Medicare Part B: Coverage Outside of a Hospital
Medicare Part B basically covers "outpatient" care: office visits to medical specialists, ambulance transportation, diagnosti...
Read moreMedicare is federal health insurance for people 65 and older and individuals with qualifying disabilities.
Generally applying to care in institutions, Medicare Part A covers inpatient hospitals, skilled nursing facilities, hospice, inpatient rehabilitation, and select home health care services.
You become eligible for Medicare at age 65. If you are currently receiving Social Security benefits, you will be enrolled automatically in Medicare Part A as well as Medicare Part B.
Local Elder Law Attorneys in Your City
Learn more on ElderLawAnswers.com about Medicare enrollment and what you need to know in order to sign up.
Medicare Part A covers expenses for 60 days of hospitalization. Then coinsurance kicks in, and beneficiaries contribute to some of the cost.
Those enrolled in Part A also get 60 lifetime reserve days with a coinsurance. They can use them all at once or through individual episodes of illness. Coverage includes semi-private rooms and private rooms when medically necessary, meals, general nursing, medications, and psychiatric treatment.
If the hospital gets blood from a free blood bank, individuals do not have to pay for it. Otherwise, they must make up for the first three units of blood they receive by paying for the blood, donating blood within the calendar year, or having someone donate on their behalf.
In addition to paying for hospitalizations, Medicare Part A pays for the first 20 days in a skilled nursing facility in which trained nurses provide medical care before coinsurance payments start.
Unlike nursing homes and assisted living facilities, skilled nursing facilities are for short-term medical assistance. Although Part A covers skilled nursing care, it does not cover long-term care in a nursing home or assisted living.
Stays in skilled nursing facilities typically follow hospitalizations. To be eligible for skilled nursing coverage, enrollees must have stayed in a hospital for at least three days and demonstrate that they need skilled nursing to improve or maintain a current condition. The program includes semi-private rooms, meals, skilled nursing, and therapy services.
Although Medicare Part A mainly encompasses care in institutions, it does pay for in-home hospice care when a doctor certifies that an individual is terminally ill. Health care must not prolong the beneficiary’s life but rather help the beneficiary be comfortable when approaching death.
Per Medicare.gov, coverage includes:
Although Medicare does not cover hospice care in a facility, it does allow beneficiaries five days of respite care, relieving their primary caregivers.
Some recipients qualify for inpatient care in religious, nonmedical health care institutions. In those cases, the insurance only covers nonreligious items that do not need a doctor’s prescription, like room and board, wound dressings, and the use of a simple walker.
2023 Premiums, Hospital Deductible, and Coinsurance Amounts
Any person who has reached age 65 and who is entitled to Social Security benefits (i.g., has 40 quarters of Medicare-covered employment) is eligible for Medicare Part A without charge. According to the Centers for Medicare & Medicaid Services (CMS), 99 percent of all enrollees do not pay a premium for Part A.
Others must pay a premium. Medicare also counts a spouse’s work for qualifying purposes.
For 2023, Part A beneficiaries are responsible for the following amounts:
Learn more about Medicare Part B, Part C, and Part D.
Medicare is a complex topic. You can consult with an elder law attorney to receive expert guidance. Find a qualified attorney near you.
Medicare Part B basically covers "outpatient" care: office visits to medical specialists, ambulance transportation, diagnosti...
Read moreThe Medicare prescription drug plan (Medicare Part D) allows private health insurers to offer limited insurance coverage of p...
Read moreFor this reason, Medicare imposes fairly significant late-enrollment penalties for those who postpone signing up. To en...
Read moreIn addition to nursing home care, Medicaid may cover home care and some care in an assisted living facility. Coverage in your state may depend on waivers of federal rules.
READ MORETo be eligible for Medicaid long-term care, recipients must have limited incomes and no more than $2,000 (in most states). Special rules apply for the home and other assets.
READ MORESpouses of Medicaid nursing home residents have special protections to keep them from becoming impoverished.
READ MOREIn addition to nursing home care, Medicaid may cover home care and some care in an assisted living facility. Coverage in your state may depend on waivers of federal rules.
READ MORETo be eligible for Medicaid long-term care, recipients must have limited incomes and no more than $2,000 (in most states). Special rules apply for the home and other assets.
READ MORESpouses of Medicaid nursing home residents have special protections to keep them from becoming impoverished.
READ MORECareful planning for potentially devastating long-term care costs can help protect your estate, whether for your spouse or for your children.
READ MOREIf steps aren't taken to protect the Medicaid recipient's house from the state’s attempts to recover benefits paid, the house may need to be sold.
READ MOREThere are ways to handle excess income or assets and still qualify for Medicaid long-term care, and programs that deliver care at home rather than in a nursing home.
READ MORECareful planning for potentially devastating long-term care costs can help protect your estate, whether for your spouse or for your children.
READ MOREIf steps aren't taken to protect the Medicaid recipient's house from the state’s attempts to recover benefits paid, the house may need to be sold.
READ MOREThere are ways to handle excess income or assets and still qualify for Medicaid long-term care, and programs that deliver care at home rather than in a nursing home.
READ MOREMost states have laws on the books making adult children responsible if their parents can't afford to take care of themselves.
READ MOREApplying for Medicaid is a highly technical and complex process, and bad advice can actually make it more difficult to qualify for benefits.
READ MOREMedicare's coverage of nursing home care is quite limited. For those who can afford it and who can qualify for coverage, long-term care insurance is the best alternative to Medicaid.
READ MOREMost states have laws on the books making adult children responsible if their parents can't afford to take care of themselves.
READ MOREApplying for Medicaid is a highly technical and complex process, and bad advice can actually make it more difficult to qualify for benefits.
READ MOREMedicare's coverage of nursing home care is quite limited. For those who can afford it and who can qualify for coverage, long-term care insurance is the best alternative to Medicaid.
READ MOREDistinguish the key concepts in estate planning, including the will, the trust, probate, the power of attorney, and how to avoid estate taxes.
READ MORELearn about grandparents’ visitation rights and how to avoid tax and public benefit issues when making gifts to grandchildren.
READ MOREUnderstand when and how a court appoints a guardian or conservator for an adult who becomes incapacitated, and how to avoid guardianship.
READ MOREWe need to plan for the possibility that we will become unable to make our own medical decisions. This may take the form of a health care proxy, a medical directive, a living will, or a combination of these.
READ MOREDistinguish the key concepts in estate planning, including the will, the trust, probate, the power of attorney, and how to avoid estate taxes.
READ MORELearn about grandparents’ visitation rights and how to avoid tax and public benefit issues when making gifts to grandchildren.
READ MOREUnderstand when and how a court appoints a guardian or conservator for an adult who becomes incapacitated, and how to avoid guardianship.
READ MOREWe need to plan for the possibility that we will become unable to make our own medical decisions. This may take the form of a health care proxy, a medical directive, a living will, or a combination of these.
READ MOREUnderstand the ins and outs of insurance to cover the high cost of nursing home care, including when to buy it, how much to buy, and which spouse should get the coverage.
READ MORELearn who qualifies for Medicare, what the program covers, all about Medicare Advantage, and how to supplement Medicare’s coverage.
READ MOREWe explain the five phases of retirement planning, the difference between a 401(k) and an IRA, types of investments, asset diversification, the required minimum distribution rules, and more.
READ MOREFind out how to choose a nursing home or assisted living facility, when to fight a discharge, the rights of nursing home residents, all about reverse mortgages, and more.
READ MOREUnderstand the ins and outs of insurance to cover the high cost of nursing home care, including when to buy it, how much to buy, and which spouse should get the coverage.
READ MOREWe explain the five phases of retirement planning, the difference between a 401(k) and an IRA, types of investments, asset diversification, the required minimum distribution rules, and more.
READ MOREFind out how to choose a nursing home or assisted living facility, when to fight a discharge, the rights of nursing home residents, all about reverse mortgages, and more.
READ MOREGet a solid grounding in Social Security, including who is eligible, how to apply, spousal benefits, the taxation of benefits, how work affects payments, and SSDI and SSI.
READ MORELearn how a special needs trust can preserve assets for a person with disabilities without jeopardizing Medicaid and SSI, and how to plan for when caregivers are gone.
READ MOREExplore benefits for older veterans, including the VA’s disability pension benefit, aid and attendance, and long-term care coverage for veterans and surviving spouses.
READ MOREGet a solid grounding in Social Security, including who is eligible, how to apply, spousal benefits, the taxation of benefits, how work affects payments, and SSDI and SSI.
READ MORELearn how a special needs trust can preserve assets for a person with disabilities without jeopardizing Medicaid and SSI, and how to plan for when caregivers are gone.
READ MOREExplore benefits for older veterans, including the VA’s disability pension benefit, aid and attendance, and long-term care coverage for veterans and surviving spouses.
READ MORE