Part A is the inpatient part of Medicare; Part B is the outpatient part of Medicare, as well as all doctors’ services, including the doctors in the hospital.
Medicare Parts A and B cover preventative services 100%.
There are expenses associated with each Part.
Gaps in Medicare
Gaps in Part A
There is a deductible for EACH 60-day hospital stay. For the first 60 days of hospitalization, you pay a Part A deductible.
If you are hospitalized after the 60-day hospital stay, you must pay another deductible.
From day 61-90, you are responsible for a daily co-payment.
From day 91-150, you are responsible for a daily copayment which is double the previous amount.
Admittance to a skilled nursing facility: if you were in the hospital a minimum of 3 days, Medicare will pay everything from day 1 to day 20. Then you pay a daily co-pay for days 21-100.
Gaps in Part B
There is a monthly premium for Part B.
There is also a yearly premium for Part B.
Basic Medicare is an “80% /20% plan”. You pay a 20% co-insurance and Medicare pays 80% of the “Medicare allowed amount”. There is NO maximum out-of-pocket protection. You are responsible for 20% of all doctors’ fees.
Excess charges. Some doctors that WILL accept Medicare, but do not accept the Medicare allowed amount can charge an extra 15% of the Medicare allowed amount to the patient.
Lack of Drug Coverage:
Usually, Medicare Part A will cover medications a person receives when they are an inpatient at a skilled nursing facility or a hospital. Sometimes, Medicare Part B will provide limited outpatient coverage for some of the prescriptions a person takes that they receive from the doctor’s office, such as chemotherapy or intravenous drugs.