Part A Medicare Hospital Insurance

Maybe you’ve heard some information about Medicare Part A from friends & family but what exactly is Medicare Part A anyway? How does Part A fit within Medicare Insurance benefits? We consolidated & simplified all the important details for you by answering common questions to help save you time, money & energy!

Feel lost in the Medicare Maze? For senior folks who want to make a good health decision but feel confused about thier options or not knowing who to trust, Bridge has a plan to help you find the protection and peace of mind you need. Contact us or take “The Medicare Journey”, a clear path to understanding Medicare from “A Complete Health Plan Perspective”. Don’t let your health insurance end up costing you an arm and a leg!

Bridge is a licensed, insurance broker specializing in Medigap Plans, Fixed Annuities & Life Settlement insurance products.

What is Medicare Part A coverage?

Medicare Part A is senior hospital insurance coverage issued by the U.S Government that includes the following services;

• Hospital care
• Skilled nursing facility care
• Nursing home care (as long as custodial care isn’t the only care you need)
• Hospice
• Home health services

Am I eligible for Medicare Part A?

The Medicare Part A eligibility requirements are;

• You must be 64 years & 9 months or older.
• Those on Social Social Security disability benefits (regardless of age) for at least 24 months
• Those diagnosed with permanent kidney failure (regardless of age)

How do I enroll in Medicare Part A?

It’s easier than you think to enroll in Medicare Part A because the availability is automatic upon turning age 65 years of age after applying for Social Security benefits. If a recipient earned their full 40 credits, this coverage is free (called Premium-free Part A) otherwise, there is a monthly premium & late enrollment incurs a penalty called Premium (paid) Part A. We touched on the credit system on the first page of, “The Medicare Journey” titled; “Social Security Benefits”.

What is Premium Free Part A?

The name speaks for itself. Premium Free Part A is free Medicare Part A Insurance from the U.S. Government. Since Medicare is funded by payroll taxes, the social security credit system is weighed by this measure. If an individual has paid into “Medicare covered employment” for at least 10 years of wages (meaning: your employer or Accountant took FICA deductions), you will have received the maximum benefit which entitles you to free Medicare Part A Insurance.

Here is the basic calculation;

10 years x 4 quarters (1 quarter year = 1 credit) = 40 total credits (Medicare Part A is Free).

Per the general requirements, individuals may also qualify for Premium-free Part A if;

• They qualified for Social Security (40 credits) or the Railroad Retirement Board (RRB) benefits (whether or not benefits have begun).
• Regardless of age, if anyone has received Social Security disability benefits for at least 24 months before Medicare benefits start.
• Anyone who has been diagnosed with End-Stage Renal Disease (ESRD).

What is Premium (Paid) Part A?

Premium Paid Part A is if an individual who is 65 but did not obtain the total of 40 social security credits, Part A is NOT automatically provided for free and must paid for by the enrollee. Depending on the enrollment period (Initial, General or Open Enrollment), one can Apply for Medicare via the Social Security sign up website but must also enroll in Part B or already have Part B Insurance.

What does Medicare Part A cost in 2019?

The cost for Medicare Part A in 2019 are;

• $0/month (if 40 credits – Fully Insured)
• $232/month (if 30-39 credits)
• $422/month (if under 30 credits)

To keep Part A coverage, monthly premiums must be paid and one must stay enrolled in Part B. According to the PPACA individual Mandate, anyone enrolled in Part A is not required to take part in the Marketplace and will not face the penalty fees.

How do I pay for Medicare Part A & Part B?

Medicare Part A is free unless one has not obtained 40 Social Security credits. If one must purchase Part A, they will almost always receive a “Medicare Premium Bill” (CMS-500) each month around the 10th. See a Sample Bill (Spanish version).

While were on the subject, Part B is deducted from your Social Security benefit payment or Railroad Retirement Board (RRB) benefits. Civil Service retirees that are NOT entitled to Social Security, premiums are deducted from your Civil Service annuity.

You can pay for Medicare via direct bank deposit, Medicare Easy Pay, check, money order, mail-in or online credit & debit. You need to pay attention to what “bill type” you get. See the “bill type” checklist.

What happens if I don’t pay my Medicare bill?

If you don’t pay your Medicare bill, you will get three (3) notices and will lose your Medicare coverage. If you have questions about your bill, you can Call Social Security at 1-800-772-1213.

If you have limited income sources, check your state or see if you apply for Extra Help through a Savings Program to save on drug costs too

What is not covered under Medicare Part A?

Medicare Part A does not cover the following;

• Deductibles
• Coinsurances
• Co-payments
• Long-term care (also called custodial care)
• Most dental care
• Eye exams related to prescribing glasses
• Dentures
• Cosmetic surgery
• Acupuncture
• Hearing aids and exams for fitting them
• Routine foot care

To find out if a test, item or service is covered by Medicare, we recommend using the Medicare.Gov “Coverage Search Tool” for more accurate information.

How does Medicare Part A work with Medicare Part D prescription drug coverage?

Part D drug plans are compatible with Medicare Part A. Enrollees have a guaranteed eligibility for a Part D plan when they enroll in Plan D (on-time). It’s best to avoid the Part D Enrollment Penalty by enrolling during your initial enrollment period (also known as, IEP). Did you know that drugs administered in a Hospital setting are generally covered under your Medicare Part A? For more information on enrollments, visit the Medicare Enrollment Periods page.

How does Medicare Part A work with Medigap Plans?

Yes! Medicare Part A is compatible with Medigap Plans however, since they are considered standalone plans, Medigap Policies need to be purchased separately. By working with a Bridge Agent, we can help you find an affordable plan to fit your needs.

Compare Medigap Plans Online

How does Medicare Part A work with Medicare Advantage Plans?

Unfortunately, Medicare Advantage Plans do not work with Medicare Part A since they are on separate programs. Those enrolling in Medicare Advantage dis-enroll from Original Medicare and should consider the pro’s and con’s.

Although, Medicare Advantage Plans are appealing based on price, they can also come with a few Medicare pitfalls that may have you reconsider the real “advantage”. For example;

• Prices have been historically unstable.
• Your coverage will change annually.
• You could be locked-in without the future option for a Medigap Plan
• You’re responsible for out-of-network, Physician costs.
• No coverage beyond your service area.
• Must use in-network providers.
• No travel coverage.
• May need a referral to see a specialist.

Additionally, If you have a MA plan & diagnosed with a critical illness such as cancer, heart attack or stroke, costs for treatment if the hospital is out-of-network may not be covered in your plan. The max out-of-pocket only applies to covered services and could require a specialist referral. People with MA plans, think they have more coverage than they actually do unlike Medigap plans, which is considered more comprehensive senior health coverage plan.

How does Medicare Part A work with Dental, Vision & Hearing Insurance (DVH)?

Part A works with DVH plans however, since they are considered standalone plans, DVH’s would need to be purchased separately. By working with a Bridge Agent, we can help you find an affordable DVH insurance plan to fit your needs.

How does Medicare Part A work with a Critical Illness Insurance for cancer, heart-attack & stroke coverage (CHAS)?

Medicare Part A is compatible with CHAS insurance / cancer plans however, since they are considered standalone plans, they would need to be purchased separately. By working with a Bridge Agent, we can help you find an CHAS and/or affordable critical illness insurance plans to fit your needs.

How does Medicare Part A work with a Long Term Care Insurance (LTC)?

LTC plans are compatible with Medicare Part A however, since they are considered standalone plans, they would need to be purchased separately. There is talk about developing a new Medigap plan to include LTC coverage. By working with a Bridge Agent, we can help you find an affordable LTC insurance plan to fit your needs(LTC).

How does Medicare Part A work with a Health Savings Account (HSA)?

Medicare Part A is considered a qualified expense to pay out of your Health Savings Account (HSA). A HSA can pay for Medicare Parts A, B, C & D. Once enrolled in Medicare, enrollees are no longer able to contribute to their Health Savings Account. However, the funds can be used to pay for qualified Medicare costs stated above. If one postpones Medicare enrollment they may still contribute to their Health Savings but enrolling late will also be subject to a Medicare Late Enrollment Penalty which is a percentage increase of costs per year. Speak with your Financial Advisor to determine what works best for you!

“But we know, as President Roosevelt knew and said 30 years ago, that this structure is not yet complete. It will continue to grow as our needs grow–a living monument to the American ideal of health, prosperity, and happiness for all. – Lyndon B. Johnson

Let’s revisit our list above of what Medicare Part A covers and expound on these coverages in a bit more detail. Due to the complexity and changing nature of health services, politics and coverages, we will do our best to provide concise information. Feel free to refer back to our sources for more information or Medicare.gov.

In General, Part A coverages include;

• Skilled nursing facility care
• Nursing home care (as long as custodial care isn’t the only care you need)
• Hospice
• Home health services

What does Medicare Part A cover for Hospital Care Services?

Medicare Part A Inpatient Hospital Care Services include;

• Semi-private rooms
• Meals
• General nursing
• Drugs as part of your inpatient treatment
• Other hospital services and supplies

Part A Hospital Facilities include;

• Acute care hospitals
• Critical access hospitals
• Inpatient rehabilitation facilities
• Long-term care hospitals

What’s not covered for Part A Hospital Care Insurance include;

• Private-duty nursing
• Private room (unless medically necessary)
• Television and phone in your room (if there’s a separate charge for these items).
• Personal care items, like razors or slipper socks

Associated costs for Part A Hospital Insurance include;

• $1,340 deductible for each benefit period.
• Days 1–60: $0 coinsurance for each benefit period.
• Days 61–90: $335 coinsurance per day of each benefit period.
• Days 91 and beyond: $670 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime).
• Beyond lifetime reserve days: all costs.

For more information about Hospital Care visit the Medicare Gov site.

What does Medicare Part A cover for Skilled Nursing Care?

Under certain conditions for a limited time, Medicare Part A Skilled Nursing Care covers;

• Semi-private room (a room you share with other patients)
• Meals Skilled nursing care
• Physical and occupational therapy (if needed)
• Speech-language pathology services (if needed)
• Medical social services
• Medications
• Medical supplies and equipment used in the facility
• Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that aren’t available at the skilled nursing facility.
• Dietary counseling

How much does Medicare Part A pay for a Skilled Nursing Facility?

The associated costs for Medicare Part A Skilled Nursing Facility are;

• Days 1–20: $0 for each benefit period.
• Days 21–100: $167.50 coinsurance per day of each benefit period.
• Days 101 and beyond: all costs.

What does Medicare Part A cover for Long-term Care Hospitals (LTCH)?

Patients receive coverage when both of these apply;

• A person has more than one serious condition.
• They may improve with time and care, and return home.

How much does Medicare Part A pay for Long-term Care Hospitals?

You’re only responsible for one deductible for any benefit period. This applies whether you’re in an acute care hospital or a long-term care hospital (LTCH).

What does Medicare Part A cover for Nursing Home Care?

Medicare Part A may cover nursing care via a certified skilled nursing facility (SNF) but is not covered when custodial care is the only care needed (like help with bathing or dressing). Additional long-term care choices & paying for a nursing home.

What does Medicare Part A cover for Home Health Services?

Normally, a home healthcare agency will coordinate doctors orders but services may include;

• Part-time or intermittent skilled nursing care
• Part-time or intermittent home health aide care
• Physical therapy
• Occupational therapy
• Speech-language pathology services
• Medical social services

What is not covered under Medicare Part A Home Health Services?

Part A and Home Health Services do not cover;

• 24-hour-a-day care at home
• Meals delivered to your home
• Custodial or personal care (help bathing, dressing, and using the bathroom) when this is the only care you need
• Homemaker services

How much does Medicare Part A pay for Home Health Services?

The associated costs of Medicare Part A Home Health Services are;

• Your home health agency should tell you how much Medicare will pay.
• $0 for home health care services.
• 20% of the Medicare-approved amount for durable medical equipment (DME)

What does Medicare Part A cover for Hospice Care?

Hospice benefits you and your family to stay together in the comfort of your home unless an inpatient facility is needed. Qualified recipients for hospice care, will work with the hospice team and the family to create a plan that meets your needs. For more information on how hospice works visit Medicare Gov.

What determines Medicare Part A Benefits?

There are three (3) main factors that determine Medicare Part A benefits which are;

• Federal & state laws.
• National coverage decisions made by Medicare.
• Local coverage decisions made by companies in each state. These companies decide whether something is medically necessary and should be covered in their area.

In Conclusion

Part A is senior hospital insurance that is funded through FICA taxes and can be granted for free based on Social Security requirements. Part A is 1/2 of Original Medicare, Part B (Medical Insurance) being the other half. One cannot be on both Medicare Advantage and Part A at the same same time. Medicare Part A is comprehensive coverage but does not cover certain health care costs which would require a Medicare Supplement Plan and Part D Prescription for a “Complete Health Plan”. Individuals are automatically enrolled in Part A upon turning 65 or collected early if a disability occurs. Medicare still has a long way to innovate in healthcare as it continues to make constant changes since early inception in 1965. If you have questions about your Medicare Part A you can contact a dedicate Bridge Agent to walk you through your Plan options today! This concludes our Guide on Medicare Part A Explained. Thank you for reading and we hope you continue our trek on the Medicare Journey to the next section link below.