nursing facility care. Covered SNF services include meals, dietary counseling, physical therapy, and occupational therapy.

You can have nursing home care coverage provided that the care you receive is not custodial or long-term. Also, the care you receive must be medically necessary.

Ambulance Services

Medicare will pay for ground transportation to the nearest hospital, critical access hospital, or SNF for a medical emergency if other forms of transportation are dangerous to you. In some cases, Medicare will also pay for your aerial transport to approved medical facilities.

You will often need a doctor’s note to receive a Medicare-covered ambulance for non-emergency situations. Otherwise, an ambulance company must give you an Advance Beneficiary Notice of Noncoverage if Medicare may not cover your transport.

Clinical Research

Clinical research studies (also known as clinical trials) test many types of medical care, including drugs, to see if they are safe and effective. Doctors will test new treatments, but they may also investigate new ways to use existing treatments.

If you decide to participate in a clinical trial, Medicare will cover some costs of these trials, like office visits and tests.

Durable Medical Equipment

Medicare insurance will help you pay for the cost of durable medical equipment if it’s medically necessary, a doctor prescribes it, and you purchase the DME through a supplier who participates in Medicare.

Covered DME includes blood sugar meters, blood sugar test strips, canes, hospital beds, traction equipment, walkers, and wheelchairs. In most cases, the DME must last for at least three years. However, Medicare will cover disposable equipment that you need to use with catheters, for example. (For more information, read our “Will Medicare pay for catheters?“).

Some Mental Health Services

Both Medicare Parts A and B cover limited mental health services, including inpatient care, outpatient care, and partial hospitalization. (For more information, read our “Will health insurance pay for mental health?“).

Part A will cover inpatient psychiatric care at a general hospital or psychiatric care facility. Note that if you need inpatient mental care in a psychiatric hospital, that care is limited to 190 days in a lifetime.

Part B’s outpatient mental health coverage includes, but is not limited to, the following:

• One annual depression screening
• Individual and group psychotherapy (where allowed)
• Family counseling to help you with treatment
• Psychiatric evaluations
• Diagnostic tests

Medicare Part B will also cover mental health treatments connected to alcohol and other substance abuse.

Some Outpatient Prescription Drugs

Medicare will also cover the following:

• Many recommended shots and vaccines
• Injectable osteoporosis drugs for women
• Immunosuppressant medication for transplant patients
• Oral ESRD drugs and erythropoietin (by injection)
• The drugs you need to take with DME usage
• Some antigens
• Intravenous and tube feeding
• Intravenous Immune Globulin (at home) if you have a primary immune deficiency disease

These treatments are those that you cannot give to yourself, and a doctor who works with Medicare must administer these treatments. Medicare recipients need to find a plan through Medicare Part D for more drug prescription coverage.

Read more: Top Family Doctors That Accept Medicare

What is not covered by Medicare Parts A and B?

Above, we mentioned that Medicare Parts A and B cover emergency dental surgery. However, Original Medicare does not cover most routine dental care. For example, Medicare excludes denture coverage. Also, we mentioned nursing home care. Part A may help, but it does not cover long-term (custodial) care.

Here are some services that Medicare Parts A and B don’t cover:

• Eye exams when you need them for prescription glasses
• Cosmetic surgery
• Acupuncture
• Hearing aids and fitting exams
• Routine foot care

If you want even more coverage, you can add a Medicare Supplement Insurance (Medigap) policy or opt for Medicare Advantage (also called Medicare Part C).

Medicare Part C involves approved private health care plans, and the recipient may also get coverage for services that Original Medicare does not cover, like hearing, vision, and dental services.

Some Medigap policies will help cover your emergency medical care if you travel outside the United States.

Read more:

• Top Medigap (Medicare Supplement Health Insurance) Coverage: What You Need to Know
• How much does long term care insurance cost?

How much do Medicare Parts A and B cost?

According to the U.S. Department of Health and Human Services, Medicare Part A is free for the following people who meet Medicare Parts A and B eligibility:

• Seniors (people aged 65 and up) who paid Medicare taxes while working for a qualifying number of years
• People who are entitled to Social Security Disability Insurance or Railroad Retirement Board disability benefits for 24 months
• ESRD patients, regardless of age

If you are a senior and married, you or your spouse need to pay the taxes for waived Part A payments. People with Lou Gehrig’s disease (regardless of their age) can waive Part A payments the first month they get their disability benefits from the Social Security Administration.

For seniors and other recipients who must make monthly payments for Part A coverage, rates range from $274 to $499 for 2022. You must pay $274 per month only if you paid Medicare taxes for 30-39 quarters.

Almost everyone must make monthly or periodic (tri-monthly) payments for Part B coverage. The standard Part B monthly rate is $170.10 for 2022. Medicare adds an extra charge, the Income Related Monthly Adjustment Amount, for 2020 IRS tax returns above a specific amount.

Besides making regular Medicare payments, you will have out-of-pocket costs as you use covered services. You must pay a deductible plus around 20% of the costs of some Medicare services. The latter is called coinsurance.

According to the Centers for Medicare & Medicaid Services, your Medicare Part A and B deductibles for 2022 are $1,556 and $233, respectively.

How do you sign up for Medicare Parts A and B?

There are generally two ways to sign up for Medicare. The first is to create an account on the Medicare.gov website and complete your Medicare Parts A and B applications online once you are eligible. You can apply separately for Part B coverage, and you must accept Part B coverage if you want to use Part A coverage.

The second method for Medicare Parts A and B enrollment is signing up for SSDI or Railroad Retirement Board benefits. The latter signs you up for Part A, but you must live inside the 50 states for automatic Part B signup. You can choose to accept just Part A or Part B coverage through this method.

You can sign up for Social Security benefits through three methods:

• Apply online at the Social Security Website and create an account.
• Call 1-800-772-1213 or 1-800-325-0778, if you are a TTY user.
• Visit your local Social Security office.

If you or your spouse are eligible for Railroad Retirement Board benefits, you can call the board at 1-877-772-5772.

If you complete your Medicare Parts A and B application directly through the website, take advantage of the initial seven-month period that begins three months before your 65th birthday to avoid paying penalties.

However, you will have an eight-month enrollment period if you work after 65 and have a group health insurance plan through your employer. Other than that, the general enrollment period is from January 1st through March 31st each year.

If you want to know more about Medicare, you can read our comprehensive Medicare guide.

In the meantime, we hope that this rundown has given you some clarity about Medicare Parts A and B. Enter your ZIP code into our free quote tool below to find some Medicare providers near you.