Medicare Part A
Medicare Part A is free for most people. But, if your work history doesn’t include paying Medicare taxes, you could be in a world of trouble.
The federal health insurance program is for people over 65. Some people with disabilities qualify.
Below we’ll discuss Part A. You’ll learn about eligibility, coverage, and enrollment. Then, we give insight into common questions about Medicare Part A.
You deserve to know, and we have all the details!
What is Medicare Part A – Hospital Coverage
Part A covers inpatient hospital care. Under certain conditions, home health and skilled nursing services also have coverage.
Most people will have premium-free Part A. But, some people will need to pay a premium. Buying Part A could cost up to $458 a month for those with less than creditable 30 work quarters.
Those with over 30 work quarters pay a reduced amount of $252 a month for Part A. Part A covers hospital and hospice care.
Part A is available to citizens and legal immigrants with at least five years of residency.
Who Qualifies for Medicare Part A
Most U.S citizens are eligible for Part A upon turning 65. If you can get Part A, you qualify for Part B. Many people have Medicare due to disability.
You’re eligible for premium-free Part A after two years of disability benefits. Also, if you or your spouse has Medicare-covered government employment, you get premium-free Part A.
Those with Amyotrophic Lateral Sclerosis don’t wait two years; benefits begin immediately and automatically. Those with End-Stage Renal Disease can apply upon diagnosis, but Medicare enrollment isn’t automatic.
Who Pays for Medicare Part A
Sometimes Part A costs money. If you don’t pay your Medicare taxes for ten years or 40 work quarters, you’ll have a premium.
Let’s go over, who pays the Part A premium and how much it’ll cost.
Ten years is about 40 work quarters. Paying in for at least 7.5 years can count for something.
Thirty work quarters are 7.5 years; if you pay Medicare taxes for that, your premium is $252 each month.
Those with less than 7.5 years of contributing to Medicare taxes have a premium of $458 monthly.
Then, of course, those that work at least ten years get premium-free Part A benefits.
When Can I Sign Up for Part A
You should sign up for Part A benefits three months before you turn 65. Even if you’re working past retirement, Part A is premium-free.
Plus, if the Part A deductible is less than your group insurance deductible, you’ll only have to pay Part A if inpatient in the hospital.
Of course, it depends on if you’re employer is large or small. When you work with a small employer, you may HAVE to get both Part A and Part B as soon as you’re Medicare eligible.
It’s best to talk to the benefits administrator at your place of employment to figure out your options.
What Does Medicare Part A Cover 2020
Part A covers inpatient services, and most of the care you get during a stay in the hospital. But, Part B pays the doctors a percentage of the cost to take part in your care.
Examples of Part A Services Covered in an Inpatient Setting:
- Hospital meals
- Semi-private room
- Special care units
- Drugs, Supplies, and Equipment
- Lab tests and X-rays
- Operating room and Recovery room
- Rehabilitation services during your stay
- Some blood transfusions
- Hospice Care
- Skilled Nursing care on a part-time basis
Part A won’t cover a private room, private nursing, personal care items, or a television. After the deductible, Medicare pays the first 60 days of your benefit period in full.
For days 61-90, you must pay a daily $352 hospital coinsurance. Then, Medicare will cover up to 60 extra lifetime reserve days.
For days 91 and beyond, the coinsurance is $704 per day. After 60 days over your lifetime benefit, ALL costs are your responsibility.
To start a new benefit period, you must stay out of the hospital for at least 60 consecutive days. Further, beginning another benefit period means paying the Part A deductible again.
Tip: Supplement Plans A through L cover the Part A coinsurance and give you up to an extra 365 lifetime reserve days. Then, Plans B through N cover the full hospital deductible!
Medicare Part A Inpatient Deductible 2020
As of 2020, the Part A deductible is $1,408. The Medicare Part A deductible benefit period begins when you become an inpatient in the hospital.
Then, the benefit period continues until you’ve been hospital free for at least 60 days. Any care in a skilled nursing facility after your hospital stay counts toward the benefit period.
Every time a new benefit period starts, you must meet the Part A deductible.
Tip: Medigap plans help cover costs associated with Medicare.
Hospital Stay Without Paying the Medicare Part A Deductible
Many seniors want to know if they can stay in the hospital without paying a Medicare Part A deductible. Hospitals and inpatient facilities cannot refuse to provide treatment.
Beneficiaries needing inpatient care have access, whether they’re able to pay or not. Your protection comes from The Emergency Medical Treatment & Labor Act.
Hospitals can’t demand that you pay the Part A deductible or make a payment before treatment. If Part A benefits run out, the hospital might apply a prepayment plan.
A similar policy is available for patients that don’t have health insurance. Policies of this nature vary depending on the hospital.
Talk to the hospital’s billing department about inpatient services. The billing specialist can tell you about your plan throughout your hospital stay.
You should never be uncomfortable obtaining care and treatment due to a lack of payment. Your insurance deductible is the amount you pay before your plan pays for your medical costs.
Once you meet the deductible, the plan covers the remaining expenses. It’s common to see a doctor many times or get several services before reaching the plan deductible.
Common FAQ’s About Medicare Part A
Can a Hospital Force Me to Leave?
While living in an inpatient facility, you can appeal if they decide to discharge you before you’re ready. Are you unhappy with the discharge date?
Request an appeal through the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO).
Within two days of your admission, the hospital must give you a notice as an Important Message (IM). The IM is to inform you about your rights under Medicare.
The IM is a notice containing contact info for the BFCC-QIO and directions on how to request a fast appeal. If you follow instructions, the hospital can’t force you to leave.
What is the Difference Between Medicare Part A vs. Part B?
Part A covers your medical costs while in the hospital, Part B covers your medical expenses at the doctors’ office.
Does Part A Cover Colonoscopy?
A Colonoscopy takes place in an outpatient setting. So, while Medicare covers the service, it’ll likely fall under a Part B service.
Though, if your colonoscopy takes place in an inpatient setting, Part A benefits will apply.
Does Medicare Part A Cover Palliative Care?
Palliative care is part of hospice. Eligibility is possible; but, you must have a diagnosis of terminal illness with an expectancy of six months or less.
Coverage will include pain management and treatments to make you as comfortable as possible. But, you must give up all other medicinal services.
How to Compare Medicare Plans Online
Are you confused about inpatient vs. outpatient? Do you find choosing a policy difficult? We understand!
Working with clients like you each day, we know how confusing Medicare seems. Our agents can help simplify the information and show you the best options.
We can even walk you through the application process over the phone. An agent will ask you a few questions about doctors, prescriptions, and insurance preferences.
Then, your agent will discuss the best plan options for you available in your service area. There are many plans and companies, don’t waste time calling each one individually.
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