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Andrew Smith

Andrew Smith

Medicare Part A: What It Covers, What It Costs?

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Part A of Medicare is responsible for paying for hospital stays and associated medical costs. Most of the time, you won’t have to pay more to get your hands on it. Read on to find out.

What Medicare Part A covers

Part A and Part B make up Original Medicare, the government-run portion of Medicare you can join through Social Security.

Medicare Part A is hospital insurance, and it normally covers costs in four areas that Medicare Part B does not.

1. Inpatient hospital care

Part A includes things like semi-private rooms, meals, general nursing, and drugs for inpatient treatments if you are admitted to the hospital on a doctor’s order. Care beyond what is covered by Part A, such as a private room or a private-duty nurse, will incur additional costs that are your responsibility to cover.

Medicare Part A also covers inpatient care at a psychiatric hospital if you are admitted for mental health treatment. Lifetime coverage is capped at 190 days.

A requirement for making use of Part A is that hospitals accept Medicare patients. However, it’s important to know that Medicare isn’t accepted at most VA hospitals or other military facilities.

Medicare Part A pays for hospital stays at hospitals and several other types of medical centers.

  • hospitals that provide immediate medical attention.
  • Hospitals that provide emergency care.
  • Residential treatment centers.
  • Hospitals with mental wards.
  • Inpatient facilities providing long-term care.
  • Hospitalization as part of an acceptable clinical trial.

2. Skilled nursing facility care

After at least three days in a hospital, Medicare will pay for your short-term care in a skilled nursing facility if you have Part A. A semi-private room, all meals, competent nursing care, and physical and occupational therapy are all part of what’s included.

Most other wellness-related therapies are also included.

  • Therapeutic interventions in the field of speech-language pathology.
  • Help with the social and economic needs of the medical community.
  • Medications.
  • The facility’s stock of medical supplies and apparatus.
  • When a service is not offered on-site, we will arrange for an ambulance to take the patient to the nearest provider (if other transport would endanger your health).
  • Advice on what to eat.
  • Adjustable bed services.
  • Your medical team may recommend more services outside the scope of Part A. You would be responsible for those costs.

3. Hospice benefits

Hospice care is provided to terminally ill patients as they near the end of their lives. Supportive care, including medicine for pain and other symptoms, is completely paid for by Part A. Part A hospice benefits also extend to all members of the caregiving medical team. Both your regular doctor and the hospice physician will collaborate on a treatment plan. We will cover the expenses necessary for your primary carer to have a break from caring for you while you and your family get grief counseling.

Medicare Part A, which is included in both Original Medicare and Medicare Advantage, pays for all aspects of hospice care. Make that hospice admission is covered by your health insurance.

4. Home health services

Medicare recipients who are housebound may qualify for in-home medical treatment. You need a doctor’s note and to work with an agency that is approved by Medicare. Part-time skilled nursing care, home health aide services, occupational therapy, physical therapy, speech-language pathology, medical social services, and injectable osteoporosis medications for women are all included in the list of covered services.

Carefully consider your options before committing to home health care. Home care that is provided 24 hours a day, 7 days a week, or that includes the provision of meals, homemaking services, or personal care such as assistance with bathing or clothing is not covered by Medicare. You’ll need to do a lot of digging to figure out what medical care is covered by Medicare Part A and what you’ll have to pay for out of pocket.

How much does Medicare Part A cost

Medicare Part A may be available at no cost to you if you or your spouse have worked and paid Medicare taxes for at least 10 years, totaling 40 quarters. Use Medicare’s eligibility tool to find out if you qualify.

You might be able to buy Part A coverage if you don’t get free coverage. The maximum monthly premium for Part A coverage in 2022 is $499 (or $506 in 2023) and is calculated using your income and the income of your spouse who also has Medicare.

Joseph Schneier, CEO, and co-founder of Trusty. care, a Medicare pricing and enrollment platform for brokers, says, “If you’re over 65 and you can afford it, it makes sense to pay for Part A.” He says, “Original Medicare plus a supplement is probably going to be the finest insurance you have.” This is a reference to Medigap plans.

The costs associated with using the healthcare system will persist even after you have your Part A plan in place. Your estimated portion of medical and nursing home expenses is detailed in the table below. Your Medigap or Medicare Advantage policy, depending on its specifications, may instead pay for these out-of-pocket expenses.

Services

Costs*

Inpatient hospital care

  • A deductible of $1,556 ($1,600 in 2023) applies to each benefit cycle.
  • For the first 60 days of each benefit period, you won’t have to pay any coinsurance.
  • Coinsurance for each benefit period between days 61 and 90 is $389 in 2022 and $400 in 2023.
  • For days 91 and up of each benefit period, you’ll have to pay a coinsurance fee of $778 in 2022 ($800 in 2023) each day, up to your total lifetime reserve days (60 days over your lifetime).
  • Assume full responsibility for all costs once the lifetime reserve has been exhausted. 

Skilled nursing facility care

  • For the first 20 days of each coverage period, you won’t have to pay anything toward your copayments or deductibles. This applies to both hospital stays and skilled nursing facility stays.
  • Each benefit period, days 21-100 is subject to a coinsurance amount of up to $194.50 ($200) each day in 2022.
  • The price tag for day 101 and beyond.

Hospice

  • Hospice treatment costs nothing.
  • Copayments for over-the-counter medications used to treat pain and other symptoms typically cost less than $5.
  • In some circumstances, the Medicare-approved rate for short-term hospitalization as “inpatient respite care” drops below 5%. 

Home health services

  • All home health care services are free of charge.
  • Wheelchairs and walkers, for example, have a 20 percent co-payment from Medicare.
 
 

Medicare Part A eligibility

Medicare Part A eligibility standards state that you must meet one of the following categories:

  • You must be 65 years or older.
  • You have been receiving Social Security or Railroad Retirement Board disability payments for 24 months.
  • You have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, and therefore qualify for disability benefits.
  • For you to qualify, you must have advanced renal failure.

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The “gaps” in Medicare coverage refer to these uninsured expenses. Medigap acts as a supplement to Original Medicare and fills up the

Medicare Part A: What It Covers, What It Costs?

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