Medicare Part A Simplified:

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 In depth:

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?

You usually don’t pay a monthly premium for Medicare Part A (Hospital Insurance) coverage if you or your spouse paid Medicare taxes for a certain amount of time while working. This is sometimes called “premium-free Part A.”

Most people get premium-free Part A.

You can get premium-free Part A at 65 if:

• You already get retirement benefits from Social Security or the Railroad Retirement Board.
• You’re eligible to get Social Security or Railroad benefits but haven’t filed for them yet.
• You or your spouse had Medicare-covered government employment.

If you’re under 65, you can get premium-free Part A if:

• You got Social Security or Railroad Retirement Board disability benefits for 24 months.
• You have End-Stage Renal Disease (ESRD) and meet certain requirements.

Part A premiums

If you buy Part A, you’ll pay up to $458 each month in 2020. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $458. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $252 in 2020.

In most cases, if you choose to buy Part A, you must also:

• Have Medicare Part B (Medical Insurance)
• Pay monthly premiums for both Part A and Part B

Contact Social Security for more information about the Part A premium.

Some people automatically get Medicare Part A (Hospital Insurance).

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 2020, the Part A deductible is $1,408.  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 $352 / day copay
• 91-150 days patient pays $703 / 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 will 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 include 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 of the benefit period at no cost to you. After that, your daily copay in 2020 for days 21- 100 will be $176 / day, and all costs after day 100 of the benefit period. . 

Still needs assistance?

Still have questions or need assistance applying for your Medicare benefits? You are not alone, AHIC is here to help. If you would like someone to walk you through the process of applying for Medicare, shopping for a plan, then please click on the link below. Our services are at NO COST to you and we will be here to help you for the lifetime of your policy.