What Is Medicare Part A Coverage?

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 additional 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:

  • You already get retirement benefits from Social Security or the Railroad Retirement Board.
  • You’re eligible to get Social Security or Railroad benefits but haven’t filed for them yet.
  • You or your spouse had Medicare-covered government employment.

If you’re under 65, you can get premium-free Part A if:

  • You got Social Security or Railroad Retirement Board disability benefits for 24 months.
  • You have End-Stage Renal Disease (ESRD) and meet certain requirements.

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:

  • Have Medicare Part B (Medical Insurance)
  • Pay monthly premiums for both Medicare Part A and Part B”

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:

  • It covers inpatient care in a hospital – This is when you are officially admitted to the hospital on your doctor’s orders and indicates you require the care for an injury or illness. The hospital, however, has to accept Medicare, and there are some instances when a “Utilization Review Committee of the hospital,” approves the stay
  • It covers inpatient care in a skilled nursing facility (SNF) (that does not include long-term or custodial care) – The official definition of SNF care is a facility or area of a hospital that offers medically necessary services from nurses, therapists, pathologists and more. You will have to have three inpatient days in a hospital or a qualifying hospital stay before your SNF benefits can be used, and there are special circumstances that apply to a qualified inpatient stay. The SNF should be entered within 30 days of leaving hospital care, and the skilled services must be related to your hospital stay. You can re-enter the same SNF within 30 days of leaving and obtain another three-day stay.
  • It covers skilled nursing facility care – Care for a limited time can occur if there are days left in the benefit period (this is the time that begins the day you are admitted to a hospital as an inpatient, or to a SNF, and ends the day you have been out of the hospital or SNF for 60 days), if you had a qualifying hospital stay, your physician deems skilled care necessary, the SNF is Medicare certified, and you need the services due to a hospital-related issue OR a condition you developed while getting care in the SNF
  • It will cover hospice care – What is Medicare Part A coverage for a hospice? You may obtain it if your doctors determine you have six months or less life expectancy, that you are accepting palliative rather than remedial care, and that you sign a statement electing hospice
  • It covers home health care – This applies only if you are in part-time care, obtaining physical/occupational therapies at home, having speech therapy, receiving social services, and have home health aides

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?

  • Inpatient hospital care – the cost breakdown for inpatient hospital stays for those on “Original Medicare,” is
    • $1,364 deductible for each benefit period.
    • Days 1–60: $0 coinsurance for each benefit period.
    • Days 61–90: $341 coinsurance per day of each benefit period.
    • Days 91 and beyond: $682 ($704 in 2020) coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime).
    • Beyond lifetime reserve days: all costs.
  • Skilled nursing facility care – the cost breakdown for those on “Original Medicare,” is
    • Days 1–20: $0 for each benefit period.
    • Days 21–100: $170.50 ($176 in 2020) coinsurance per day of each benefit period.
    • Days 101 and beyond: all costs
  • Hospice – No charges apply with the exception of prescription drug copayments of no more than $5 for each prescription drug or similar products for pain relief and symptom control while at home, you may need to pay 5% of the Medicare-approved amount for inpatient respite care, and room and board are not covered in home or another facility where you live
  • Home health care – No charges apply with the exception of 20% of the Medicare-approved amount for durable medical equipment (DME)

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.

What is Medicare Part A…Understanding By Looking at What It 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:

  • Long-term care (also called custodial care )
  • Most dental care
  • Eye exams related to prescribing glasses
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Routine foot care

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.

A Look at Medicare Part A and Medicare Advantage Plans

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:

  • Health Maintenance Organizations
  • Preferred Provider Organizations
  • Private Fee-for-Service Plans
  • Special Needs Plans
  • Medicare Medical Savings Account Plans

If you’re enrolled in a Medicare Advantage Plan:

  • Most Medicare services are covered through the plan
  • Medicare services aren’t paid for by Original Medicare”

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 may include additional 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:

  • You must have Medicare Parts A and B in place
  • You cannot have End-Stage Renal Disease
  • You must live in the Service Area of the plan

The Part C option may enable the beneficiary to get additional benefits that traditional Medicare doesn’t offer, may include routine 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?”

The Total Costs of Medicare A – Are There Deductibles, Copays and Coinsurance?

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.

What is the Medicare Part A Enrollment Period?

There are different times that you can enroll in Medicare, and they include the:

  • Initial Enrollment Period or IEP – This is the first time you can sign up for Medicare and may opt for Parts A-D at that time. This is a seven-month window that includes three months prior to the 65th birthday, the month of the birthday and three months afterward. Coverage begins no earlier than the birthday month.
  • Special Enrollment Period or SEP – This applies if you delay enrollment in Parts A-D and will only be effective if you have coverage from an employer; OR within the eight months after coverage via Part A and Part B end; OR 63 days after coverage ends for Part C and Part D
  • Medicare Advantage & Prescription Drug Plan Annual Enrollment Period – This is frequently called the Annual Election Period and begins on October 15 each year and ends December 7. During this window, you can switch to a Medicare Advantage plan (Part C) from Original Medicare (Part A & Part B); You can switch back to Original Medicare from a Medicare Advantage plan (Part C); you can drop, add or switch to a different Medicare Prescription Drug Plan (Part D) if you have Part A & Part B; and you can switch from one Medicare Advantage Plan to another. Coverage begins January 1 of the following year.

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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