What Does Medicare Part A & Part B Cover? | Medigap Comparison

What Should You Notice About Medicare Part A?

The Part A chart above shows some of the potentially large expenses that Original Medicare can leave to the beneficiary, and how Plan G can help fill those gaps.

• Hospital deductible: Original Medicare has a Part A deductible for each benefit period. Plan G pays that deductible.
• Longer hospital stays: Medicare begins charging daily hospital coinsurance after the first 60 days. Plan G pays the applicable Medicare Part A coinsurance shown in the chart.
• Skilled Nursing Facility care: Medicare can cover qualifying skilled nursing care, but Medicare’s payment changes as the stay becomes longer. The chart shows what Medicare and Plan G pay.
• Hospice: Medicare provides substantial hospice coverage, while Plan G can cover applicable Medicare coinsurance or copayments.

Learn more:

• My web page — Medicare Skilled Nursing Facility Coverage
• My web page — Medicare Home Health Care
• My web page — Medicare Hospice Coverage
• Medicare & You — CMS Product #10050

What Should You Notice About Medicare Part B?

The Part B chart illustrates another important difference between Original Medicare alone and Original Medicare with Plan G.

• You pay the annual Part B deductible yourself with Plan G.
• After the Part B deductible has been met, Original Medicare generally pays 80% of the Medicare-approved amount for many Part B services.
• Plan G generally pays the remaining 20% Medicare Part B coinsurance.
• Plan G also covers Part B excess charges when they apply.
• Clinical laboratory services can be different because Medicare may pay 100% of the Medicare-approved amount for covered diagnostic laboratory tests.

This 80% / 20% split is an important reason to look beyond the Medicare premium alone. Without supplemental coverage, Original Medicare has no annual maximum limiting your total out-of-pocket expenses for covered Part A and Part B services.

Part A of Original Medicare is very good at containing costs associated with a hospitalization. Part B can be a wildcard of cost containment. There are situations where the 20 percent coinsurance of Part B is much larger than a lengthy hospitalization.  Learn More – InsureMeKevin.com 

Learn more:

• My web page — Durable Medical Equipment, Ambulance & Other Medicare Part A & B Benefits
• My web page — Medicare Mental Health Coverage
• My web page — Medicare Preventive Services
• Medicare & You — CMS Product #10050
  • Your Medicare Benefits Publication 10116  Medicare.gov
• Advanced Primary Care Management Services cms.gov 
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Plan G Also Has a Limited Foreign Travel Emergency Benefit

• Original Medicare generally provides very limited coverage outside the United States. As the official Plan G chart above shows, Plan G includes a limited foreign travel emergency benefit, subject to its deductible, percentage limits and lifetime maximum.
• This is not unlimited international health insurance. If you travel frequently or spend extended periods outside the United States, additional international medical coverage may be worth considering.
  • Get quotes and enroll online for travel insurance  

How Do You Compare This With Medicare Advantage?

A Medicare Advantage plan works differently from a Medicare Supplement. It does not simply pay the amounts shown in the “You pay” column above.

Instead, a Medicare Advantage plan becomes the way you receive your Medicare Part A and Part B benefits. To compare a Medicare Advantage plan with Original Medicare plus Plan G, look at the Medicare Advantage plan’s Summary of Benefits and compare the same services shown above.

• Hospital stay: What is the Medicare Advantage plan’s inpatient hospital copayment?
• Doctors and specialists: What are the office visit copays?
• Outpatient services: What are the copays or coinsurance for surgery, testing and therapy?
• Skilled Nursing Facility: What does the plan charge per day?
• Durable Medical Equipment: What percentage does the member pay?
• Ambulance: What is the copayment?
• Maximum out-of-pocket: What is the most you could pay during the year for covered Part A and Part B services?
• Doctors and hospitals: Are your providers in the plan’s network?
• Prior authorization: Which services require the plan’s approval before receiving care?

There isn’t one answer that is best for everybody. The purpose of comparing these costs is to understand what you are giving up and what you are gaining before choosing between Original Medicare with a Medicare Supplement and a Medicare Advantage plan.

Learn more:

• My web page — Original Medicare vs. Medicare Advantage
• Medicare & You — CMS Product #10050