The parts of Medicare can be confusing. Let’s break them down piece by piece! No complicated medical jargon. No superfluous anecdotes that don’t apply to you. Just the SIMPLE facts. Here’s everything you need to know about Medicare Part A.
You do not have to pay a premium to receive Medicare Part A if, in your lifetime, you or your spouse have worked for at least 10 years (40 quarters) and paid Medicare taxes.
You do have to pay a premium for Part A if you have worked less than 40 quarters. If you or your spouse worked between 30 and 39 quarters, Part A will cost $278 per month. If you or your spouse worked less than 30 quarters, Part A will cost $506 per month.
The Part A deductible for inpatient care is $1,600 for each benefit period.
A benefit period begins the day you’re admitted as an inpatient. The benefit period ends when inpatient care has not been received for 60 days in a row. If 60 days have passed and you are admitted as an inpatient, then a new benefit period begins. Thus, a new deductible of $1,600 will have to be met.
Benefit Period – the measure of your use of hospital and skilled nursing services under Original Medicare (Parts A and B).
If you receive Medicare Part A hospital insurance, you can expect to pay the following for services:
For each benefit period:
The Part A deductible for inpatient care is $1,600.
You pay $0 per day for days 1-60.
You pay $400 per day for days 61-90.
You pay $800 per day for days 91-150. This 60-day period is part of your lifetime reserve days.
You pay all costs after exceeding lifetime reserve days.
Lifetime Reserve Days – Additional days that Medicare will pay for when you are an inpatient for more than 90 days. You have a total of 60 days to use during your lifetime. For each lifetime reserve day, Medicare pays all covered costs except for daily copays (i.e. $800/day).
For each benefit period:
You pay $0 per day for days 1-20.
You pay $200 per day for days 21-100.
You pay all costs per day for days 101 and beyond.
You pay $0 for hospice services.
You pay up to $5 for prescription drugs for pain relief and symptom management at home.
You pay 5% of the Medicare-approved amount for occasional inpatient respite care.
Medicare-Approved Amount – The amount Original Medicare will pay for a particular service or item.
Medicare Part A and Part B will pay for part-time or intermittent (i.e. once-in-a-while) eligible home health services as long as you are homebound.
Homebound – Medicare.gov defines this as a person who has trouble leaving their home without help, a person who doesn’t leave their home ever because it’s a major effort, or a person whose doctor has recommended they stay home because of their condition.
You pay $0 for covered home health care services.
You pay 20% of the Medicare-approved amount for durable medical equipment.
Durable Medical Equipment – Any medical equipment used in the home to aid in a better quality of living (i.e. wheelchairs, hospital beds, or walkers).
So, what does Medicare Part A actually cover? What services are included? Here’s a comprehensive list of everything you can expect Medicare Part A to cover and not cover:
You are considered an inpatient when you are formally admitted to a hospital with a doctor’s direct order. You are considered an outpatient if a doctor has not given a direct order for you to be admitted. Examples of outpatient services are x-rays, lab tests, or outpatient surgeries. Here’s everything you can expect to be covered and not covered if you are considered an inpatient.
Medicare Part A will pay for care in a skilled nursing facility on a short-term basis if you qualify as an inpatient and a doctor has prescribed the care.
Those who have a life expectancy of 6 months or less can use hospice, medical support used for comfort and symptom management near the end of life. Medicare will pay for most services or treatments that a person’s hospice care team recommends. Here are the most common.
Although Medicare mostly pays for hospice care, be aware that there are a few things it will not cover.
Medicare will pay for part-time or intermittent home health services as long as you are homebound.
If you’re looking for more information about Medicare Part A or how to enroll when you turn 65, then check out these resources on Senior Resource:
Still need help? Then check these websites:
Originally published March 30, 2023
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