Medicare Explained Parts A & B

2018 Medicare Part A
Part A is Hospital Insurance and covers costs associated
with confinement in a hospital or skilled nursing facility.
When you are
Hospitalized for:
Medicare Covers
You Pay
1 – 60 days Most confinement
costs after the
Per benefit period*
61 – 90 days All eligible expenses
after the patient pays
a per-day copayment
$335 a day
91 – 150 days All eligible expenses
after a per day
Lifetime maximum
of 60 days.
$670 a day
151 days or more Nothing All costs
Skilled Nursing

When you are hospitalized
for at least 3 days and enter a Medicare approved skilled
nursing care facility within 30 days after hospital
discharge and are receiving skilled nursing care.
All eligible expenses
for the first 20 days;
then all eligible
expenses for days
21-100, after patient
pays a per-day
After 20 days
$167.50 a day
co-payment for days
For days 101+
You pay all costs.
Part A also covers: Blood, Home Health Services, Hospice Care
*Benefit periods are defined by confinement periods that are separated by 60-days. If you are confined in a hospital and then released, your Benefit Period will continue for the next 60 days. If you are readmitted to the hospital during that time, your Benefit Period will continue. However, if you are readmitted to the hospital after more than 60 days have elapsed, a new Benefit Period begins and you will have to meet the deductible again.
2018 Medicare Part B
Part B is Medical Insurance and covers physician services, outpatient
care, tests and supplies. Part B premium in 2018 begins at $134.00*
On expenses
Incurred for:
Medicare Covers
You pay $183 Annual
Deductible PLUS
Medical Expenses
Physician’s services for inpatient and outpatient medical/surgical services; physical/speech therapy, diagnostic tests.
Most confinement
80% of approved
20% of approved
Clinical Laboratory
Blood tests, urinalysis
Generally 100% of
approved amount
Nothing for services
Home Health Care
Part-time or intermittent skilled care, home health aide services, durable medical supplies and other services.
100% of approved amount; 80% of approved amount for durable medical equipment Nothing for services; 20% of approved amount for durable medical equipment
Outpatient Hospital
Hospital services for the diagnosis or treatment of an illness or injury.
Medicare payment to hospital, based on outpatient procedure payment rates Coinsurance based on outpatient procedure payment rates
Blood After first 3 pints of
blood, 80% of
approved amount
First 3 pints plus
20% of approved
amount for
additional pints
On all Medicare-covered expenses, a doctor or other health care provider may agree to accept Medicare “assignment.” This means the patient will not be required to pay any expense in excess of Medicare’s approved charge. The patient pays only 20% of the approved charge not paid by Medicare. If the health care provider does not accept assignment, the patient is responsible for the “excess” charges that Medicare does not cover.
* Monthly premium for those filing as single taxpayers with income under $85,000 per year, or married and filing jointly with income under $170,000 annually. Part B premiums increase with income level.
2018 Part B Monthly Premium
Tax Filing Status
Individual Joint Married but Separate
Premium is If Your 2016 Annual Income Was*
$134.00 $85,000 or less $170,000 or less $85,000 or less
$187.50 $85,001 – $107,000 $170,001 – $214,000
$267.90 $107,001 – $133,500 $214,001 – $267,000
$348.30 $133,501 – $160,000 $267,001 – $320,000
$428.60 Above $160,000 Above $320,000 Above $85,000
* Social Security uses the income reported on your federal tax return two years ago to determine your Part B premium. If your income has decreased, you can ask for a more recent tax year to be used to determine your premium, but you must meet certain criteria.
Part B Covered Services
Part B Covered Services Details
Bone Density Measurement One every 24 months
Cardiac Rehabilitation Exercise, education and counseling
Cardiovascular Screenings One every 5 years
Chiropractic Services Limited
Clinical Laboratory Services Certain screening tests
Clinical Research Studies Tests to determine safety of new procedures
Colorectal Cancer Screenings

• Fecal Occult Blood Test
• Sigmoidoscopy
• Colonoscopy
• Barium Enema
One every 12 months
One every 4 or 10 years depending upon risk
One every 4 or 10 years depending upon risk
One every 4 years
Defibrillator Implantable automatic
Diabetes Screenings Up to two each year
Diabetes Self-Management Training With doctor’s order
Diabetes Supplies Includes monitors, test strips and lancets
Insulin is covered if using an external pump
Doctor Services Includes outpatient and some hospital inpatient
Durable Medical Equipment Oxygen equipment and supplies, wheelchairs, walkers,
and hospital beds
EKG Screening Initial Medicare exam and as a diagnostic test
Emergency Room Services Doctor’s services
Eye Glasses One pair after cataract surgery
Health Center Services At federally approved community based organizations
Flu Shots Once per flu season
Foot Exams If you have diabetes
Glaucoma Tests One every 12 months
Hearing and Balance Exams Does not include hearing aids
Hepatitis B Shots For people at high or medium risk
HIV Screening One every 12 months
Home Health Services Part-time skilled nursing care or physical therapy,
speech-language pathology, or occupational therapy
Kidney Dialysis Services and supplies
Mammograms One every 12 months
Medical Nutrition Therapy Services If you have diabetes or kidney disease or kidney
transplant in the last 36 months
Mental Health Care Outpatient to help with conditions like depression
Non-doctor Services Physician assistants, nurse practitioners, social
workers, physical therapists and psychologists
Occupational Therapy After an illness or accident to help you return to work
Outpatient Medical and Surgical
Services and Supplies
For procedures like X-rays, a cast or stitches
Pap Tests, Pelvic and Breast Exams Checks for cervical, vaginal and breast cancer
Physical Exams One per year – must be 12 months apart
Physical Therapy For injuries and diseases
Pneumococcal Shot Helps prevent pneumonia
Prescription Drugs – Limited Injections at a doctor’s office, certain oral cancer drugs,
drugs used with some types of durable medical
equipment, and some outpatient drugs at a hospital
Prostate Cancer Screenings Once every 12 months
Prosthetic/Orthotic Items Limbs and braces; includes ostomy supplies
Pulmonary Rehabilitation If you have moderate to severe COPD
Rural Health Clinic Services Includes many outpatient primary care services
Second Surgical Opinions If surgery is not an emergency
Smoking Cessation If you’re diagnosed with a illness caused or
complicated by smoking
Speech-Language Pathology Services Treatment to regain and strengthen speech and
language skills and swallowing skills
Surgical Dressing Services For treatment of a surgical wound
Telehealth Provided in an approved rural facility
Tests X-rays, MRIs, CT scans, EKGs and some other
diagnostic tests
Transplants and Immunosuppressive
Pays for doctor services in a Medicare-certified facility.
Immunosuppressive drugs covered if Medicare or
employer group plan paid for the transplant and you
were entitled for Part A at the time of transplant
Urgently-Needed Care For sudden illness or injury that isn’t an emergency
Services and Items Not Covered by Part A and Part B
• Long-term care
• Routine Dental Care
• Dentures
• Cosmetic Surgery
• Acupuncture
• Hearing Aids
• Exams for Fitting Hearing Aids
• Most Prescription Drugs
How Do I Enroll in Medicare
If you are receiving Social Security benefits or benefits from the Railroad Retirement Board, you will be automatically enrolled in Parts A and B. Benefits will begin the first day of the month you turn 65. If your birthday is on the first day of the month, Part A and B will begin the first day of the prior month. So if your birthday is September 1, Medicare benefits will begin on August 1.
If you are younger than 65 and disabled, Medicare benefits will automatically begin 24 months after you begin receiving disability benefits.
If you are not receiving Social Security benefits, you will need to enroll. Beginning 3 months prior to the month you turn 65, you can sign up for Medicare. The fastest way to enroll is go to It should take you fewer than 10 minutes.
You can also call Social Security at 1-800-772-1213. For Railroad Retirement Board benefits call 1-877-772-5772.
Finally, you can make an appointment at your local Social Security office and enroll there.