Medicare Part A
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Medicare Part A in 2019 & 2020
What it covers: Hospital Insurance
Inpatient hospital care
Which can include semi-private rooms, meals, nursing services, and prescription drugs. Inpatient care in long-term care hospitals, mental health hospitals, acute care hospitals, and critical access hospitals also may be covered by Part A insurance.
Skilled nursing facility care
Semi-private room, meals, skilled nursing care, prescription medications, medical supplies and equipment, and ambulance transportation could be included in your Part A coverage if medically necessary.
Nursing home care
Skilled nursing facility care could be covered for a short period of time if ordered by your doctor.
Part A coverage may cover doctor services, nursing care, durable medical equipment, medical supplies, and other things if you have six months or less to live.
Home health services
Medicare part A coverage may incorporate at-home skilled nursing care, physical therapy, and occupational therapy when medically necessary, but only for a limited period of time.
Note that Medicare Part A does not cover outpatient services. It’s important to ask your hospital if you are considered an inpatient or an outpatient, as even if you stay overnight in a hospital bed, you may be considered an outpatient during your stay. A patient can only be declared an inpatient. Your doctor must order the hospital admission, and they must confirm that you are in an inpatient. This can affect what you can and cannot pay. Outpatient services are covered by Medicare Part B.
Who does it cover
Medicare Part A is health insurance offered by the federal government to United States citizens and legal immigrants. You’re eligible if you’re 65 and older. Also certain disabilities can qualify you even if you are under under age 65. If you worked for a least 10 years and pay medicare taxes you qualify for premium-free Part A coverage.
Medicare Part A provides coverage for hospital related costs such as hospital stays, nursing care, hospice, and home-health care. Medicare Part B covers outpatient medical services.
Medicare Part A counts as minimum essential coverage and satisfies the law that requires people to have health insurance.
Medicare Part A – Coverage and Payments
In general, Medicare Part A covers:
- Hospital care
- Skilled nursing facility care
- Nursing home care (as long as custodial care isn’t the only care you need)
- Hospice stays or services, if you have 6 months or less to live.
- Home health services
Part A Deductibles & Coinsurance in 2019 and 2020
While Medicare Part A covers the majority of expenses for medically necessary services, there is an initial deductible of $1,364 before any Medicare payments are made. After this deductible is met, you often pay about 20% of the Medicare-approved amount. This is for most doctor services (including services while you’re a hospital inpatient), outpatient therapy, and durable medical equipment.
After you’ve met your deductible, you are responsible for hospitalization or mental health inpatient stay coinsurance payments according to the following schedule for each benefit period:
- First 60 days, $0 coinsurance
- 61-90 days, $341 a day
- 91 and beyond, $682 a day (for a lifetime reserve of up to 60 days)
- After the 60 lifetime reserve days are used up, You pay all costs
Similarly, for skilled nursing facility care, coinsurance payments are:
- $0 coinsurance for days 1 to 20
- $170.50 each day for the 21st to 100th days
- You are responsible for all costs for days 101 and beyond
Part A Premiums 2019 and 2020
Premium-free Medicare Part A will cost nothing depending on whether or not you are at least 65 years old or not. If you’re at least 65, you will receive the premium-free version if you receive Social Security or RailRoad Retirement Board (RRB) benefits, qualify for those benefits but have not filed or you and/or your spouse had Medicare-covered government employment. If you are younger than 65, then you will receive the premium-free version if you have received Social Security or RRB disability benefits for 24 months or longer or you have End-Stage Renal Disease (ESRD) and meet certain requirements.
The premium version of Medicaid Part A is available for a monthly premium of $437 each month should you choose to purchase the plan. This is the case if you have paid Medicare taxes for less than 30 quarters, if you paid Medicare taxes between 30 to 39 quarters, the premium will be $240 a month. In most cases, if you choose to pruchase Part A you must either:
- Have Medicare Part B (Medical Insurance)
- Pay monthly premiums for both Part A and Part B
Who Signs Up Automatically
If you have already collecting Social Security or RRB retirement benefits for at least 10 years when you turn 65, you will automatically be enrolled in Medicare Part A.
When Do You Need to Sign Up Manually
While most people are enrolled in Medicare Part A automatically, you can also manually sign up for coverage. If you don’t receive either Social Security or RRB (possibly because you are still working), then you will have to sign up manually.
You can enroll in Medicare Part A three months before you turn 65 for coverage that starts when you turn 65.
If you are not enrolled automatically, be careful as you should sign up manually at least 3 months before you turn 65 to avoid possible penalties.
If you live in Puerto Rico, you must sign up for Medicaid as you will not automatically be enrolled in the program.
Where to Sign Up Manually
You can do this online at www.SocialSecurity.gov
You can also do so at your local social security office or by calling the national hotline at 1-800-772-1213 (TTY users 1-800-0778) weekdays between 7AM and 7PM eastern time.
Your coverage for Medicare Part A can begin as early as 6 months before the time you filed, but no earlier than the month you meet all Part A requirements.
You must have worked 10 years under Medicare Covered Employment by the time you are 65 to receive free Medicare Part A.
If you are not eligible for free Medicare Part A, you can purchase it along with Medicare Part B during the general enrollment period or the special enrollment period.
The general enrollment period is every year from January 1st to March 31.
The special enrollment period can occur for a number of different reasons. If you or your spouse continue to work and receive health insurance coverage from an employer, your Special Enrollment Period continues indefinitely. If you lose your job or your health coverage with that job, you have a Special Enrollment Period for 8 months. There are other exceptions, so check with your Social Security office if you have questions.