Medicare Part A
Part A of Medicare provides coverage for hospitalization expenses, including the cost of room and board. Most people are eligible for Part A without having to pay a premium, provided they have worked and paid Medicare taxes for at least ten years. However, those who do not meet this requirement may have to pay a significant premium.
In addition to hospital stays, Part A also covers critical access hospitals, certain skilled nursing facilities (excluding long-term care), hospice care, and partial home health care. To access these benefits, it’s crucial to meet the eligibility criteria.
What is Medicare Part A
Medicare Part A not only covers inpatient hospital stays but may also include short-term home healthcare and skilled nursing care.
For those who are not eligible for premium-free Part A, the premium amount is determined by the number of quarters they have paid into Medicare taxes. Individuals with less than thirty qualifying quarters will have to pay $506 per month for Part A premium, while those who have worked for thirty to thirty-nine quarters will have to pay $259 per month.
Part A Benefits Include:
- A Semi-Private Room
- Operating Room
- Post-op Recovery Room
- Care in Special Units
- Hospital Meals
- Lab Tests
- Medications and Equipment
- Rehabilitation Services While Inpatiend
- Blood Transfusions
- Hospice Care
- Skilled Nursing Care
Individuals must meet their Part A deductible prior to coverage. After the deductible has been met, Part A will pay for 80% of the expenses. However, there are limits on how many days are covered. The first sixty days of inpatient stay are paid in full after the deductible. Days 61-90 will cost the beneficiary $371 each day. After that, Medicare offers coverage for sixty extra lifetime reserve days. After day 90, beneficiaries will pay $742 each day. When the lifetime benefit has been exhausted, Medicare offers no coverage, and the beneficiary must pay entirely out-of-pocket. Once the beneficiary has been out of the hospital for 60 consecutive days, a new benefit period begins. This means that the deductible must be met again prior to any coverage.
Who Is Eligible for Medicare Part A
To qualify for Medicare Part A, an individual must be a U.S. citizen or legal immigrant who has lived in the country for at least five years. Once they turn 65, they become eligible for Part A, and if eligible, they are also eligible for Part B.
Those who have been receiving disability benefits for 24 months are also eligible for Medicare, regardless of age. They will be automatically enrolled in Medicare during their 25th month on disability.
For individuals with Amyotrophic Lateral Sclerosis (ALS), enrollment in Medicare is immediate and automatic. Those with End-Stage Renal Disease (ESRD) are eligible upon diagnosis, but they must manually enroll themselves.
How Much Does Medicare Part A Cost?
The majority of individuals do not have to pay a premium for Medicare Part A. Premium-free Part A is available to those who have worked and paid Medicare taxes for at least ten years or 40 quarters, which need not be consecutive. If this requirement is met, Part A is provided at no cost.
For those who have not met this requirement, the premium for Part A will be based on the number of years or quarters worked. If an individual has worked for thirty quarters (7.5 years) and paid Medicare taxes during that time, the Part A premium is $259 per month. However, those who have worked and paid Medicare taxes for fewer than thirty quarters will pay the maximum premium of $471 per month.
How Much Is The Medicare Part A Deductible?
At present, the Part A deductible amount is $1600, which individuals will be responsible for paying upon their admission to the hospital as an inpatient. This marks the beginning of their benefit period, which extends to include stays in skilled nursing facilities.
Once an individual has been hospital-free for 60 days, their Part A benefit period ends and the deductible resets. If they are admitted to the hospital again, they will be responsible for paying the deductible once more.
Avoiding the Part A Deductible
Some people wonder if they can bypass paying the Part A deductible when they are admitted to the hospital. It is against the law for hospitals to refuse treatment based on a person’s financial situation, thanks to The Emergency Medical Treatment & Labor Act.
Patients do not need to pay the Part A deductible before receiving hospital care. However, after Part A benefits are exhausted, some facilities may require a prepayment plan. This also applies to those without any health insurance, although the payment policies will vary among hospitals. Each hospital has a billing specialist who can help individuals with payment arrangements.