Medicare Questions & Answers: Medicare Part A
Medicare Part A Q&A
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I just enrolled in Medicare, and I've got my Part A and B, but I'm hearing there are gaps in coverage. What are these gaps exactly?
The gaps come from Cost Share for Part A, Deductible of $257 and co insurance of 80/20% for Part B. In Part B you are responsible for 20% of the cost which is open ended. This means there is no maximum out of pocket. An example is a $60,000 hospital bill. You would be responsible for 20% or $12,000 of this cost. Provided everything billed is an accepted Medicare expense. I would be happy to go into this in more detail, please call me for further information.
Why is regular Medicare better than an advantage plan?
There's a lot of confusion with Medicare-Medicare Supplement/Medigap/-Medicare Advantage "alphabet soup"! Do your homework and learn the Pros and Cons of each Option! Work with someone who can offer both: Medicare Supplement/Medigap and Medicare Advantage plans! This was you get the FACTS not the HYPE and then make the best decision for YOU! :)
What’s the financial risk of sticking with Original Medicare without a Medigap plan?
I have a client who if she had went with her first choice of a Medigap plan her annual cost would be around $2,400. She decided to take a less expensive route and enrolled in a Medicare Advantage plan. She was diagnosed with a health issue requiring a doctor to administer shots in her eye every quarter for the remainder of her life. This cost is reaching her out of pocket maximum of $5,500 which is more than twice the annual cost of her supplement. In this particular case it would have been more cost effective for her to have been on the Medigap plan costing her $2,400 per year.
I just got Medicare Part A, and I’m worried about hospital stays. How do I know if my overnight stay will be covered fully?
Under Medicare Part A, you must first ensure that you have a doctor's order admitting you as an inpatient. This indicates that you require hospital care. Once you are admitted, Medicare Part A will cover the cost of your stay, including services like medication and testing, but it does not cover everything. That is where Medicare Part B steps in to cover the additional expenses of surgery. Of course, there will be more expenses that Medicare Part B will not cover, leaving gaps. That is when a Medigap policy comes in to cover all the remaining expenses.
What happens if I delay Medicare Part A enrollment because I’m still on my spouse’s employer plan?
Simple answer is nothing! Although I do suggest signing up for Part A and just delaying Part B, that way you are in the system and when Part B does need to be activated you have a fast turn around time!
Does Medicare Part A cover outpatient surgery, or is that strictly under Part B?
Medicare Part A does not cover Outpatient surgery. Medicare Part B covers outpatient surgery with 20% coinsurance you are responsible for.
I’m on Original Medicare with no supplement, and I’m wondering how much I’d pay if I need an ambulance ride to the hospital tomorrow.
Original Medicare generally covers ambulance services when they are medically necessary. This means that transportation in any other vehicle could endanger your health. This coverage applies to both emergency and certain non-emergency situations.Your Potential Costs:
- If Medicare covers your ambulance trip, you'll typically be responsible for 20% of the Medicare-approved amount.
- You'll also need to meet your Part B deductible for the year before Medicare begins to pay its share.
The actual cost of an ambulance ride can vary significantly depending on factors such as:
- The distance traveled.
- The level of care provided during transport (e.g., basic life support vs. advanced life support).
- Your location.