Medicare Part A is the part of Medicare that covers inpatient hospital stays. It is part of, along with Medicare Part B, “original” Medicare and is often referred to as “Hospital Part A”. Part A covers services and supplies considered medically necessary to treat a sickness or a condition.
How Much Does Medicare Part A Cost?
Medicare Part A does not have a monthly premium in most cases. If you or your spouse have worked 40 quarters in the United States, you have paid in to “the system” through payroll taxes. Therefore, you’ll receive Medicare Part A at no premium once you reach age 65.
The people who get Medicare Part A at no premium include those who are already receiving Social Security benefits, those who are eligible to receive Social Security but have yet to file, and those who have had Medicare-covered government employment.
Most people, of course, get premium-free Part A. However, if you or your spouse did not work enough quarters and pay enough in payroll taxes to qualify for premium-free Medicare Part A, you can still purchase Part A if you choose to do so. Costs are high, though, at up to $411/month.
How To Sign Up for Medicare Part A
If you are already receiving Social Security, you will be automatically enrolled in Medicare Parts A and B, effective the first day of the month you turn 65. In other words, if you turn 65 on July 30, Medicare will start on July 1. The exception to this is if your birthday falls on the 1st day of the month. In that case, your Medicare will start one month prior (i.e. if you turn 65 July 1, your Medicare will start June 1). You should receive your “Welcome to Medicare” mailing, with your red, white and blue Medicare card approximately 3 months before your Medicare start date.
If you are NOT receiving Social Security yet, but are eligible to do so, you will still be automatically enrolled in premium-free Medicare Part A for the month you turn 65 but would have to contact Social Security (800.772.1213 or a local office) to add Medicare Part B.
What Does Medicare Part A Cover?
Medicare Part A covers primarily hospital and inpatient services. But, there are a few other covered services that fall under Part A also. Here is a list of what Part A covers:
- Hospital care – Medicare covers semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital supplies and services. Part A does NOT cover private-duty nursing, a private room (unless medically necessary), and personal care items while in the hospital.
Your Costs: Medicare Part A has a $1288 deductible per benefit period that must be met first unless you have a Medigap plan that covers this deductible. After the deductible is met, you have a $0 coinsurance for days 1-60. For days 61-90, you have a $322/day coinsurance. For days 91 and beyond, you pay $644/day coinsurance per each “lifetime reserve day”. You have up to 60 “lifetime reserve days” and pay all costs after those are used up. Keep in mind that all or most (depending on plan) of these gaps would be covered/filled by a Medigap plan if you have one. Both Plan F and Plan G pay everything Medicare does not pay under Part A.
- Skilled nursing facility care – Medicare Part A covers skilled nursing care provided in a skilled nursing facility (SNF) under certain conditions for a limited time. Medicare-covered services in a SNF include: semi-private room, meals, skilled nursing care, physical and occupational therapy, medications while there, medical equipment and supplies, and ambulance tranportation. NOTE: Medicare does not cover nursing home care, if it is only for custodial care. But it does cover care in a skilled nursing facility if it is medically necessary care.
Your Costs: You must meet the Medicare Part A deductible first ($1288). After that, days 1-20 are $0 coinsurance. Days 21-100 are $161/day coinsurance. For days 101 and beyond, you pay all costs. Keep in mind, again, that Medigap policies will pay all or most (depending on plan) of these gaps in Medicare.
- Hospice care – Medicare Part A covers all aspects of your treatment plan if you hospice, or palliative, care. This can include many things including doctor services, nursing care, medical equipment, prescription drugs for pain and relief, physical therapy, grief and loss counseling and many other things that are a part of your overall care plan created by your hospice team.
Your Costs: $0, except for occasional prescription drug co-pay of no more than $5. Keep in mind also that the hospice benefit does not include room and board if you get hospice care in your home or a hospice inpatient facility.
- Home Health Services – Medicare Part A does cover some care received at home, such as intermittent skilled nursing care, physical therapy, occupational services, and more. Typically, it will be a home health care agency conducting the care that has been ordered by a physician. Medicare does NOT pay for: 24 hours a day care, meals delivered to your home, homemaker services or personal care.
Your Costs: You pay $0 for home health care services. However, you are responsible for 20% of durable medical equipment.
Coverage for Medicare Part A does change from time to time. So it is important to stay apprised of any changes. All of the figures above are current for 2016 but are subject to change in future years. If you have questions or want updated rates/information, feel free to contact us online or call us at 877.506.3378.