Medicare Part A is your hospital coverage. It provides you with affordable inpatient care. So what’s the definition of inpatient? Here at Boomer Benefits, we tell our clients to think of it as “room and board” in the hospital. It’s going to cover a semi-private room with a bed for you, and all your regular meals while you are there.
You may get your inpatient care at an acute care hospital, a critical access hospital, an inpatient mental healthcare hospital or at an inpatient rehabilitation facility.
What Does Medicare Part A Cover?
In addition to Medicare hospitalization coverage, Medicare Part A also covers post-hospital skilled nursing and short-term post-hospital home health care, so long as it is medically necessary. Part A covers hospice services which may include palliative care, DME, counseling, social services, short-term respite care and pain relief.
Part A also provides for some home health care services received in the hospital or immediately following an inpatient stay. This includes skilled nursing care, medical social services, and physical therapy. Home health aid services are generally only covered when skilled nursing is also occurring.
Medicare does NOT cover long-term care, such as extended stays in a nursing home. Individuals can consider purchasing long-term care insurance if this is something they want to plan for.
There are some things that you might think would fall under Part A but sometimes fall under Part B, such as outpatient surgeries. When it comes to determining if something is inpatient vs outpatient, it’s always a good idea to consult your Medicare insurance broker for guidance.
However, in general, what is covered by Part A is generally hospital-related for immediate or acute care of an injury or illness.
How Much Does Medicare Part A Cost?
Is Medicare Part A free?
Well, not exactly. Most beneficiaries will pay nothing for Medicare Part A at age 65 though because they have already pre-paid it. You see, we all pay taxes during our working years that are specifically for our future Medicare hospital coverage during retirement. These taxes go to offset the cost of Part A later on.
As long as you have worked for 10 years in your lifetime in the United States, you will generally pay nothing at all for Part A. If you do not have this work history, you can purchase Part A as long as you have been a legal resident or greencard holder for at least 5 years. Read more about the cost of Part A on our Medicare costs page.
If you do not have 40 quarters, you can pay for Part A. Premiums in 2019 are $437 if you have less than 30 quarters or $240 for people with 30 – 39 quarters.
When do I enroll in Medicare Part A?
Enrolling in Medicare Part A is automatic for people already taking Social Security income benefits. When this happens, you’ll open your mailbox 2 – 3 months before you turn 65 and find your card waiting for you.
You’ll want to keep your eye on the mail for your card. It is a red, white and blue card printed on heavy card stock. It is okay to laminate the card when you receive it so that it will stay in good shape over the years of being in your wallet or purse.
If you are not already receiving Social Security income benefits or Railroad Retirement income benefits yet, then you will need to actively sign up for Part A at age 65. You can do this at the Social Security website.
What is my Medicare Cost-sharing under Part A?
Your Medicare Part A coverage will pay for a great deal. However, you will have some cost-sharing as well that you are responsible for.
Each year CMS determines the Medicare Part A deductible and coinsurance that you will be responsible for during the following year. These are the cost-sharing amounts that you must pay when using your Part A benefits. In 2019, you will pay:
- a $1364 deductible for each inpatient hospital stay when you have not been in the hospital during the previous 60 days.
- $341 per day for days 61 – 90 of a consecutive hospital stay
- $682 per day for days 91 – 150 of a consecutive hospital stay
- Any and all costs for day 150 and beyond
For skilled nursing facility stays, Medicare covers the first 20 days. Your daily copay in 2019 for days 21- 100 will be $170.50. Fortunately, both Medigap policies and Part C Advantage plans will help cover these costs. Either type of plan will help you to significantly reduce your financial exposure.