Medicare Part A
What is Medicare Part A
Medicare in general is a health insurance system established by the US Government. Its purpose is to aid US citizens in paying the costs of their healthcare.
Medicare is broken up into 4 categories:
- Medicare Part A
- Medicare Part B
- Medicare Part C
- Medicare Part D
Medicare Part A is hospital coverage. It consists of yearly deductibles as well as coinsurance.
What is covered under Medicare Part A
In general Medicare Part A covers the following inpatient services: (these are a list of general services and is not an all inclusive list)
Hospital care
Hospital coverage includes facilities such as:
- Acute Care Hospitals
- Critical Access Hospitals
- Inpatient Rehabilitation Facilities
- Long-Term Care Hospitals
- Mental Health Care
- Inpatient Care as part of a qualifying Clinical Research Study
Medicare Part A covers the following hospital services while admitted as an inpatient: (these are a list of general services and is not an all inclusive list)
- Your meals
- General nursing
- Your drugs
- Other hospital services and supplies
Skilled Nursing Facility Care
Medicare Part A covers the following hospital services while admitted as an inpatient at a Skilled Nursing Facility: (these are a list of general services and is not an all inclusive list)
- Meals
- Skilled nursing care
- Physical and occupational therapy
- Speech-language pathology services
- Medical social services
- Medications
- Medical supplies and equipment used in the facility
- Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that aren’t available at the SNF
- Dietary counseling
Hospice
Hospice care is generally administered in your home and is for palliative care (for comfort) for your terminal illness and related conditions. It includes the following services if your doctor includes them in your plan of care:
- Doctor services
- Nursing care
- Medical equipment (like wheelchairs or walkers)
- Medical supplies and durable medical equipment
- Drugs for symptom control or pain relief
- Hospice aide and homemaker services
- Physical and occupational therapy
- Speech-language pathology services
- Social work services
- Dietary counseling
- Grief and loss counseling for you and your family
- Short-term inpatient care (for pain and symptom management)
- Short term respite care
- Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness, as recommended by your hospice team
Home Health Services
The following services are covered under Home Health Care: (these are a list of general services and is not an all inclusive list)
- Intermittent Skilled Nursing Care
- Physical Therapy
- Speech-language Pathology Services
- Continued Occupational Services
What is NOT covered under Medicare Part A
The following services are not generally covered under Medicare Part A: (these are a list of general services and is not an all inclusive list)
- Private-duty nursing
- Private room (unless medically necessary)
- Television and phone in your room (if there’s a separate charge)
- Personal care items, like razors or slipper socks
24-hour-a-day care at home - Meals delivered to your home
- Homemaker services
- Personal care
How do I qualify for Medicare Part A
There are several different ways you can qualify for Medicare Part A. The most common requirement is if you are a US citizen and you are 65 or older. However, being a US citizen age 65 or older is not the only way you can qualify to receive Medicare benefits. You may also qualify to receive Medicare benefits if you are under the age of 65 if you meet certain requirements. Certain disabilities, permanent kidney failure and other conditions can also make you eligible for Medicare benefits. You can always call your local Social Security administration if you need further assistance with Medicare Eligibility.
How much does Medicare Part A cost
Generally speaking having Medicare Part A will not cost you a monthly premium. As long as you or your spouse paid in to Medicare taxes while working your Medicare Part A premium would be satisfied. The following is a general outline of who would qualify for Free Medicare Part A:
Premium Free Part A
Over 65
- You already get retirement benefits from Social Security or the Railroad Retirement Board
- You’re eligible to get Social Security or Railroad benefits but haven’t filed for them yet.
- You or your spouse had Medicare-covered government employment.
Premium Free Part A
Under 65
- You got Social Security or Railroad Retirement Board disability benefits for 24 months.
- You have End-Stage Renal Disease (ESRD) and meet certain requirements.
Most of the time if you have to purchase Part A you will also be required to purchase Part B and you will have to pay a premium for both. Part A premiums can be as high as $458.00 per month for 2020.
For more information on Part A premiums you can visit the Social Security website at: http://www.ssa.gov/
What you can expect to pay for services under Medicare Part A
What you can expect to pay under Original Medicare Part A in 2020 for each benefit period:
Hospital care
- $1,408 deductible for each benefit period
- Days 1–60: $0 coinsurance per day
- Days 61–90: $352 coinsurance per day
- Days 91 and beyond: $704 coinsurance per each “lifetime reserve day” after day 90 (up to 60 days over your lifetime)
- All costs beyond lifetime reserve days
Skilled Nursing Facility Care
- Days 1–20: $0
- Days 21–100: $176 coinsurance per day
- Days 101 and beyond – All Costs
Hospice
- $0 for hospice care.
- You may be responsible for paying a copayment of no more than $5 for each prescription drug and other similar products for pain relief and symptom control.
- You may be responsible for paying 5% of the Medicare-approved amount for inpatient respite care.
- You will be responsible for your usual Part B deductible and coinsurance for your doctor’s services.
- Room and board is not covered by Medicare when you get hospice care in your home or another facility where you live.
Home Health Services
- $0 for home health care services
- 20% of the Medicare-approved amount for durable medical equipment
For more information on covered services and their related costs you can visit the Medicare website www.medicare.gov or refer to your Medicare and You Handbook.
