Medicare Part A – Hospitalization Coverage
By Scott Snider
key takeaways
Medicare Part A is automatically provided if you are age 65 and enrolled in Social Security or Railroad Retirement benefits.
You have a 7-month window to enroll in Medicare Part A if you are not enrolled in social security or railroad retirement benefits
Medicare Part A has no monthly premiums for most people
Medicare Part A covers in-patient care in the hospital, skilled nursing facility care, home health care, and hospice care.
With the second installment of our Medicare blog series, this article will be overviewing Medicare Part A, commonly referred to as hospitalization coverage. Note that there are many components to Medicare, and some of those components are intertwined. So, if you are interested in getting the full picture, we suggest you refer to our Medicare blog series page to keep up with the details you need.
How to Get Coverage
For some, getting Part A coverage is easy because it is automatically provided if you are age 65 and already enrolled in Social Security or Railroad Retirement benefits. For those not receiving Social Security or Railroad Retirement benefits, you have a 7-month window to enroll – 3 months before your birth month, your birth month, and 3 months after your birth month. It’s important to be aware that if you miss the 7-month window you could be subject to premiums penalties (more will be covered on this later in our Medicare series with our Medicare Part B article).
The best part is that Medicare Part A has no monthly premiums for most people. If a person has 30 quarters or less of Medicare-covered employment the Part A premium is $499/month. If a person has 30-39 quarters of Medicare-covered employment the Part A premium is $274/month1. However, the “free part” for most comes with a caveat – the coverages offered by Medicare Part A are narrow and limited.
What Does Medicare Part A Cover?
In-patient care in a hospital
Skilled nursing facility care
Home health care
Hospice care
In-Patient Care
In-patient hospital care takes effect after you are formally admitted to a hospital by a physician. You are covered up to 90 days each benefit period and get 60 lifetime reserve days. For example, if you stay in a hospital for 100 days during your first benefit period, you use up 10 of your 60 lifetime reserve days. Therefore, if you have a second and separate benefit period of 160 days, 20 of those days would not be covered (90 each benefit period + 50 lifetime reserve remaining = 140 of days covered). Keep in mind that for the second benefit period to take effect, you must not have received in-patient care for a period covering 60 consecutive days.
In addition, in-patient mental care covers up to 190 days as a lifetime amount. This coverage includes care you get in acute care hospitals, critical access hospitals, in-patient rehab facilities, in-patient psychiatric facilities, and long-term care hospitals.
In situations when your doctor recommends services beyond the scope of what Part A covers, you will have to pay for some or even all the costs. Therefore, it’s wise to ask your doctor questions and double check which parts will be covered by Part A.
Medicare in-patient services include semi-private rooms, meals, general nursing, and other hospital services and supplies as part of your in-patient treatment2. It does not include private rooms (unless medically necessary), private duty nursing, TV or phone in your room when there is a separate charge for these items, and personal care items such as razors.
The following is a breakdown of the cost structure for Medicare Part A as it relates to inpatient care3:
$1,556 Deductible each benefit period
$0 co-insurance for days 1-60
$389 co-insurance per day for days 61-90
$778 co-insurance per day for each day past 90 (up to 60 reserve days)
100% of the costs for each day beyond the lifetime reserve days
Skilled Nursing Facility Care
For skilled nursing care, you are covered up to 100 days each benefit period if you qualify for coverage. Part A requires a 3-night in-patient stay at a hospital prior to being sent to the skilled nursing facility, and that this occur within 30 days of being admitted to the skilled nursing facility.
However, if the patient spent 3-nights at the hospital under observational status, then Original Medicare will not cover the skilled nursing stay. Observational status is often where the confusion lies and when patients are most surprised that they are left paying the bill. Medicare Part A also does not cover long-term care for people who only need assistance with the activities of daily living.
$0 co-insurance for days 1-20
$194.50 per day for days 21-100
100% of the costs for days 101 and beyond
Home Health Care and Hospice Care
In-home services are provided when you are homebound and need skilled care. This coverage is good for 100 days of daily care or an unlimited amount of intermittent care. In order to qualify you must have received at least 3 days of in-patient care at a hospital and must apply within 14 days of receiving home health care.
You qualify for Hospice care when your provider determines you are terminally ill and have a life expectancy of 6 months or less. The care is for comfort purposes only and cannot be used for curing your illness. In most cases, hospice care is provided at home, but it can be provided at other facilities such as a nursing home.
Both in-home and hospice services do not have co-insurance payments like you see with in-patient care and skilled nursing facility care.
Stay Tuned…
Coming up next with our Medicare blog series is Medicare Part B – Medical Insurance. If you care to get more in-depth information about Medicare, we recommend watching our Medicare video segment from The Retirement Continuum™ class recorded in 2020, here. Please note that the numbers are slightly outdated, but the overview and explanations are still applicable today.
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