Medicare Part A
Medicare is divided into four parts: Part A, B, C, and D. Each part covers different services.
Part A is your hospitalization. It will cover you for your hospital stay and services received while admitted to the hospital.
Details for Part A
- Part A covers hospital care if you are formally admitted and require a stay longer than two nights.
- Your treatment must be medically necessary and must require in-patient care.
- There is no premium for Part A if you have been a legal resident of the U.S. for at least five years and have earned 40 Social Security credits.
- Part A has a deductible of $1,316 per benefit period.
- If you do not qualify, you may obtain coverage by paying a premium of up to $413 per month.
The Part A “benefit period” is not a calendar year. It begins when you are admitted as an inpatient to a hospital, long-term care facility, or skilled nursing facility. It ends when you have not received in-patient care for 60 consecutive days. After the 60 days, a new benefit period begins, and you are subject to another $1,316 deductible. You also then begin at day 1 for hospital coverage and have 60 days of care without a co-pay. You may have more than one benefit period per year.
In summary, Part A:
- Covers you for in-patient hospital care.
- Has no premium if you qualify.
- Has a $1,316 deductible per benefit period.
- May have more than one benefit period in a year and you may have to pay more than one deductible in a year.
- Does not cover emergency room care.
Hospital Care
After your deductible is met, there is no co-pay your first 60 days in a hospital. Days 61–90 there is a $329 per day co-pay. After 90 days in a benefit period, you are entitled to 60 ‘‘Lifetime Reserve Days.’’ These have a co-pay of $658 per day. Beyond your “Lifetime Reserve Days,” the patient is responsible for all costs.
Long-Term Care
Not to be confused with long-term care insurance, long-term care is subject to the same limitations and charges as acute care. The number of days listed in the Hospital Care section is a total of your combined stay in a hospital or other covered facility.
Skilled Nursing Services
Medicare Part A covers services provided in a “skilled nursing facility.” This would include physical and occupational therapy and speech pathology services. Medication, medical supplies, and equipment needed while you are an in-patient are also covered.
The first 20 days per benefit period in a skilled nursing facility are paid at 100% for covered services. For days 21–100, there is a charge of $164.50 co-pay per day. Days 101 and after are the full responsibility of the patient.
Homecare
Medicare Part A and Part B together cover homecare if your doctor has certified that you are homebound and that your treatment is medically necessary. Physical therapy, speech pathology, or occupational therapy may be covered. Your condition must be expected to improve within a certain period of time. The services provided must require a skilled therapist and the associated agency must be Medicare-certified. Medicare does not cover 24-hour care.
Hospice
Hospice care is provided for patients who are terminally ill and have opted not to seek curative care. The focus is on comfort, not curing an illness. Drugs to make you more comfortable, counseling and medically necessary supplies are covered. Most hospice services are provided in the home.
Medicare Part A provides a long list of services that almost all retirees will require at some point as they age. We are most fortunate to have it available when we need it.
Medicare might be getting an overhaul. What parts would you like to see changed? Please leave a comment. I’d love to hear from you.
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