Part A of Medicare is your hospital coverage. Medicare Part A ensures that you will be provided inpatient hospital care that is affordable. It can be compared to hospital room and board. It covers your room and your regular meals while you are admitted to the hospital. Medicare Part A can also cover after hospital skilled nursing or short term after hospital home health care if medically necessary. There is a chart below that helps break down your Part A coverage.
If you’re already receiving Social Security or Railroad Retirement, you will automatically be enrolled in Part A at age 65. If you have a disability, End Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease), you can qualify for Medicare Part A earlier than age 65. Not already receiving benefits from the Railroad Retirement Board or Social Security? You need to manually enroll in Part A during your Initial Enrollment Period. I put together a how to here on our company website https://www.avenueinsuranceplanners.com/how-to-enroll-into-medicare/
How do you know what your Initial Enrollment Period is?
Your Initial Enrollment Period when you “age in” to Medicare is the three months prior to your birthday, the month of your birthday and the following three months. For example, if you were born in May your Initial Enrollment Period would be February through August of the year your turn 65. For more details about Initial Enrollment Periods and Medicare Part A & B Initial and Open Enrollment Periods please see our article on Open Enrollment for Medigap Plans. Your individual Initial Enrollment Period could be different than the standard time if you have a disability, End Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease). If you have questions about this, please contact us and we can help you translate this info for your current situation.
Benefits of Part A
|Benefits For Medicare||2021 Out-Of-Pocket Cost|
|Part A Benefits||Part A Cost|
Day 1 Through Day 60
|$1,484 Deductible each benefit period|
|Day 61 Through Day 90||$371 Per Day|
|60 Day “Lifetime Reserve Day”||$742 Per Day|
|Skilled Nursing Facility Day 1 through Day 20||$0 Day|
|Skilled Nursing Facility Day 21 through Day 100||$185.50|
|Hospice Care For Terminally Ill||Nominal Coinsurance For Drugs And Respite Care|
There is a catch to obtain the Skilled Nursing Facility benefit. The catch is, you must be admitted to the hospital for 3 days prior to going to the facility. Being under observation does not count toward the three days. Also the day you are discharged from the hospital does not count toward the three days.
Most people don’t pay a monthly premium for Part A (Hospital Insurance). That is because they or their spouse paid Medicare taxes (including self-employment tax) while they were working.
If you only paid Medicare taxes for 30-39 quarters of work your Part A premium would be $232.00 per month.
If you are not otherwise eligible for premium-free Part A (Hospital Insurance), your Part A premium would be $437.00 per month.
How to know if Medicare Part A Covers What You Currently Need
The second way is to discuss your needs with your healthcare provider or doctor and ask if Medicare will cover the needs. If you need something that is typically covered by Medicare, your provider should be able to let you know if there is any circumstances that might exclude you from coverage.
Medicare coverage has three main factors that control what it covers or what it does not cover. The first is State and Federal laws. The second is national coverage decisions made by Medicare about whether or not something is covered. And finally, local coverage decisions can be made by companies in each state that process claims for Medicare. These companies can decide whether something is medically necessary for the area of coverage.
Are you still confused? Do those Out of Pocket costs concern you? Want to know more about your benefits or how different Medigap Supplement plans may protect you from the Out of Pocket costs? Please call us today and talk to a licensed professional today!