Basic Concepts of Medicare
Laying a Solid Foundation | Lesson 3

Medicare Parts A and B

Let’s start out at the beginning of the alphabet with Parts A and B, and we combine these together, because they’re the package deal known more commonly as Original Medicare.

You might also hear this type of coverage referred to as Traditional Medicare, or a type of Fee-for-Service coverage.

Part A is hospital insurance, which provides coverage for inpatient care, like inpatient hospital stays, skilled nursing facility stays, and hospice care.

Part B is medical insurance, which provides outpatient coverage.

Think doctor visits or other health care providers’ outpatient services, durable medical equipment, home health care, and some preventive services.

Neither Part A nor Part B are sold by agents.

But, helping your clients understand these key building blocks of Medicare coverage helps explain the built-in need for additional coverage, which we’ll get to in a moment.

Part A and Part B cover some costs for the services I just mentioned, but they do not cover all of the costs in their entirety.

In general, Medicare only covers about two-thirds of the cost of healthcare services for the program’s 62 million or so beneficiaries.

And there is no cap on yearly out-of-pocket spending when a beneficiary is covered solely by Original Medicare.

For beneficiaries holding Original Medicare coverage only, with no additional coverage, it can be a struggle to pay their bills and get the care they need.

According to a KFF report, 28 percent of those beneficiaries with just Original Medicare coverage have either struggled to pay their medical bills or get needed care due to the associated cost.

The takeaway?

Additional insurance coverage could very well cover some of those services and costs that beneficiaries didn’t realize Original Medicare does not cover.

And that’s why Medicare education is so important.

Yes, as an agent, you’ll help your clients find their plan. But along the way, you’ll likely be teaching them about how the different forms of coverage work.

And speaking of that, it’s time to move on to the next part of Medicare.

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