Turning 65 is an important milestone, especially when it comes to healthcare. Medicare, the federal health insurance program, plays a crucial role in ensuring that seniors get the medical coverage they need. For most seniors, Medicare Parts A and B serve as the foundation of their healthcare coverage. At Franklin Knows, we’re committed to helping you navigate these essential parts of Medicare with ease.
In this guide, we’ll explain what Medicare Parts A and B cover, how to enroll, and what steps you should take to ensure you get the best coverage for your needs.
What is Medicare Part A?
Medicare Part A is often referred to as “hospital insurance.” It primarily covers inpatient hospital stays, care in skilled nursing facilities, hospice care, and some home health care.
Here’s a breakdown of what Part A covers:
- Inpatient hospital care: This includes semi-private rooms, meals, general nursing, and drugs as part of your inpatient treatment.
- Skilled nursing facility care: Following a hospital stay, Part A covers the care you may need in a skilled nursing facility.
- Hospice care: If you have a terminal illness, Part A covers hospice services.
- Home health care: In certain cases, home health services such as physical therapy or nursing care are covered under Part A.
Do You Have to Pay for Part A? Most people qualify for premium-free Part A, meaning you won’t have to pay a monthly premium if you or your spouse worked and paid Medicare taxes for at least 10 years. If you don’t qualify for premium-free Part A, you may need to pay a monthly premium.
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What is Medicare Part B?
Medicare Part B is known as “medical insurance.” It covers services such as doctor visits, outpatient care, preventive services, and medical supplies.
Here’s what Part B covers:
- Doctor visits: Routine doctor visits, specialists, and outpatient services.
- Preventive services: Screenings, vaccines, and wellness visits to help prevent illness or detect it early.
- Medical equipment: Durable medical equipment like wheelchairs, walkers, and oxygen tanks.
- Mental health services: Outpatient mental health services, including counseling and therapy.
Monthly Premium for Part B Unlike Part A, most people will have to pay a monthly premium for Part B. The standard premium amount can change annually, but the cost may be higher based on your income. In addition, you may have to pay deductibles and coinsurance for services under Part B.
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Medicare Part A & B: What You Need to Know Before Enrolling
Step 1: Learn About Your Initial Enrollment Period
Your Initial Enrollment Period (IEP) is a seven-month window when you can first sign up for Medicare. It starts three months before the month you turn 65, includes your birthday month, and ends three months after. This is the best time to enroll in Medicare Part A and Part B to avoid any late enrollment penalties.
- If you’re already receiving Social Security benefits, you’ll be automatically enrolled in both Medicare Part A and Part B when you turn 65.
- If you’re not receiving Social Security benefits yet, you will need to manually enroll in Medicare by visiting the Social Security Administration’s website or contacting them by phone.
Missing your Initial Enrollment Period can lead to late enrollment penalties, so it’s crucial to act within this window.
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Step 2: Decide if You Need Both Parts A & B
For most seniors, enrolling in both Part A and Part B is the best way to ensure comprehensive coverage. However, if you’re still working or covered by your spouse’s employer-based health insurance, you may be able to delay Part B without penalty. Keep in mind that delaying Part B without having creditable coverage may result in penalties.
At Franklin Knows, we offer personalized guidance to help you make the best decision based on your current coverage and healthcare needs.
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Step 3: Understand How Medicare Part A & B Work Together
Medicare Parts A and B work together to cover both inpatient and outpatient services. If you only have one part, you may face significant out-of-pocket expenses for services not covered by that part.
- Part A will cover your hospital-related expenses, such as surgeries and stays in skilled nursing facilities.
- Part B will cover doctor visits, outpatient care, and preventive services.
Having both parts ensures you have well-rounded coverage for both hospital stays and routine medical care. If you’re concerned about out-of-pocket costs, you may also want to consider Medigap or Medicare Advantage plans to fill the gaps in coverage.
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Step 4: Enroll in Medicare Part A & B
To enroll in Medicare Part A and B, visit the Social Security Administration website or contact them by phone. You can also visit your local Social Security office to complete your enrollment.
If you’re already receiving Social Security benefits, you should automatically be enrolled, but it’s important to double-check to ensure everything is set up properly.
After you enroll, you’ll receive your Medicare card in the mail. This card will indicate whether you have Part A, Part B, or both. Keep this card safe, as you’ll need to show it when receiving Medicare-covered services.
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What Happens If You Delay Part B Enrollment?
If you delay signing up for Medicare Part B without having creditable health coverage (like employer-based insurance), you may face a late enrollment penalty. This penalty adds a 10% premium increase for every 12-month period you were eligible but didn’t sign up.
If you have insurance through your employer, or your spouse’s employer, you can delay Part B without facing penalties. Once that coverage ends, you’ll have a special enrollment period to sign up for Part B without any penalty.
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Franklin Knows Can Help You Through the Medicare Process
At Franklin Knows, we understand that enrolling in Medicare can be confusing, especially when trying to understand what each part covers and how to avoid penalties. That’s why we’re here to guide you every step of the way.
Our platform provides you with easy-to-understand resources, personalized tools to compare plans, and access to licensed Medicare agents who can answer your questions. Whether you’re just starting to explore your options or are ready to enroll, we’re here to make the process as smooth as possible.
- Medicare Plan Comparison Tool: Compare Part A and Part B coverage options, along with Medicare Advantage and Medigap plans.
- Expert Guidance: Get help from experienced agents who can walk you through the enrollment process.
- Avoid Penalties: Learn how to avoid late enrollment penalties and ensure continuous coverage.
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