Medicare is made up of four parts: Part A, Part B, Part C, and Part D. Many people getting ready to start Medicare, even people already on Medicare, don’t know exactly what all these parts cover. Part A and Part B are referred to as Original Medicare. These two parts together give a beneficiary great coverage. Part A is the first part of the puzzle that Medicare beneficiaries have to tackle. What does this cover, who is eligible, and how much does it cost? Read below to find out!
What does Medicare Part A cover?
Part A is hospital insurance. Overall, Part A covers inpatient hospital care, some home health services, skilled nursing care, and hospice in limited situations. All of these benefits are subject to the beneficiary meeting certain requirements
Hospital care coverage includes hospital expenses that are critical to your care, such as a semi-private room, meals, and medications. This care can be received through acute care hospitals, inpatient rehabilitation facilities, critical access hospitals, mental health care, and a few other qualifying facilities. Private room, personal care items, and private-duty nursing are some services that are not considered critical and therefore are not covered.
Medicare Part A does not cover the cost of blood. If the hospital has to purchase blood, you must pay for the first 3 units that you need each calendar year. A Medicare Supplement will normally cover this cost.
Part A also covers home health care services when deemed medically necessary and ordered by a doctor, who also must certify that you are home-bound. Home health care services may include part-time skilled nursing care, physical therapy, occupation therapy, etc. It does not cover 24-hour home care, meals, or homemaker services.
Skilled nursing facility stays are another service sometimes covered by Medicare Part A. To qualify for this coverage, you must stay at the facility for a minimum of 3 days and must be at a Medicare-certified facility. Your doctor must certify that you need these services and cannot receive them at home. It is very important to remember, Medicare does not cover long-term care costs. Many people on Medicare believe this myth, and when they need long-term care, a huge strain is put on their family and friends, who are trying to figure out how to pay for this care.
If your doctor certifies that you have a terminal illness with less than 6 months to live, you may be eligible for Part A to cover hospice care. You must agree to give up curative treatments for your illness to receive this coverage.
Who is eligible for Medicare Part A?
Anyone 65 or older is eligible for Medicare. If you have already been receiving Social Security benefits, or Railroad Retirement Board benefits for at least 4 month, you will be automatically enrolled in Medicare. For those automatically enrolled, the benefits begin the 1st of the month they turn 65.
If you are not automatically enrolled, you must enroll during your Initial Enrollment Period. This period lasts for 7 months: the 3 months before your birth month, your birth month, and the three months after your birth month. You file this application through the Social Security Office. Even if you already have coverage from work, filing for Part A is a good idea: it costs you nothing and will cover gaps your work policy may have.
If you do not qualify for premium-free Part A, you must enroll during your Initial Enrollment Period. If not, you could be subject to a late-enrollment penalty which will be added onto your Part A premium once you do sign up. There are Special Enrollment Periods where this penalty might not apply, such as losing work coverage.
The disabled are also eligible for Part A coverage. This coverage will begin after receiving Social Security disability benefits for 24 months.
If you have ALS, you are eligible for Medicare Part A the same month that your Social Security disability benefits begin.
If you have end-stage renal disease and require dialysis, you are eligible in the fourth month of your dialysis treatments. In this situation, you must apply for Medicare if you are younger than 65.
What does Part A cost?
Medicare Part A is typically referred to as premium-free, as it is for most people. As long as you or your spouse paid Medicare payroll tax for at least 40 quarters (basically 10 years). The rare few who do not qualify have to pay a premium for Part A, an amount which depends on the number of quarters they paid Medicare taxes. Currently, it is $422 a month if you have worked fewer than 30 quarters. If you have worked 30-39 quarters, it is $232 in 2018. Typically when purchasing Part A, you must purchase Part B as well.
Part A has a deductible of $1,340 in 2018. It is not annual, but applies to every benefit period. A benefit period begins at admission and ends when the beneficiary has been discharged from the hospital for 60 days. There are also coinsurance and hospital costs which beneficiaries must pay after a certain amount of days. The deductible and coinsurance are both covered by most Medicare Supplement policies.
Part A is just one part of the Alphabet soup of Medicare. If you have any questions about Part A, or any of the other parts, fill out the form below or call Cardinal Advisors at 919-535-8261.