Medicare Part A (Hospital Coverage)
Original Medicare includes two parts, Medicare Part A hospital insurance coverage & Medicare Part B medical insurance coverage.
Medicare includes Part ABCD, each part of Medicare covers different types services and has different benefits.
Below we’ll discuss what Medicare Part A is, who’s eligible, what it covers, when to sign up and end with answers to some frequently asked questions.
What is Medicare Part A?
The federal government provides Medicare Part A health insurance to U.S. citizens, as well as legal immigrants, who’ve resided in the country for a minimum of 5 years.
Medicare Part A includes coverage for inpatient care services received during a hospital stay or services received in a skilled nursing facility. In some cases, you may receive coverage for at home care.
Who is Eligible for Medicare Part A
Most citizens meet the Medicare Part A eligibility requirements at age 65. Usually you become automatically eligible once you’ve reached the age of 65 and are receiving benefits from the Railroad retirement board or the Social Security Administration.
If you have a disability, End Stage Renal Disease or Amyotrophic Lateral Sclerosis, you may be eligible before you turn 65.
What Does Medicare Part A Cover?
Medicare Part A coverage benefits include:
- Inpatient hospital care: Part A Medicare hospital coverage might include benefits for care you receive at an inpatient mental health hospital, long term care hospitals, critical access hospitals and acute care hospitals. It also may include coverage for semi-pricate rooms, nursing services, meals and some prescription drugs.
- Skilled Nursing Facility care: you might receive coverage for daily skilled nursing care if medically necessary as well as coverage for a semi-private room, meals, medical supplies, transportation via ambulance and prescription drug medications.
- Home health services: Coverage for services such as at home skilled nursing care, part time home health care, therapeutic services, physical therapy and occupational therapy.
- Hospice care (more information below)
What Does Medicare Part A Not Cover?
Medicare Part A does not cover extras like private duty nursing or private hospital rooms, unless they’re medically necessary. Part A will help you pay for medical care in a long-term care facility, but not custodial care such as help with bathing and feeding.
Medicare Part A Benefit Chart 2018
|wdt_ID||Service||Benefit||Medicare Pays||You Pay|
|1||Hospitalization, per benefit period*. Hospitalization includes semiprivate room and board, general nursing, and miscellaneous hospital services and supplies.||First 60 days
61st to 90th day
91st and after: (Reserve Days)**
Beyond 150 days
|All but $1,340
All but $335 per day
All but $670 per day
$335 per day
$670 per day
|2||Posthospital: Skilled Nursing Facility Care, per benefit period*. You must have been in a hospital for at least three days, enter a facility approved by Medicare within 30 days after hospital discharge, and require skilled care.||First 20 Days
21st thru 100th day
101st day and after
|100% of covered services
All but $167.50 per day
$167.50 per day
|3||Blood||Unlimited during a benefit period if medically necessary||All but first 3 pints; 3 pint deductible needs to be met only once per calendar year as an inpatient and/or outpatient||Cost of first 3 pints|
|4||Hospice Care||For as long as doctor certifies need||All but limited costs for outpatient drugs and inpatient respite care||Limited cost-sharing for outpatient drugs ($5 copay) and inpatient respite care (5% copay). These rates apply to hospice care outpatient drugs only. All other services are covered as described in your carrier plan materials|
|1||A Benefit Period begins on the first day you are admitted to the hospital and ends after you have been out of the hospital or skilled nursing facility for 60 consecutive days.|
|2||Once you have been hospitalized for 90 days, Medicare will provide you with 60 reserve days. Each reserve day can only be used once during your lifetime. Medicare will pay all but $658 per reserve day.|
What is the Medicare Part A Deductible?
The Medicare Part A deductible is listed in the benefits chart above.
Medicare Part A deductible works like many other health insurance policies in that you must the deductible and pay a portion of your costs, known as “coinsurance.
These costs are based on “benefit periods” which begin on the day you’re admitted to the hospital and end when you haven’t had inpatient care for 60 days in a row.
You can minimize Part A’s out of pocket costs by signing up for one of the 10 Medicare Supplements, also known as Medigap plans.
All supplement plans reduce your out of pocket costs for deductibles, coinsurance and copayments.
The majority of Medicare beneficiaries sign up for a Medicare Supplement plan as soon as they’re enrolled in both Medicare Part A and B.
By doing so, they receive piece of mind knowing most, if not all, of their medical costs will be covered. Fill out the form you see to the side to compare rates in your area or call the number above for more information on supplement plans for Medicare.
When Can I Sign Up for Part A Medicare?
If you turn 65 and are already getting Social Security benefits, you’ll automatically be enrolled in Medicare Part A.
If you’re not automatically enrolled, you can sign up for Part A during a 7-month period that begins three months before the month you turn 65, includes the month of your birthday and ends three months after.
If you don’t sign up for Part A during this 7 month time frame, you’ll have to wait until the next General Enrollment Period, which runs from January 1-March 31 each year.
If you pay a premium for Medicare Part A coverage, you may have to pay a late enrollment penalty. You may qualify for a Special Enrollment Period if you are covered by employer-sponsored insurance when you turn 65.
For more information on the different types of Medicare Enrollment Periods, click here.
Does Medicare Pay for Hospice?
If your primary physician has diagnosed you with a terminal illness that has a life expectancy of 6 months or less, you may be eligible for Medicare Part A Hospice Care coverage.
If a Medicare beneficiary is under Hospice Care, Part A may include additional benefits that are not normally covered for grief of spiritual counseling.
Hospice Care services are normally received in the patient’s home and includes some of the below benefits:
- Hospice services
- Physical or Occupational therapy
- Short term inpatient care
- Short term respite care
- Social services
Pain relief management
- Nursing Care
- Doctor Care
- Medical supplies
Does Medicare Cover Palliative Care?
Palliative care is included with your hospice care benefits.
As stated above, you may be eligible for a palliative care if your doctor has diagnosed you with a terminal illness with a life expectancy of six months or less.
Coverage will include treatments for pain management and treatments to make you as comfortable as possible. However, you’ll be required to give up all other medicinal services.
Is Medicare Part A Free?
Most people don’t pay a monthly premium for Medicare Part A hospital coverage.
Medicare Part A is free at age 65 if you’re eligible for (or already receiving) Social Security benefits or Railroad Retirement Board benefits, or if you or your spouse had government employment covered by Medicare.
If you didn’t pay 40 quarters of Medicare taxes while you were working, you may have to pay a premium for Part A Medicare coverage.
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