A Guide to the Difference Between Medicare Parts A and B

The different parts of your Medicare plan may be named for the alphabet, but they’re not nearly as easy to learn. To start learning your Medicare ABCs, you need to distinguish between the first two letters of the alphabet: A and B. HealthMarkets can help you learn the difference between Medicare Parts A and B, the services they insure, and their costs.

Medicare Part A—Hospital Insurance

Medicare Part A is designed to cover the parts of your major medical care that involve being in the hospital or its aftermath.

If you need to be hospitalized and the hospital you choose accepts Medicare, Medicare Part A will usually cover these aspects:

• Inpatient care
• Skilled nursing facility care

Medicare Part A also covers other important services:

• Hospice care
• Home health care
• Nursing home care (non-custodial or long-term)

Most people who qualify for Medicare Part A will not pay a premium for their care. If you or your spouse are over 65 and qualify for Social Security benefits, currently receive benefits from Social Security or the Railroad Retirement Board, or had Medicare-covered government employment, you will likely not pay a premium for Medicare Part A. Some younger people with disabilities or life-threatening diseases, such as End-Stage Renal Failure (ESRD), may also qualify for premium-free Medicare Part A.

You likely will pay certain out-of-pocket expenses, such as coinsurance and deductibles, with Medicare Part A. But what’s the difference between Medicare A and B?

Medicare Part B—Medical Insurance

Medicare Part B is designed to cover medical needs that do not involve the hospital and are considered medically necessary as defined by the federal and state governments. These could include various services, such as:

• Preventive care, such as doctor’s appointments, lab tests, and vaccines
• Diagnostic services from your primary doctor or from specialists
• Durable Medical Equipment
• Mental health care
• Ambulance services

You will likely pay a premium and deductible for your Medicare Part B insurance. After your deductible is met, coinsurance for most services will be 20% when the doctor accepts Medicare assignment.

Take Note—You May Need to Sign Up for Both Medicare Part A and B.

Sometimes, people need to sign up for both Medicare Part A and Part B. The following are instances in which you should sign up for both parts:

• You aren’t getting or don’t qualify for Social Security or Railroad Retirement Board benefits.
• You qualify for Medicare because you have ESRD.
• You live in Puerto Rico and want Part B. (You must already have Part A to apply.)

Make sure you do your research and fully understand the difference between Medicare A and B before you start the enrollment process.

Are There Alternatives to Medicare Part A and B?

Yes. If you are still working, you could stay on your employer’s insurance plan. However, be aware that you may pay a penalty if you later enroll in Medicare outside of your enrollment period. Or, if you want Medicare benefits but need more flexibility than Parts A and B provide, you could opt for the next letter of the alphabet: Medicare Part C, known as Medicare Advantage.

Medicare Part C plans are offered by private insurance companies in accordance with federal guidelines. Beneficiaries that purchase Medicare Advantage are still enrolled in Medicare Parts A and B.

Find Medicare Plans with HealthMarkets

If you’re interested in reviewing Medicare plans, get started comparing your options online today. Additionally, a licensed insurance agent can help you find a Medicare plan that works for you. Give us a call today at (800) 827-9990 or search for a local agent in your area.