Navigating away from traditional health insurance to Medicare can seem like a confusing venture, but it is far easier than many imagine. The trick is to understand all of the terminology and the options. For those seeking standard Medicare benefits, there are a few things you need to consider as you get started, and then additional factors that may make you eager to consider things like drug coverage and supplemental insurance.
Let’s begin with an answer to the question of just what is Medicare Part A?
When discussing Medicare of any sort, you need to start with a fundamental recognition of “Original Medicare” which is comprised of Part A and Part B. It can be expanded on to include Part D (prescription drug coverage) and also include Medicare Supplement Insurance also known as Medigap.
Many people are unclear about whether or not there are premiums for Part A coverage, and the answer is maybe. According to Medicare, you “usually don’t pay a monthly premium for Medicare Part A (Hospital Insurance) coverage if you or your spouse paid Medicare taxes for a certain amount of time while working. This is sometimes called “premium-free Part A.’”
Most get it “premium-free” and you qualify for it at age 65 and if:
If you’re under 65, you can get premium-free Part A if:
There are some who are going to have to purchase it, and they can face a premium of up to $437 per month. This is usually because they have “paid Medicare taxes for less than 30 quarters, the standard Part A premium is $437. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $240.
In most cases, if you choose to buy Medicare Part A (Hospital Insurance), you must also:
Yet, we still have to answer the basic question of what is Medicare Part A?
Medicare Part A is known as “hospital insurance,” and it is designed to help cover the costs of a hospital stay, but that is not the only sort of facility or care that your Medicare Part A delivers. According to the official Medicare website, the answer to “what is Medicare Part A,” includes the following details:
There are costs associated with each of these areas, and they vary according to the care or treatment received. What is the Medicare Part A cost break down on the different options?
With these details about the answer to “What is Medicare Part A?” you may still have questions. Because of that, we are going to reverse the question and instead look at what Medicare Part A is NOT.
Medicare is very upfront with enrollees about what the insurance covers and what it cannot cover. The items that Medicare will not cover include:
It also does not include any of your medication or prescription drug costs. This is something that is addressed via Medicare Part D coverage.
Interestingly enough, there is a Medicare Part C option, also known as a Medicare Advantage Plan that combines the benefits of Medicare Part A and Part B in one plan and usually includes Medicare Part D (also known as a Medicare Advantage Prescription Drug plan.
Medicare Advantage is a “type of Medicare health plan offered by a private company that contracts with Medicare. Medicare Advantage Plans provide all of your Part A and Part B benefits. Types of Medicare Advantage Plans include:
If you’re enrolled in a Medicare Advantage Plan:
Most Medicare Advantage plans also have prescription drug coverage.
This makes many wonder what is Medicare Part A in the context of a Medicare Part C configuration? The answer is actually simple. It offers all of the same benefits as Original Medicare and usually extra benefits including prescription drug coverage all bundled into a single plan. The specifications vary by plan. They must adhere to the Medicare guidelines, and the three most specific in terms of qualifications are:
The Part C option may enable the beneficiary to get extra benefits that traditional Medicare doesn’t offer, including hearing, vision, and dental. Medicare will typically pay only a fixed amount for medical care to the insurance providers making the Medicare Advantage Plans available. They may require different out of pocket costs. And it is important to understand factors like out of pocket costs (also known as copays and coinsurances) when wondering “what is Medicare Part A going to cost me?”
When you say “out of pocket” in regard to insurance, it means the monies you are paying towards healthcare that are not paid for by the insurance company. Unfortunately, Original Medicare – Parts A and B – when taken in that form, have no cap on the out of pocket payments you can find yourself making.
The Part A deductible is $1,364 per benefit period. As you might remember, the benefit period is time between the first day you are admitted to a hospital or Skilled Nursing Facility and comes to an end after you have been out of the hospital for 60 days in a row.
Are there any plans that pay your Medicare deductible? Actually, Medicare Supplement Insurance Plans (also known as Medigap) help pay for some of the costs that Original Medicare does not. As of this writing, it is Plan G alone that provides such coverage.
There are also your copays, or a set amount paid out for health care related services you receive. As a simple example, let’s say you have a regular office visit, a copay applies to that visit, and you pay a fixed amount towards the cost of the care. Some hospital stays and Part A covered care can also have items where copays apply.
Your Medicare coinsurance payment is the percentage of a medical bill that you are required to pay. The coinsurance amount for Part A expenses is fixed at a dollar amount, and because Part A is hospital insurance, it applies only to a hospital or other qualified facility stay, which we outlined earlier in this article.
Medicare Supplement Insurance Plans (Medigap) from private insurance providers exist to provide you with 365 additional days in the hospital, at no further cost than the premium for the coverage.
So, an answer to the question of “what is Medicare Part A,” means that you’ll need to know about the deductibles, potential copays, and coinsurances, as well as the out of pocket limits.
And while you are going to have to know about the specifics of Medicare Part A before you choose between Original Medicare and Medicare Part C, you should also know when you can or should enroll in the different options.
There are different times that you can enroll in Medicare, and they include the:
And if you are concerned about penalties being applied to a late enrollment into Medicare Part A, don’t. This is a penalty that applies only to a late Medicare Part B enrollment.
You will still want to enroll in Medicare Part A as soon as you qualify and begin enjoying the hospital coverage it offers. There are no real mysteries to the question of “what is Medicare Part A?” but it is not always the most straightforward. You’ll have to find out if the coverage fits your needs, and whether or not you’ll want it as part of a combined plan that may offer additional treatment options and an out of pocket limit, or if you can do well with the Original Medicare format that millions choose every year.
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