With so many different plans, Medicare can seem confusing to many people. Our goal is to explain it to you in a way that makes sense so you can make the best choice possible for your healthcare.
What is Part A?
Part A of Medicare is your hospital coverage. It covers the following:
- Inpatient hospital care
- Meals while you’re in the hospital
- Medications administered while you’re in the hospital
- Skilled nursing facility care
- Nursing home costs
- Hospice care
- Home health care as long as it is deemed medically necessary
While Medicare Part A covers some nursing facilities, it does NOT cover long-term care at a nursing facility.
What Else Does Medicare Part A NOT Cover?
- Most dental care
- Eye exams
- Cosmetic surgery
- Routine foot care
- Hearing aids
How Can I Find Out If Medicare Covers My Care?
Generally speaking, the above list is what Medicare Part A covers. However, many people want to be certain that Medicare will cover their specific situation. It’s also important to know exactly how much Medicare will cover because it’s not always one-hundred percent. If you have an appointment coming up, call your doctor’s office. Ask them to check if Medicare is covering your upcoming visit. Your doctor should be able to help you figure this out.
How Much Does Medicare Part A Cost?
Sometimes It’s Free
Many people who are eligible for Medicare Part A will end up not having to pay a monthly premium. If you or your spouse paid Medicare taxes for 10 years, you will be eligible for Plan A for free. Additionally, you qualify for premium-free Part A if you are at least 65 years of age, and
- You already receive retirement benefits from Social Security or the Railroad Retirement Board,
- You are eligible for Social Security or Railroad benefits but you have not enrolled yet, or
- You or your spouse had Medicare-covered government employment.
If you’re under the age of 65, you will qualify for Plan A without any monthly premiums if you receive social security benefits or Railroad Retirement Board disability benefits for 24 months, or if you have end-stage renal disease.
If I Don’t Qualify For Premium-Free Plan A, Can I Purchase It?
Yes! If you don’t qualify to receive plan A for free, you can still enroll by paying for it yourself if you meet the following criteria:
- You’re 65 or older and you have or you are enrolling in Part B and meet the citizenship and residency requirements, or
- You’re under 65 years old and disabled, but your premium-free Part A coverage ended because you returned to work.
Cost of Part A
The cost of Part A depends on how long you paid Medicare taxes. As of 2023, if you paid Medicare taxes for less than 30 quarters, your Part A premium will be $506 per month. If you paid Medicare taxes for 30-39 quarters, it will be $278 per month.
Part A Deductible
A deductible is the amount of money you have to pay out of your own pocket before Medicare will kick in and start paying for your healthcare. In 2023 for Medicare Part A, the deductible for each benefit period is $1,600
Example: You end up in the hospital and have a $5,000 bill. You will be responsible for the first $1,600. After that, Medicare Part A kicks in and will cover a percentage of your bill.
The deductible for Part A increases every year, so make sure you’re aware of that so you can plan appropriately.
Part A Coinsurance
Coinsurance is the amount of money that you are responsible for after Medicare has paid its part. For Medicare Part A, your coinsurance will depend on how many days you’ve been in the hospital. For days 0 through 60, your coinsurance is zero. This means you are not responsible for any amount of the bill from day 0 through day 60. On day 61, your coinsurance increases to $400. This means that from day 61 until day 90, you will be responsible for $400 per day. After day 90, your daily coinsurance increases to $800 per lifetime reserve day, up to 60 days throughout your lifetime.
Your lifetime reserve days are extra days after day 90 that you will be permitted to pay a coinsurance of $800 per day instead of the full cost of care. These reserve days never replenish, meaning that you have 60 of them and that’s it. However, your 90 days of inpatient care is not a one-time occurrence. The 90 days of covered services are per benefit period. Your benefit period begins when you go into the hospital, and ends once you leave and have been out for 60 days.
Example: You are in the hospital for 100 days. For the first 60 days, you are responsible for zero dollars. For days 61-90, you will have to pay $400 per day. For days 90-100, you will have to pay $800 per day. You go home on day 101 and stay out of the hospital for another 60 days. On day 61, you end up back in the hospital again. Your benefit period restarts, and for the first 60 days, you again will not be responsible to pay anything. Once you hit day 91, your lifetime reserve days kick in. You will have 50 left. They do not reset just because a new benefit period was initiated.
Part A Late Enrollment Fee
It’s really important to make sure you sign up for Medicare as soon as you become eligible. If you don’t sign up on time, you will be penalized. If you received Part A for free, you won’t receive any kind of penalty if you enroll after you become eligible. However, if you’re not eligible for the free premium and you don’t enroll when you become eligible, your monthly premium will go up ten percent. It will remain ten percent higher for twice the number of years that you could have been enrolled in Part A but weren’t.
You were eligible to purchase Part A one year ago but didn’t sign up. When you do purchase Part A, your premium will be ten percent higher for two years.
We Can Help
Having as much information as possible about Medicare Part A will help you significantly. If you know when and how to sign up, you won’t miss the enrollment period and be charged a penalty.
To learn about Medicare Part B, click here.