Medicare A & B

• Medicare is a federal health insurance program primarily designed for people age 65 and older, although some individuals under 65 may qualify due to certain disabilities or medical conditions

• Medicare was established in 1965 to ensure that older Americans have access to affordable healthcare. While it provides broad coverage for many medical services, it does not cover everything. Because of this, beneficiaries often choose additional coverage options to help reduce out-of-pocket costs or expand their benefits

• Medicare is divided into several parts, each covering different types of healthcare services

When Do People Become Eligible for Medicare?

Most people become eligible for Medicare when they turn 65

Eligibility typically occurs during what is known as the Initial Enrollment Period, which is a 7-month window that includes:

• 3 months before the month you turn 65

• The month you turn 65

• 3 months following your 65th birthday month

Many people choose to enroll three months before turning 65 so their coverage can begin right away when they become eligible

Some individuals receive Medicare automatically, while others must actively enroll

Medicare Part A

(Hospital Insurance)

Medicare Part A is commonly referred to as hospital insurance. It helps cover costs associated with inpatient medical care

Most people receive Part A with no monthly premium if they or their spouse paid Medicare taxes while working for at least 10 years (40 quarters)

Part A generally covers:

• Inpatient hospital stays

• Skilled nursing facility care (following a qualifying hospital stay)

• Hospice care

• Some home health services

While Part A covers many hospital-related expenses, it still includes deductibles and cost sharing, which means beneficiaries may still be responsible for certain costs

Medicare Part B

(Medical Insurance)

Medicare Part B covers outpatient medical services and physician care

This includes services such as:

• Doctor visits

• Specialist appointments

• Preventive services and screenings

• Lab work and diagnostic testing

• Outpatient procedures

• Durable medical equipment (such as wheelchairs or oxygen equipment)

How To Enroll in Medicare Part A and Part B

Most individuals are automatically enrolled in Medicare Parts A (if you or your spouse has paid taxes contributing to Medicare for 40 working quarters; 10 years)

Enrollment in Medicare Part B can be completed through the Social Security Administration and can be done:

• Online through the Social Security website
  

• Over the phone
  

• In person at a Social Security office

  
  

It is recommended that individuals apply about three months before turning 65 to ensure their coverage begins on time

Medicare Part currently (2026) has a monthly premium of $202.90/per month

What is not covered by Original Medicare?

While Medicare provides strong hospital and medical coverage, there are several services it generally does not cover such as:

• Routine dental care

• Vision exams and eyeglasses

• Hearing aids

• Most prescription drugs (unless a separate Part D plan is added)

• Many wellness or lifestyle benefits

This is one reason many people explore Medicare Advantage plans, which frequently bundle these additional benefits

What Costs Am I Responsible For With Medicare A & B?

Medicare Part A Deductible

Medicare Part A primarily covers inpatient hospital services, skilled nursing facility care, hospice care, and some home health services. The Part A deductible applies when a beneficiary is admitted as an inpatient to a hospital or qualifying facility.

Unlike most insurance deductibles, the Medicare Part A deductible is not an annual deductible. Instead, it applies to each benefit period.

A Medicare Part A benefit period begins the day a beneficiary is admitted as an inpatient in a hospital or skilled nursing facility. The benefit period ends after the beneficiary has been out of the hospital or skilled nursing facility for 60 consecutive days.

If the beneficiary is admitted again after the benefit period ends, a new Part A deductible applies.

Medicare Part A Deductible Coverage

The Part A deductible covers the beneficiary's share of inpatient hospital costs for the first 60 days of each benefit period after Medicare Part A pays its portion.

After the Part A deductible is met, Medicare covers:

Days 1–60: Medicare pays 100% of covered inpatient hospital costs after the deductible.

Days 61–90: The beneficiary is responsible for a daily coinsurance amount.

Days 91–150: The beneficiary enters the lifetime reserve day period and is responsible for a higher daily coinsurance amount.

After 150 days: The beneficiary is responsible for all inpatient hospital costs unless they have additional coverage.

Medicare Part A Benefit Period Example

A beneficiary is admitted to the hospital on January 10.

Medicare Part A applies the inpatient deductible for that benefit period.

The beneficiary is discharged on January 20.

If the beneficiary is readmitted on February 15, they are still within the same benefit period because they have not been out of the hospital for 60 consecutive days. A new Part A deductible would not apply.

However, if the beneficiary does not receive inpatient care again until April or later and has been out of the hospital for more than 60 consecutive days, a new benefit period begins and another Part A deductible may apply.

Medicare Part B Deductible

Medicare Part B covers outpatient medical services, including physician visits, specialist care, preventive services, outpatient procedures, durable medical equipment, and other medically necessary services.

Unlike Part A, the Part B deductible is an annual deductible.

The beneficiary is responsible for meeting the Part B deductible once each calendar year before Medicare begins paying its share of covered Part B services.

Medicare Part B Deductible Coverage

After the beneficiary satisfies the annual Part B deductible, Original Medicare typically pays 80% of the Medicare-approved amount for covered Part B services.

The beneficiary is generally responsible for the remaining 20% coinsurance, unless they have additional coverage such as a Medicare Supplement plan.