Medicare Part A is hospital insurance that covers your room and board when you are admitted to an inpatient acute care hospital, an inpatient mental facility, or an inpatient rehabilitation facility. Part A provides benefits as long as you meet one of the following requirements:
- A licensed physician provides your care
- Required care is provided in a hospital or clinic setting
- Treatment is medically necessary
- Medicare has designated and approved the participating hospital or clinic
Who Is Eligible For Part A?
You are eligible for Medicare Part A at no cost if you are a citizen of the United States or if you have been a legal resident of the United State s for at least five years.
Additionally, you may be eligible if you have received Social Security Disability Insurance for at least 24 months. You may apply in the 25th month and your coverage will usually take effect by the 30th month of your disability.
There is an exception for you if you have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s Disease. With this condition, you would be eligible for Medicare in the first month you are entitled to Social Security Disability Insurance (SSDI).
Is There a Premium for Part A?
At 65, you are eligible to receive Medicare Part A at no cost if you have worked at least 10 years, or 40 quarters. These quarters do not have to be consecutive. If you haven’t accumulated enough quarters, you may be eligible to qualify if you have a spouse, whether living, deceased, or divorced, who receives, or is eligible to receive retirement benefits.
For example, we had a client turning 65 who had not worked enough quarters and wasn’t qualified to receive Part A at no cost based on her own employment record. Her husband, however was 63, and eligible to receive retirement benefits, so she was able to receive Part A based on his employment record and retirement benefit eligibility. Another client, in almost the same position except that her husband was only 59, wasn’t so fortunate. She found that she would not be eligible to receive her Part A coverage at no charge until her husband reached the required minimum retirement age of 62 for being able to begin his Social Security benefits.
If you haven’t met any of the listed conditions to be eligible for premium-free Part A, you may purchase the coverage with the cost based on your work history.
What Does Medicare Part A Cover?
Medicare Part A, your hospital insurance, covers the following inpatient hospital services
- Inpatient hospital care
- Semi-private room (If a private room is deemed medically necessary, Medicare will cover the charge. If you insist on a private room when it isn’t required, Medicare will pay the semi-private room rate and you will be responsible for the difference.
- General nursing provided by licensed registered nurses
- Care provided by interns or residents of an approved teaching hospital
- Hospital services and supplies
- Hospital operating rooms, recovery room, and anesthesia
- Drugs administered as part of inpatient treatment
- Rehabilitation services
- Skilled nursing facility care (not long-term care)
- Home health care
- Hospice care
- Blood (after the first three pints),
Medicare Part A will also cover inpatient services in a psychiatric hospital with a lifetime maximum of 190 days. If you are already hospitalized in a psychiatric hospital when you turn 65, the lifetime maximum is reduced to 150 days and the days already spent will be counted against the 150-day maximum.
What Doesn't Part A Cover?
- Private duty nursing
- Private room (Unless the doctor requires it as medically necessary
- In-room television and phone (If billed separately from the room charge)
- Personal care items (slippers, socks, razors)
- Routine dental, vision, hearing, and foot care
- Long-term care which is custodial in nature
- Alternative medicine
- The first three pints of blood (A donation you make or one made on your behalf would waive the blood deductible
- Physician’s and surgeon’s services (These are covered under Part B)
Sometimes, after a discharge from a hospital, you may need ongoing care which can be provided in your home rather than in a skilled nursing facility. Medicare Part A covers these expenses provided you meet the following conditions:
- Your care must be part of a formal health care plan certified by your doctor
- Your care must be part-time
- You must be confined at home except for travel to your doctor’s office or to religious services
- Your home health care provider must be a participating agency approved and certified by Medicare
- Physical, occupational, and speech therapy
- Part-time services of a home health aide to administer medications or change dressings
- Medical social services
- The use of certain medical equipment such as wheelchairs or hospital beds (A 20% coinsurance may apply for these items as this benefit falls under Medicare Part B)
If your doctor certifies you as terminally ill (with a life expectancy of not more than six months, Medicare Part A will pay for hospice care. The cost is covered in full except for a 5% copayment for prescription medication (with a maximum copayment of $5.00) and a 5% copayment for inpatient respite care so that caregivers may receive a break from continual care. The total copayment is capped at the current Part A deductible of $1408.
While in hospice, you and your family may receive:
- Care provided by nurses and physicians
- Medical social services including grief counseling
- Drugs for the control of pain
- Home health aide services
- Short-term inpatient care for the control of pain or to provide respite care
If you are admitted to a nursing home for care that is custodial in nature, Medicare typically pays nothing. Medicaid may pay nursing home expenses but only after you have spent down your own resources to the point where you are at the poverty level.
2020 Deductibles for Part A
2020 Part A Hospital Coinsurance
- Days 1-60: $0.00 Coinsurance. After you satisfy the $1408.00 benefit period deductible, Medicare pays for all covered inpatient expenses.
- Days 61-90: $352.00 Coinsurance per day
- Days 91-150 $704.00 Coinsurance per day for these lifetime reserve days. You have only 60 lifetime reserve days to use over the course of your life. Once you have used these 60 days, you are responsible for the total cost of your hospital care for any hospital stay exceeding 90 days.
2020 Part A Skilled Nursing Facility Care Coinsurance
- Days 1-20: $0.00 Coinsurance
- Days 21-100: $176.00 Coinsurance per day
- Over 101 Days: You are responsible for all cost
A review of the deductibles and coinsurance required by Medicare Part A reveals that there are many substantial gaps in the coverage Medicare provides. And the worst news is that Original Medicare has no maximum out-of-pocket!
All these gaps can be filled with a Medicare Supplement (Medigap) insurance policy. To speak with a licensed agent about how you can be protected from these unpredictable costs, contact us at (888) 860-1002 for a FREE consultation. As an independent insurance broker, we are licensed and appointed with all the major carriers and can recommend a policy that will cover these expenses at an affordable cost. Our services are always free and we track your premiums annually to monitor increases so that we can always keep you with the lowest-cost provider.
It’s our job to keep an eye on that so you don’t have to.