Original Medicare Part A Overview: Coverage & Premium
What is Medicare Part A?
To put it simply, Part A of Medicare is your hospital coverage. It will provide you with all the affordable inpatient care that you need in case something happens. A question you may want to consider, or may be considering already, is “when it comes to inpatient care, what exactly is included in Medicare Part A?”
It is easiest to consider it your “room and board” while you are hospitalized as an inpatient.
This means that it will cover your semi-private room with a bed, and all your regular meals while you are at the hospital during your stay.
Medicare Every state and insurer is required to offer MediGap plan A (sometimes under a different name). It is important to remember that this is Plan A NOT Part A will also cover any medications that have been administered to you by the hospital, along with any necessary lab services or medical supplies used for your treatment.
There are many different places where you can get your inpatient care and take advantage of your health benefits.
Some of these places will include an acute care hospital, a hospice care facility, a critical access hospital, and even an Inpatient Rehabilitation facility.
You need to know what it will cover and more importantly, what it won’t cover. This way, you can be prepared for any expenses that you may be liable for.
It will also help you understand if you need Medicare Part B, C, or D to further any medical expenses or any future healthcare you may need.
What Does Medicare Part A Cover?
- Inpatient Hospital Care: This is the care you will receive when you’re admitted to the hospital. With this, you’re covered up to 90 days for each benefit period and an additional lifetime reserve of 60 days. It will also cover up 190 lifetime days for any approved psychiatric hospital.
- Skilled Nursing Facility Care: This covers room, board, and other specific services you may need. You’ll be covered for 100 days for each benefit period, although you will begin to pay a copayment beginning on day 21 ($185.50 per day in 2021). You must spend at least three consecutive days at the hospital and 30 days of admission to a nursing facility to qualify for these services.
- Home Healthcare: You can received intermittent skilling nursing care, as well as services from physical, speech, or occupational therapists. Home healthcare services must be ordered by your doctor, and you must remain under your doctor’s care throughout.
- Hospice Care: If your provider determines that you are terminally ill, you can receive hospice care under Medicare Part A. Your care is covered for as long as your provider says you need it. When it comes to your Medicare hospitalization coverage, Medicare Part A will cover things like post-hospital skilled nursing and even short-term post-hospital home healthcare. This is as long as it is deemed medically necessary by your provider. It covers Hospice Services, including counseling, social services, DME, and palliative care. This hospice coverage will also provide short-term respite care for any caregivers so they can rest. This will not only benefit your caregiver, but it will also help you as the person who is taking care of you will have a chance to recharge. This will allow them to serve you better in your time of need.
Part A of Medicare also provides some of the healthcare services received in the hospital or immediately following your inpatient day. This includes things like skilled nursing care, physical therapy, and medical social services. Keep in mind that when it comes to skilled nursing, while it is occurring in your home, the healthcare services are generally covered under this part of Medicare.
What if you exceed your 100 days of skilled nursing care, but still need continued services? Will Medicare cover long-term care?
Unfortunately, Medicare will not cover long-term care. This includes any extended stays in a nursing home or extended stays in the hospital. To help plan for such an occurrence, any long-term care you may want need, you’ll want to consider purchasing additional insurance to help with any of these long-term stays that you may have in the future.
Many people don’t realize that although it is your hospital insurance, it actually does not cover everything related to your hospital stay. Some of the things that you may think are part of Medicare Part A are actually under Centers for Medicare and Medicaid Services. Also known as CMS.
Both Medicare Part A and Part B, and one of these is outpatient surgeries. When it comes to inpatient for outpatient healthcare, it is always a good idea to consult with your Medicare broker or agent for any guidance when it comes to determining what your Medicare Part A will pay for. To put it simply, Medicare Part A is technically only your hospital-related care for the immediate or acute care of any injury or illness that you may sustain. It is not meant for any long-term health provisions.
What Does Medicare Part A Cost?
There are two factors to consider when looking at the cost: the premium and the cost-share that comes from deductibles and coinsurances.
What is the Premium?
For most people, there is no premium. The reason the premium is "free" is that you have been paying throughout your entire working life. If you did not work enough quarters to fund and qualify for premium-free, you will end up paying a monthly premium. Your premium will depend on the amount of quarters you worked.
What are the Costs?
Although it does not have a premium for most people, you will still be responsible for some cost-share for your hospital coverage (if you do not have additional coverage such as a Medigap or Medicare Advantage plan). The cost share includes the deductible of $1,484, as well as coinsurances for additional hospital days and skilled nursing care.
Is Part A of Medicare Free?
The short answer is, no. Those who qualify for premium-free will not pay a monthly premium. You’re probably think- wait you just said it isn’t free, but now you’re saying I don’t pay for it?! While this may sound like it is free, the only reason for this is that you would have already prepaid for your future health insurance by the time you can take part a Medicare, which is age 65 and older. This is because you have had taxes withdrawn that were taken out of your paycheck during your working years. These were specifically designed for your future hospital coverage during your retirement with Medicare. These taxes that you have paid will offset the cost of Part A later on when you enroll so you can use them.
To take advantage of this in your lifetime while in the United States, you would have had to work for at least ten years in your lifetime. This means you will have generally paid everything you need to into Part A. Consider it as a pre-paid insurance plan. When you enroll in, you will not have to pay anything additional for a monthly premium. If you do not have this excessive work history, you can purchase Medicare Part A as long as you have spent five years as a legal resident or this amount of time as a green cardholder.
You must have a have a minimum of 40 quarters paid in or you will have to pay for it. Premiums in 2021 are approximately $471 if you have less than 30 quarters or around $259 for those with 30-39 quarters of work history.
Now, although most people do not pay a monthly premium, this does not mean that you don’t still have some cost share with this plan. Both the Part A deductible and the coinsurances will be discussed below.
What is My Cost-Sharing?
With your coverage, you can rest easy that it will pay for a great deal of your healthcare and medical needs. However, there are some cost-sharing things that you will be responsible for.
Every year, the CMS will determine the deductible and any coinsurance you will be responsible for during the following year. These will be all the amounts you will have to pay when using your Part A benefits.
In 2021 you will be paying the following for your hospitalizations:
- There is a $1,484 deductible for every inpatient hospital stay per benefit period. If you go more than 60 days between hospitalizations, you will have to pay the deductible again.
- Every day from 61 through 90, you will be paying a $371 coinsurance for each of those days.
- For every consecutive hospital stay from day 91 through 150, there is a coinsurance of $742 for each of those days.
- At 150 days and over, you will be responsible for all costs that you have accumulated.
For any of your skilled nursing facility stays, it covers the first 20 days. There is a daily copay in 2021 in days 21 through 100 of $185.50. Fortunately for you, both Medigap policies and Medicare Part C, which is Medicare Advantage, will help cover these costs. Either type of plan you have will significantly lower your financial cost when it comes to your healthcare
When Do I Enroll?
If you are already taking advantage of any social security income benefits, then your enrollment in Medicare Part A (and Medicare Part B) will be automatic. Because of your social security enrollment, you will not have to take any additional steps to enroll in Medicare that you had already paid for. Usually, around 3-4 months before you turn 65, you will find your Medicare card waiting for you in your mail. You will also be automatically enrolled if you are drawing benefits from the Railroad Retirement Board.
If you are close to or turning 65, you may want to keep an eye on your mail so you can see when your card does show up. If you need to know what it looks like, it will be red, white, and blue and printed on heavy cardstock. Since cardstock is a little susceptible to liquids, and if you want to protect your card, you can laminate the card when you get it. That way, it can stay in good shape over the years of picking out your wallet or getting lost in the shuffle at the bottom of your purse. It will also save you time applying to get a new card that takes up valuable time that you don’t have.
When it comes to your Social Security income benefits or even the railroad retirement income benefits, if you are not receiving them yet, you will have to actively sign up by the time you hit 65.
The easiest and fastest was to apply for Medicare benefits is through the Social Security website. If you apply through your Social Security portal, you can both submit an application, as well as track the progress of your application. We have created a easy forwarding link that will take you to exactly where you need to apply for your Medicare benefits on the Social Security website- www.StartPartB.com
The other option for applying is to visit your local social security office. Currently, all Social Security offices are working remotely, so applying online is the most ideal situation. If not, you can call your local office and they will give you either a fax number to fax over your application, or an address to mail your application in.
Enrolling In Medicare Part A: A Quick Breakdown
Are you receiving Social Security Benefits?
- If YES:
- You’re automatically enrolled to become effective the 1st of the month of your birthday (unless you were born on the 1st of the month).
- You should receive your Medicare card within 3-4 months prior to your 65th birthday.
- If you do NOT want your benefits to begin when you turn 65 because you are covered under an employer group plan (your spouse’s or your own) you need to sign the back of your Medicare card and mail it back to Social Security to defer your Medicare Part B.
- If NO:
- You must actively apply through Social Security.
- If you are turning 65, you can applying during your Initial Enrollment Period, which is 3 months prior to turn 65, the month of your 65th birthday, and ends 3 months after your 65th birthday.
So Now You Know Everything!
Your healthcare is essential for continued well-being and your quality of life. While no one likes the idea of planning for the future, it’s necessary to take some time and do what’s essential to make your transition into your golden years as smooth as possible. Learning everything you can about your Medicare, in particular, Part A. This will help you make the appropriate decisions on whether or not you need to consider Part C or seek another type of supplemental insurance to cover any additional expense you may accrue.
You’ve spent years planning for your retirement. Knowing what Medicare covers and what it doesn’t will help you make the choices you need so you aren’t stuck with staggering medical bills in case something happens. Your senior years should be peaceful and lived to the fullest and not stressing how you will pay for your medical expenses.