If you’re 65 or older or under the age of 65 with certain disabilities, you may be eligible for Medicare. In fact, Medicare benefits are utilized by over 60 million Americans. The federal program provides access to healthcare insurance and it covers a wide range of medical services.
Medicare coverage is provided through several different parts of the program. These parts include Medicare Part A (hospital insurance), Medicare Part B (medical insurance), Medicare Part C (Medicare Advantage), and Medicare Part D prescription drug coverage. Most people are automatically enrolled in Part A when they turn 65, or after they have received benefits from the Social Security Administration or the Railroad Retirement Board for 24 months. Let’s find out more about Part A (hospital insurance) coverage.
What is covered by Medicare Part A?
As the inpatient benefit portion of Medicare, Part A covers things like hospital care, care in a skilled nursing facility, and hospice. This coverage only applies to care administered by the facility and/or its staff. If outside medical professionals are brought in to provide treatment, you may receive separate billing for the services rendered by these providers.
Inpatient coverage includes your semi-private room, general nursing care, medications, stabilization and other common services provided when formally admitted into a hospital. If you need to be admitted to skilled nursing facility following surgery, your covered expenses would include aftercare, but the actual surgical procedure itself may be billed as a separate expense.
Medicare Part A is also sometimes utilized to cover home health care expenses. This often happens when a hospital or skilled nursing facility supplies medical professionals who travel to a Medicare recipient’s home to administer care.
In terms of coverage limitations, Medicare Part A covers hospital stays at 100% up to 60 days per benefit period. From day 61 through day 90, coverage is provided at a discounted rate. After day 90, you can still receive ongoing discounted coverage by utilizing lifetime reserve days. Once lifetime reserve days have been used up, 100% of the cost falls on the Medicare recipient.
Costs of Part A
Most people get Part A premium-free because of taxes paid while working. If you haven’t worked and paid taxes for the time required (40 quarters), you may be able to pay for Part A coverage. In 2021, people who buy Part A will pay a premium of either $259 or $471 each month, depending on how long they or their spouse worked and paid Medicare taxes. If you choose not to enroll in Part A, you can still enroll in Part B.
If you require care as an inpatient in a hospital in 2021, you’ll likely pay a deductible of $1,484 for each benefit period. For days 1–60, you’ll have $0 coinsurance for each benefit period. From day 61–90, you’ll likely pay $371 coinsurance per day of each benefit period. You’ll likely pay $742 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime).
As defined by the Centers for Medicare & Medicaid Services (CMS), a benefit period begins the day you’re admitted as an inpatient in a hospital or Skilled nursing facility (SNF). The benefit period ends when you haven’t gotten any inpatient hospital care (or skilled care in a SNF) for 60 days in a row. If you go into a hospital or a SNF after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There’s no limit to the number of benefit periods.
Your overall costs for care will depend on how often you need to use your benefits, whether you have purchased a Medicare Supplement plan, and where you receive your care. If you have Original Medicare, you may visit any hospital or inpatient facility that accepts assignment and is participating in Medicare. If you are enrolled in a Medicare Advantage plan, you may need to visit doctors and hospitals within your plan’s network or risk paying more out-of-pocket.