Medicare Part A

What is Medicare Part A?

Medicare Part A is hospital insurance. It also pays for Skilled Nursing Facility (SNF) Care, Home Health Care, and Hospice Care.

Part A pays for the care you receive when you are admitted to the hospital or a skilled nursing facility.

Medicare Part A Covers:

A semi-private room
Your hospital meals
Skilled nursing services
Care on special units, such as intensive care
Drugs, medical supplies and medical equipment used during your hospital stay
Lab tests, X-rays, and medical equipment as an inpatient
Operating room and recovery room services
Some blood transfusions in a hospital or skilled nursing facility
Rehabilitation services
Home health care
Hospice care

How much is the Medicare Part A Premium?

Most people do not pay a monthly Part A premium. This is because they or a spouse has 40 or more quarters of paid Medicare taxes through employment.
About 99% of people with Medicare don’t pay Part A premiums.
However, if you purchase Part A, the premium is $458.00 per month.

Part A Deductible

The Medicare Part A Deductible amount in 2020 is $1,408 per each benefit period.
You may have to pay the deductible more than once per year. That’s why Medigap Plans are important.
A benefit period begins the day you are admitted in the hospital or skilled nursing facility. A benefit period ends when you have been out of the hospital or skilled nursing facility for 60 consecutive days.
Medicare Supplement Plan A is the only plan that does not pay for the Part A deductible. In addition, Plans K and M pay 50% of the Part A deductible. Plan L pays 75% of the Part A deductible. The rest of the Medigap plans pay 100% of the Part A Deductible.
Plans F and C are not available to new Medicare eligibles
Some employer group plans will pay the Part A Deductible
Part A Deductible tends to increase each year. It rose 3.2%, or $44, to $1,408 in 2020.
CMS determines the deductible amount.
Part A Deductible will likely be higher in 2021. Estimated to be $1,452 (up from $1,408 in 2020). The amount will be announced later this year.

Inpatient Hospital Care

Medicare covers up to 90 days each benefit period plus 60 lifetime reserve days in a hospital. It also covers up to 190 lifetime days in a Medicare-certified specialty psychiatric hospital.

Inpatient Hospital Copayment and Co-insurance:

$1,408 (2020) deductible and $0 co-insurance for days 1-60 each benefit period.
$352 (2020) per day for days 61-90 each benefit period but it is expected to be $363 in 2021.
$704 (2020) per lifetime reserve day after day 90 each benefit period (up to 60 days over your lifetime). Expected to be $726 in 2021.
All costs for each day after the lifetime reserve days.
Inpatient mental health care in a psychiatric hospital limited to 190 days in a lifetime.

Skilled Nursing Facility Care

Medicare covers up to 100 days each benefit period. Includes semi-private room, meals, skilled nursing and rehabilitative services. It also includes other services and supplies that are medically necessary after a 3-day minimum inpatient hospital stay for a related illness or injury. An inpatient hospital stay begins the day you’re formally admitted with a doctor’s order and doesn’t include the day you’re discharged. In addition, to qualify for care in a skilled nursing facility, your doctor must certify that you need daily skilled care like intravenous injections or physical therapy.

Skilled Nursing Facility Copayment and Co-insurance:

$0 for the first 20 days each benefit period.
$176.00 per day for days 21-100 but it is expected to be $181.50 per day in 2021.
All costs for each day after day 100 in a benefit period.
Medigap Plans A and B do not pay the co-payment.
Plan K pays for 50% of the co-payment.
Plan L pays 75% of the co-payment.

Home Health Care

To quaify for home health care, you have to be homebound. In other words, you are unable to leave your home without considerable effort or without the help of another person, wheelchair or a walker.
You have to be certified by a doctor, or by a medical professional such as a nurse practitioner. The certification must confirm that you are in need of intermittent occupational therapy, physical therapy, skilled nursing care and/or speech-language therapy.
That certification emerges from a documented, face-to-face meeting with the medical professional no more than 90 days before or 30 days after the start of home health care.
Your certification must confirm that you are under a plan of care that a doctor has established and reviews regularly. The plan should include the services you need and frequency. In addition, who will provide them, which supplies are required and the expected results from the doctor.

Home Health Care Copayment and Co-insurance:

$0 for home health care services
20% of the Medicare-approved amount for durable medical equipment

Medicare Does not Cover:

24-hour care at home
Custodial or personal care
Household services

Hospice Care

Hospice Care is for people with a terminal illness. Your life expectancy must be 6 months or less.

Medicare does not cover room and board for hospice patients who live at home, in nursing homes, assisted living facilities and also inpatient hospice facilities. Room and board is only covered during short-term inpatient or respite care stays.

Hospice Care Copayment and Co-insurance:

$0 for hospice care
You may need to pay a copayment of no more than $5 for each prescription drug.
5% of the Medicare-approved amount for inpatient respite care (short-term care given by another caregiver, so the usual caregiver can rest)

If someone decides to receive healing treatment for their terminal illness, then hospice care is no longer covered. Patients have the right to withdraw from hospice care at any time. They may also resume treatment at any time as long as they still meet all eligibility requirements.

How do I enroll in Medicare Part A?

If you receive Social Security benefits before you turn 65, you will automatically be enrolled in Part A the first day of the month you turn 65. However, if your birthday falls on the first day of the month, Part A will begin the 1st day of the prior month.

If you won’t be receiving benefits from Social Security or the Railroad Retirement Board at least 4 months before you turn 65, you will need to sign up with Social Security to get Part A.

You can enroll on the Social Security website. You can also visit your local Social Security office. In addition, you can call Social Security at 1-800-772-1213. If you are a railroad retiree, you can call the Railroad Retiree Board at 1-877-772-5772.