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Medicare Part A Texas – Questions and Answers

Medicare is a federal health insurance program managed by the federal government, and it consists of four parts. These parts are named alphabetically and each part covers different medical services. Part A covers inpatient hospital services, Part B covers outpatient services, Part C is known as Medicare Advantage and it gives minimally the same coverage as Part A and B together with some extra benefits, and finally, Part D is prescription drug coverage. Part A and Part B together make the Original Medicare. Part C is not offered through government institutions, but instead through private insurance companies.

This Q&A blog will breakdown everything you need to know about Medicare in the state of Texas. It is conceived in 4 major sections, each giving answers to the most frequent questions asked. The first section is focused on Medicare Part A, the second on the difference between Part A and Part B, the third section is focused on Part A costs, and the fourth on Medicare at age 65.

What is Part A in Medicare?

Part A is the first half of Original Medicare and it is commonly known as hospital insurance. It covers the following services: hospital stay in a semi-private room, daily meals, nursing care while admitted, skilled nursing facility care, hospice care, and limited home health care services. 

Does Medicare Part A cover 100% of the costs?

Medicare Part A pays for 100% of the costs produced while admitted to the hospital for the first 60 days when you reach Part A deductible, which is $1600 in 2023.

How much is Medicare Part A premium in Texas in 2023?

Most beneficiaries have the benefit of premium-free Part A insurance. If you have been paying Medicare taxes while working for at least 40 quarters, you are qualified for premium-free Medicare Part A. If not, the premium could be from $278 up to $506.

What does Medicare Part A not cover?

Medicare Part A does not cover your first 3 pints of blood, with the exception of if the blood comes from the central blood bank, in which case you may not be charged. It does not cover long-term care or nursing home care. Part A does not cover hospital or skilled nursing facility stay in a private room.

Can you have only Medicare Part B? 

It is always recommended to have Medicare Part A, but there is the possibility to refuse to enroll in it or to opt it out. You can buy only the Medicare Part B policy if you want, as long as you meet the eligibility requirements. The most common reason for this is that people do not qualify for premium-free Part A and then choose not to enroll in it, and only enroll in Medicare Part B. 

What are the 4 parts of Medicare?

Medicare Part A or hospital insurance, Medicare Part B or medical insurance, Medicare Part C or Medicare Advantage, and Medicare Part D or prescription drug coverage.

What is the difference between Part A and Part B of Medicare?

Medicare Part A is hospital insurance, which covers services provided to you while admitted as an inpatient. Medicare Part B is medical insurance that covers medical services provided by doctors and other medical personnel to you as an outpatient. Part A and Part B are not in competition, they are complementary and together they make Original Medicare. It is wise to have both parts Medicare Part A and B.

What is the Medicare Part B premium in Texas in 2023?

In 2023, the standard Medicare Part B premium will be $164.90 on the federal level, Texas included.

Does everyone get Medicare Part B?

Everyone who met the eligibility requirements can enroll in any part of Medicare. To be eligible you need to be a U.S. citizen or permanent resident who is 65 years old or older, or receiving Social Security disability benefits, or be diagnosed with ESRD or ALS. 

Does Medicare Part A cover hospital stay?

Part A covers inpatient hospital stay and all the services and medications provided to you during your admitted hospital stay.

Do you have to pay for Medicare Part B?

Yes, you are required to pay a monthly premium, which is $164.90 in 2023. Also, you need to meet the Part B deductible before insurance kicks in, which is $226 in 2023. In addition, you are obligated to pay coinsurances and copayments for some services.

Can you have Medicare Part A only?

If you are eligible for Medicare you can choose to enroll only in Medicare Part A. However, it is recommended to have both Part A and Part B, because with Part A only you are covered only for inpatient hospital care, and everything you might need as an outpatient will be charged fully to you without Part B.

Is Medicare Part A and Part B free?

Medicare Part A is free for beneficiaries who have been paying Medicare taxes during their employment for at least 40 quarters, which is over 90% of Medicare beneficiaries. Medicare Part B is not free, you are required to pay a monthly premium, deductible, coinsurances, and copayments. But have in mind there is 10 Medicare Supplement plans that help fill the gaps in costs that are left by Original Medicare.

Hospital representing Medicare Part A coverage in Texas

What does Medicare Part A pay for?

Medicare Part A covers you at 100%, after you meet your deductible, for the following services: inpatient hospital care, hospice care, skilled nursing facility care, laboratory tests, surgeries, and limited home health care.

Does Medicare Part A cover 100% of costs?

It does after the deductible is met. The deductible for Part A is $1600 in 2023. 

Is Medicare Part A always free?

Medicare Part A is free in the case where you or your spouse have been paying Medicare taxes while working for at least 40 quarters, which is approximately 10 years of work. 

Does Medicare Part A cover MRI?

It does not unless you are admitted to the hospital as an inpatient and your doctor ordered it. In that case, MRI is covered under Part A, but you need to pay your deductible.

What services are not covered under Medicare Part A?

Long-term care, DHV care (Dental, Hearing, and Vision), cosmetic procedures, not medically necessary surgeries, massage therapy, and routine physical exams are not covered under Medicare Part A. Also, services that are covered under Part B generally are not covered under Part A. Part A does not cover prescription drugs, but all medication needed for your treatment while admitted to the hospital will be covered.

Is there an out-of-pocket maximum for Medicare Part A?

With Part A there is no out-of-pocket maximum. Most beneficiaries do not pay a premium for Part A, but there are deductibles and coverage limits. However, Medicare Advantage has an out-of-pocket maximum limit for services covered under Original Medicare – Part A and B. That limit is $8300 in 2023.

Is Medicare Part A free at age 65?

Medicare Part A is free for those who have been paying Medicare taxes during their period of employment for at least 40 quarters (10 years). Those who are not in this category will be required to pay a monthly premium, calculated on the time they spend working and paying Medicare taxes.

Do you have to pay for Medicare Part A in Texas?

If you have been paying Medicare taxes while you were working for at least 40 quarters, you are qualified for premium-free Medicare Part A. If not, then you will need to pay a monthly premium. If you have trouble paying Medicare charges, think about enrolling in the Medicare Savings program, which helps with paying Medicare costs.

How much does Medicare cost for a 65 years old person?

It depends on which parts of Medicare have you enrolled in. In general, Part A will most probably be premium-free and leave you only with a deductible to pay, Part B will require you to pay a monthly premium together with a deductible, coinsurance, and copayment, and Part D will require you to pay a monthly premium.

Who is not eligible for Medicare Part A?

People under the age of 65, people who are not U.S. citizens or permanent residents, and people who do not meet other Medicare eligibility requirements.

What are Medicare deductibles in 2023 in Texas? 

In 2023, in Texas like in other states, Medicare Part A deductible is $1600, Part B deductible is $226, and Part D deductible is $505.

What are the 3 requirements for Medicare?

To be eligible for Medicare you need to meet one of the requirements:

  • to be 65 years old or older
  • to receive Social Security disability benefits for at least 24 months 
  • to be diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig`s disease)

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