Medicare Part A covers hospital care; Medicare Part B covers doctor visits and outpatient services
Medicare Part A is hospital insurance. It pays for inpatient hospital stays, skilled nursing facility care after a hospital stay, hospice care, and some home health services. You do not pay a monthly premium for Part A if you or your spouse paid Medicare taxes for at least 10 years while working.
Medicare Part B is medical insurance. It pays for doctor visits, outpatient care, diagnostic tests, durable medical equipment, and preventive services. Part B requires a monthly premium, which changes each year based on your income. In 2024, the standard premium is $164.90 per month, though higher earners pay more.
Most people are enrolled in both Part A and Part B automatically when they turn 65, unless they are still working and covered by an employer plan. The two parts work together but cover different things, and understanding what each one pays for helps you know what costs you are responsible for.
Key Takeaways
- Part A covers hospital stays, skilled nursing care, and hospice; Part B covers doctor visits, outpatient services, and preventive care.
- Part A has no monthly premium for most people, but Part B requires a monthly premium that varies by income.
- Both parts have deductibles and coinsurance amounts you pay out of pocket before and after coverage kicks in.
- You are automatically enrolled in both parts at age 65 unless you are still working and covered by an employer health plan.
- If you delay enrolling in Part B after you become may be able to access, you may face a permanent penalty on your premium.
What Part A Covers and What You Pay
Part A covers a hospital stay from the first day through day 60 with only a deductible ($1,556 in 2024). From day 61 through day 90, you pay coinsurance of $389 per day. If you stay longer than 90 days, you have 60 additional "lifetime reserve days" you can use, and you pay $778 per day for those. After your lifetime reserve days are exhausted, you pay the full cost of the hospital stay.
Part A also covers skilled nursing facility care for up to 100 days following a hospital stay of at least three days. You pay nothing for days 1 through 20, and $194.50 per day for days 21 through 100 (in 2024). Skilled nursing means you need daily nursing or rehabilitation services — not custodial care like help with bathing or dressing.
Hospice care is covered at no cost to you when a doctor certifies you have six months or less to live. You pay nothing for the hospice services themselves, though you may pay small copayments for medications and respite care. Home health services are covered when you are homebound and a doctor orders them, with no copayment if the provider is Medicare-approved.
What Part B Covers and What You Pay
Part B covers doctor office visits, including primary care doctors and specialists. You typically pay a copayment of $20 to $50 per visit after you meet your annual deductible ($240 in 2024). Part B also covers outpatient hospital services, emergency room visits, and urgent care clinics.
Preventive services covered by Part B include annual wellness visits, cancer screenings (mammograms, colonoscopies, Pap tests), cardiovascular screenings, bone density tests, and diabetes screenings. These preventive services are covered at no cost to you after you meet your Part B deductible, with no copayment or coinsurance.
Part B also pays for durable medical equipment like wheelchairs, walkers, oxygen equipment, and diabetic supplies. You typically pay 20 percent coinsurance after you meet your deductible. Mental health services, including therapy and psychiatric visits, are covered under Part B with the same copayment and coinsurance structure as other doctor visits.
How Part A and Part B Work Together
Part A and Part B are separate coverages that cover different settings and services. If you are admitted to a hospital, Part A pays the hospital bill. If a doctor visits you in that hospital and bills separately, Part B pays the doctor's bill. If you have outpatient surgery at a hospital, Part A covers the facility costs and Part B covers the surgeon's fee.
You need both parts to have complete coverage. Part A alone leaves you responsible for all doctor bills and outpatient care. Part B alone leaves you responsible for hospital bills. Most people have both parts, and together they cover about 80 percent of your healthcare costs — you are responsible for the remaining 20 percent plus deductibles and copayments.
If you want more comprehensive coverage, you can add Medigap insurance (supplemental insurance) or switch to Medicare Advantage (Part C), which is an alternative to Original Medicare that includes Part A and Part B coverage through a private insurance company, usually with additional benefits like dental or vision.
When You Are Automatically Enrolled and When You Must Act
You are automatically enrolled in Part A and Part B three months before the month you turn 65, if you are a U.S. citizen or permanent resident who has lived in the country for at least five years. The enrollment happens automatically if you are already receiving Social Security benefits. If you are not yet receiving Social Security, you will receive a notice in the mail explaining your coverage and when it starts.
If you are still working at age 65 and covered by your employer's health plan, you can delay Part B enrollment without penalty as long as you are actively employed and covered. You must enroll in Part B within eight months after your employment ends or your employer coverage ends, or you will face a permanent premium penalty of 10 percent for each year you delayed.
Part A enrollment does not have the same penalty for delay, but you should still enroll when you become may be able to access to avoid gaps in coverage. If you miss your initial enrollment window, you can enroll during the General Enrollment Period from January 1 through March 31 each year, with coverage starting July 1.
Part A and Part B Costs You Should Know About
Part A has no monthly premium for most people, but it has a deductible of $1,556 per benefit period (2024). A benefit period starts when you enter a hospital and ends after you have been out of the hospital or skilled nursing facility for 60 consecutive days. If you are hospitalized again after that 60-day period, a new benefit period begins and you pay a new deductible.
Part B has a monthly premium that varies by income. In 2024, the standard premium is $164.90 per month for most beneficiaries, but if your modified adjusted gross income exceeds certain thresholds, you pay more. Higher earners can pay between $230.80 and $560.50 per month. The premium is usually deducted automatically from your Social Security check.
Both parts have annual deductibles and coinsurance amounts. Part B's deductible is $240 per year (2024), and after you meet it, you typically pay 20 percent coinsurance for most services. These costs reset each calendar year on January 1. If you have limited income, you may be able to get help paying Part B premiums and cost-sharing through programs like Medicaid or the Medicare Savings Program.
What Part A and Part B Do Not Cover
Neither Part A nor Part B covers long-term care in a nursing home or assisted living facility unless you need skilled nursing care following a hospital stay. Custodial care — help with bathing, dressing, and daily activities — is not covered. Dental care, vision exams, eyeglasses, and hearing aids are not covered by Original Medicare, though some Medicare Advantage plans include these benefits.
Prescription drugs are not covered by Part A or Part B. You need to enroll in Part D (prescription drug coverage) separately, either through a standalone Part D plan or through a Medicare Advantage plan that includes drug coverage. If you do not enroll in Part D when you first become may be able to access, you may face a permanent penalty on your premiums.
Routine foot care, routine eye exams for glasses, and most dental work are not covered. Travel outside the United States is generally not covered, except in limited circumstances in Canada and Mexico. If you need coverage for these services, you can add Medigap insurance or choose a Medicare Advantage plan that includes them.
Frequently Asked Questions
Do I have to pay for Part A if I worked and paid Medicare taxes?
If you or your spouse paid Medicare taxes for at least 10 years while working, you do not pay a monthly premium for Part A. You still pay the deductible when you use hospital services, but there is no ongoing premium. If you have fewer than 10 years of Medicare tax payments, you may still be able to purchase Part A coverage, though the premium will be higher.
What happens if I do not enroll in Part B when I turn 65?
If you delay Part B enrollment after you become may be able to access and are not covered by an employer plan, you will pay a permanent penalty of 10 percent of the standard premium for each year you delayed. This penalty stays on your premium for the rest of your life. The only exception is if you are still working and covered by an employer health plan.
Can I have Part A without Part B?
Yes, you can have Part A alone, but you will be responsible for all doctor bills and outpatient care costs. Most people have both parts because together they provide more complete coverage. If you have Part A only, you should understand that you are not covered for any doctor visits or outpatient services.
Do Part A and Part B cover everything I need?
Part A and Part B together cover about 80 percent of healthcare costs on average. You are responsible for deductibles, coinsurance, and services they do not cover, like dental, vision, hearing aids, and long-term custodial care. Many people add Medigap insurance or choose Medicare Advantage to cover these gaps.
How do I know if I am enrolled in Part A and Part B?
You can check your enrollment status by creating an account on Medicare.gov, calling 1-800-MEDICARE, or visiting your local Social Security office. Your Medicare card will show which parts you are enrolled in. If you are automatically enrolled and do not want Part B coverage, you must decline it in writing within a specific timeframe.