Medicare Part A
Medicare Part A covers hospital visits and inpatient care. Medicare Part A hospital insurance is what helps pay for services when you are admitted to the hospital. Medicare Part A, along with Medicare Part B, helps to make up the basic coverage that is referred to as Original Medicare.
What is Medicare Part A?
In the simplest terms, Medicare Part A covers inpatient visits, whether it be at the hospital, a skilled nursing care facility, or, in limited situations, a nursing home. It also includes home health care and hospice care coverage.
Medicare Part A makes up one half of Original Medicare, the other half being Medicare Part B. You can enroll in Original Medicare through Social Security, either online, over the phone, or at your local office.
Many people choose to enroll in (or are automatically enrolled in) Medicare Part A when they first sign up for Medicare. Deciding whether or not to also sign up for Medicare Part B medical insurance, the other half of Original Medicare, depends on your personal situation.
However, in some situations, it may not be in your best interest to enroll in Medicare when you are first eligible, not even Medicare Part A. For example, if you have an HSA account, you will no longer be allowed to contribute to it once you sign up for Medicare. However, you will still have access to the money you have saved in the account, and your spouse can still contribute up to the family maximum in his or her name, regardless of whether he or she is enrolled in Medicare.
In this case, it may be best to hold off on your Medicare enrollment. Plus, if you have creditable health insurance that is primary to Medicare from a large employer (20+ employees), you won’t face any late enrollment penalties should you sign up for Part A after your Initial Enrollment Period (IEP) has finalized.
Medicare rules and regulations are quite complicated, which is why it is so important to be properly informed before making enrollment decisions. Reach out to one of our experienced insurance agents today for a free Medicare consultation.
What does Medicare Part A cover?
As we mentioned, Medicare Part A is the part of Medicare that covers hospital-related expenses and inpatient stays. Some of the Part A hospital and inpatient benefits are as follows:
- Inpatient Hospital Care: If you are admitted to a hospital as a patient under a doctor’s order, Medicare Part A hospital insurance covers this stay. Benefits include semi-private rooms, meals, general nursing, drugs administered in the hospital, and more. Part A covers up to 90 days of hospital stays each benefit period. You also have a lifetime reserve of 60 days of hospitalization. Finally, inpatient mental health care in a psychiatric hospital has a lifetime limit of 190 days under Medicare Part A.
- Skilled Nursing Care Facility: Medicare Part A covers skilled nursing care under certain conditions and for a limited time. If your doctor decides that you need daily skilled care, you can receive these services at a Medicare-certified facility. To qualify for skilled nursing facility (SNF) care, you must have spent three days in the hospital. You must also have been admitted to a nursing facility for at least 30 days. Benefits include semi-private rooms, meals, skilled nursing care, physical therapy, occupational therapy, medications, and more. You get up to 100 days of SNF care coverage during each benefit period. However, you will start to pay a premium on the 21st day of your stay ($185.50 coinsurance per day during each benefit period).
- Long-Term Care Hospital Services: If you require care in a long-term care hospital (LTCH), Medicare Part A can help to cover the corresponding costs. LTCHs specialize in treating patients that are hospitalized for a period of more than 25 days. Deductibles and coinsurance will depend on the length of your stay and the state of your benefit period.
- Home Health Care: Either Medicare Part A or Part B will cover medically necessary home health care services. This entails skilled nursing care, physical therapy, occupational therapy, speech-language pathology services, and more. You are eligible for these services if your doctor certifies that you are homebound.
- Hospice Care: Medicare Part A covers hospice care when a physician certifies that you are terminally ill, meaning that you have a life expectancy of six months or less. Hospice care implies palliative care, or comfort care, rather than treatment to cure your condition. Hospice care coverage is free and benefits include medications and services needed for pain and symptom management; medically necessary equipment; medical, nursing, and social services; home aides and homemaker services; and other services needed to treat your pain and symptoms, including grief counseling for you and your loved ones.
How much does Medicare Part A cost?
Though Medicare does work to help pay for your health care costs, it does come with some inevitable related expenses. Many people think of Part B as the part of Medicare that you have to pay for, as it comes with a monthly premium. However, Medicare Part A also comes with its expenses, such as a premium for certain individuals and the Part A deductible.
Medicare Part A Premium
How much Medicare Part A will cost you depends on a number of factors. If you or your spouse paid Medicare taxes for the required amount of time, you won’t have to pay a premium for Medicare Part A. This is called “premium-free Part A”.
Most people who are eligible for Medicare are also eligible for premium-free Part A. However, if you don’t qualify, you have the option to purchase Medicare Part A.
If you choose to buy premium Part A, you typically will have to buy Medicare Part B as well. You will also have to pay a Medicare Part A premium of either $259 or $471 per month.
Medicare Part A Hospital Deductible
Medicare Part A also has a deductible. The Part A deductible has been set at $1,484 in 2021. You will be responsible for paying the deductible each benefit period until Medicare starts to pay for your hospital expenses.
The Medicare Part A deductible resets each benefit period. How this works is that 60 days after being discharged from the hospital, your benefit period resets. If you are admitted to the hospital after those 60 days have passed, you will once again be responsible for covering your Part A deductible.
As you can see, having lots of unexpected hospital admissions in a year can cost you thousands of dollars out-of-pocket. However, there are certain Medicare Supplement Insurance plans that can help to cover your Part A deductible, which is something that you may want to consider.
Medicare Part A Copayments and Coinsurance
Medicare Part A also comes with some copayments and coinsurance that you should be aware of. For example, for inpatient hospital stays, you may be responsible for paying coinsurance on top of your deductible.
For the first 60 days of your stay, there is a $0 coinsurance per benefit period. However, there is a $371 coinsurance per day for days 61-90 of each benefit period. If you are in the hospital more than 90 days, there is a $742 coinsurance for each “lifetime reserve” day used during each benefit period.
Lifetime reserve days are days that you can draw on if you are in the hospital for more than 90 days. You only get 60 of these days in your lifetime (they don’t reset per benefit period), and once you expend them, you will be responsible for covering all costs for hospital stays of over 90 days.
These same rules apply for inpatient mental health stays. And when it comes to Skilled Nursing Facility stays, you have a $0 coinsurance for days 1-20 of your stay. For days 21-100, you will be responsible for paying a $185.50 coinsurance per day, and for stays longer than 100 days, you will have to cover all of the costs of your SNF care.
Medicare Part A Eligibility
Most people qualify to enroll in Part A when they turn 65. You don’t have to pay a premium for Part A as long as you or your spouse were working and paying Medicare taxes for at least 10 years. Additionally, you won’t have to pay a premium for Part A if you are 65 or older and are receiving Social Security or RRB (Railroad Retirement Board) benefits.
Additionally, people who are receiving disability benefits and those suffering from End-Stage Renal Disease (ESRD) may also be eligible to receive Part A coverage without having to pay a monthly premium.
However, even if you aren’t eligible for premium-free Part A, you have the option to pay for your Part A coverage as long as you qualify for Medicare. In this case, you will have to pay a monthly Part A premium of either $259 or $471. This amount will depend on how long you or your spouse worked and paid Medicare taxes.
As you can see, Medicare coverage comes with a number of nuances that the average beneficiary might not be aware of. Sign up for a free call about Medicare options with the team here at Medicare Plans Direct to discuss your Medicare options.