What is Medicare Part A

Medicare Part A:

What is it: Part A or known as “Hospital Insurance” is the driving component of Original Medicare (Part A and Part B).

Is health insurance provided by the federal government to U.S. citizens and legal immigrants who have permanently resided in the U.S. for at least 5 years.

What does it cover:

Medicare Part A covers:

  • “Inpatient” care. Must be admitted as an “inpatient” to a Medicare recognized health facility for a medical necessary need.
  • Skilled Nursing. Prescribed by a physician after a qualified Medicare Part A stay. 1st 20 days are covered. Costs are graded after day 20.
  • Hospice Care. For those who have been diagnosed with a terminal illness that will last for 6 months or less.
  • Home Healthcare. Must be prescribed by a physician for those who are considered to be “homebound”.

Eligibility:

Part A is available to all U.S. citizens who qualify for coverage. Qualifying is being employed for 40 quarters (10 years) and attaining the age of 65 years old.

Part A is also available for those who have not reached age 65 years old but are defined as disabled or who have End-Stage Renal Disease (ESRD).

For legal immigrants who have resided in the United States for a minimum of 5 years are eligible to purchase Part A coverage.

Costs:

Premiums:

Medicare Part A is considered to be premium free for those who have been employed for 40 quarters. For those who have not qualified or for those legal immigrants Medicare Part A costs are as follows:

  • For those who only have 30 quarters: $252.00 a month.
  • All others who are under 30 quarters: $458.00 a month

Other Costs:

Inpatient hospital deductible: $1,408.00 per incident. Please note a Medicare beneficiary may have multiple incidents within any given year.

Co-Insurance for stays:

  • $0 coinsurance for the first 60 days of each benefit period.
  • $352 a day for the 61st to 90th days of each benefit period
  • $704 a day for days 91 and beyond per each lifetime reserve day of each benefit period (there are up to 60 lifetime reserve days)
  • After lifetime reserve days are used all costs are incurred

Skilled nursing facility care:

  • $0 for days 1 to 20 for each benefit period
  • $170.50 a day for the 21st to 100th days (skilled nursing facility coinsurance of each benefit period)
  • Days 101 and beyond: all costs

Home healthcare:

Costs incurred for services not covered, which are, according to CMS.gov:

  • 24-hour-a-day care at home.
  • Meals delivered to your home.
  • Homemaker services (like shopping, cleaning, and laundry), when this is the only care you need.
  • Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need.
  • 20% for all durable equipment prescribed.

Enrollment:

For those who are already enrolled into Social Security or the Railroad Retirement Board (RRB), they are automatically enrolled in both Medicare Part A and Part B starting the first day of the month of their 65th birthday. If the birthday happens to fall on the first day of the month, then enrollment will be on the first day of the month before that birthday month.

For those who have already passed their 65th birthday and who were enrolled in a creditable health plan through an employer or spouse’s employer enrollment must happen within 6 months from when coverage ends.

Cobra is not considered to be a creditable form of health coverage.

Please note:

With certain Supplemental Plans (Medigap) most Part A costs can be covered as well extending certain types of coverage like stays within a Medicare recognized facility.

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