Medicare Part A
What Medicare Part A covers?
Medicare Part A is also referred to as hospital insurance. It is going to help provide coverage for inpatient care in hospitals, skilled nursing facilities, hospice care and home health. The way coverage is provided under Part A sometimes gets misunderstood, so we are going to break down each of these sections of coverage and explain exactly how coverage is provided.
Inpatient Hospital Care: Inpatient hospital care is going to provide coverage while admitted as a patient in a hospital. This provides coverage to all services provided while admitted. Medicare will cover semi-private rooms, meals, nursing, drugs, and other hospital services and supplies. Medicare will cover up to 90 days per benefit period, with an additional 60 days of lifetime reserve. Along with 190 lifetime coverage at a psychiatric hospital.
Skilled Nursing Facility Care: Skilled Nursing care is going to provide coverage after you have had a 3-day hospital stay and a physician decides you need daily skilled care before going home. Medicare will cover: semi-private room, meals, skilled nursing care, physical therapy, occupational therapy, speech-language therapy, medical social services, medications, medical supplies, ambulance transportation, and dietary counseling. Medicare will cover up to 100 days for a benefit period.
Hospice Care: Hospice care is going to provide coverage after you have been certified as terminally ill (6 months or less life expectancy). With hospice care, you will have coverage for doctors services, medical services, durable medical equipment, therapy services, social services, respite care, and other services that covered under Medicare to help with managing pain related to terminal illness.
Home Health Services: Home Health Services will fall under Part A coverage if you have had a 3 day hospital stay or get discharged from a Skilled Nursing Facility and it is recommended for you to have home health services provided then they can provide the following services: Medically necessary part-time skilled nursing care, physical therapy, occupational therapy, speech-language services, medical social services, injectable osteoporosis drugs for women, durable medical equipment, medical supplies
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Who Qualifies for Medicare Part A
People who are 65 or older that are citizens or permanent residents of the United States are eligible for Part A.
People under 65 that are entitled to Social Security Disability for 24 months, have ALS, or have ESRD are entitled to Part A as well.
How to Apply for Medicare Part A
Applying for Part A can happen a couple different ways.
Automatic enrollment:
Automatic enrollment happens when you are already drawing Social Security or Railroad Retirement and will become active the 1st of the month of your 65th birthday month.
Manual enrollment:
Manual enrollment happens when you are not drawing Social Security or Railroad Retirement, you can do this by going to social security website, calling social security, going in person, or mailing social security your application. If you are not staying on a group plan you should plan to start this process about 3 months before your birthday.
How Much does Medicare Part A cost
Medicare Part A for most individuals will have a $0 monthly premium. However if you do not have 40 working quarters in your lifetime (10 years of paying Medicare taxes) then you will have premiums to have Part A coverage. To qualify for premium free Part A, you or your spouse must have the 40 working quarters.
Part A Monthly Premium:
40 or more working quarters: $0 monthly premium
30-39 working quarters: $278 monthly premium
Less than 30 working quarters: $506 monthly premium
Medicare Part A will have other expenses than monthly premium (if you don't qualify for premium free Part A).
Part A Deductible: The Part A deductible in 2024 is $1,632 per benefit period. A benefit period for hospital coverage is 60 days. So, every 60 days your Part A deductible resets.
Inpatient Care costs:
Day 1-60: $0 after the $1,632 deductible.
Day 61-90: $408 Each day
Day 91-150: $816 Each day while using your 60 day lifetime reserves.
After day 150: You pay all costs. If you have used your 60 day lifetime reserves, then you pay all costs after day 90.
Skilled Nursing Facility:
Days 1-20: $0 copay
Days 21-100: $200 Each day
After day 100: You pay all costs.
Hospice: Hospice care has no expense.
Drugs: Copay of $5 for outpatient drugs for pain.
Inpatient respite care: can be up to 5%
Room and Board: You pay expenses related to nursing home costs.
What Medicare Part A Doesn't Cover
We talked about all the services Medicare covers above, so lets go into the nuances within those coverages about what is not covered.
Inpatient Hospital Care: Medicare provides coverage to most services provided while admitted to a hospital, but there are a few things they will not provide coverage to. Medicare will NOT provide coverage for a private-duty nurse, a private room (unless medically necessary), a TV or phone in your room (if separate charges), or personal care items.
Skilled Nursing Facility: Medicare will provide coverage to most services while in a Skilled Nursing Facility. Medicare will NOT provide coverage for a private room, long term care, or assisted living facility.
Hospice: Medicare will provide all the covered services related to illness, but will NOT provide coverage for treatment of the terminal illness, prescriptions to help cure terminal illness, care from providers not set up by hospice medical team.
Home Health Services: While, Medicare provides coverage for this it is in a limited way. Medicare will NOT provide coverage under this service for 24 hour a day care at home, meals to your hours, cleaning services, custodial or personal care with daily activities of living.