Medicare Part A:

What does Part A Cover?

Part A covers inpatient hospital, skilled nursing facility, hospice, and eligible home health care. Part A-covered hospital services include medically necessary services and equipment to treat your condition. While this seems fairly clear cut, there may be some surprises when we look deeper.

Medicare Part A offers coverage in time periods called “Benefit Periods”. These “Benefit Periods” begin the day you are admitted as an inpatient in a hospital and ends when you have not been an inpatient in either a hospital or skilled nursing facility for 60 consecutive days. There is no limit to the number of benefit periods. Note: Skilled Nursing benefits only take effect after a qualifying hospital stay (inpatient for 3-days)

Medicare does NOT cover long-term care. This includes extended stays in a nursing home. Long-term care insurance is available if this is something you want to plan for.

How Much Does Medicare Part A Cost?

Most individuals will pay nothing for Medicare Part A. As residents of the United States, we all pay Medicare taxes during our working years These taxes go to offset the cost of Part A when we do decide to enroll in Part A.

As long as you have worked for 40 quarters or 10 years in in the United States, you will generally pay nothing for Part A. If you do not have this work history, you can purchase Part A.

When do i enroll in Medicare Part A?

Most people enroll or are automatically enrolled in Medicare Part A when they turn 65. If you are already taking your social security benefits, you will be automatically enrolled in Part A. When automatically enrolled, you should receive your Medicare card in the mail 2-3 months before your 65th birthday.

If you are not receiving or looking to receive Social Security income benefits or Railroad Retirement income benefits, then you will need to sign up for Part A at age 65 with Social Security. You can sign up right from the Social Security website.

What am i responsible for under Part A?

Each benefit period has a deductible. As of 2019, the Part A deductible is $1,364. This means that once this deductible is paid, Part A coverage begins. If you are admitted into a hospital your Part A coverage includes a semi-private room, meals, general nursing care, drugs that are part of your inpatient treatment, and other hospital supplies and services. Below is the chart for coverage for the lifetime days of coverage.

1-60 days 100%
61-90 days patient pays $341 / day copay
91-150 days patient pays $682 / day copay (60 Lifetime reserve days)
151 days or more not covered (Beyond lifetime reserve days)

As we can see, 60-full days of 100% inpatient coverage is a lot of coverage. However, if you think you can go into a hospital, pay your deductible and have no other healthcare related bills, you be in for a surprise. If we look back at the previous paragraph, we can see nothing about doctor services or outpatient services.

Unless the doctor is an employee of the hospital, the doctor fees will be billed under Medicare Part B. In that case, you are responsible for a 20% co-pay. Now, there can be a lot of confusion over who is or who is not an employee of the hospital. One of the easiest ways to break it down is this: if you are billed for services directly from the hospital, it should be covered under Part A.

If you receive a separate bill from your doctor, anesthesiologist or any other medical professionals, they will be covered under Part B and you will be responsible for the co-pay.
Your hospital status, inpatient or outpatient, determines which Part will pay for the services provided. Your doctor must formally admit you to the hospital in order for you to be considered “inpatient”. Part A will pay if you are admitted into the hospital. Otherwise, Part B will cover your services and you are now responsible for the 20% copay. These includes Emergency Room visits that you are not admitted, even if kept overnight for observation.

For skilled nursing facility stays, Medicare covers the first 20 days at no cost to you. After that, your daily copay in 2019 for days 21- 100 will be $170.50.

While this does seem like a lot to pay, Medigap and Medicare Advantage plans help cover these costs. For more information on these plan, contact an AHIC agent today.