For those looking to enroll in your standard Original Medicare plan, you must familiarize yourself with the different types of policies that cover various aspects of health care. Medicare is a very complex health coverage offered as a federal program and run by The Centers for Medicare and Medicaid Services (CMS). The coverage offerings offered to Medicare recipients are split into four different distinct categories known as Parts A, B, C, and D. Also, Medicare Parts A and B make up Original Medicare. Medicare Part A has its own schedule of covered services that we will go over in this blog. If you are interested in learning a bit more about Medicare Part A, how it works, what it covers, who can and when to enroll, and its unique cost-sharing read on!
Medicare Part A and Its Covered Services
Part A is known as hospital coverage for Medicare beneficiaries. Medicare Part A has it’s own unique and specified coverage’s and is the medical coverage used when a Medicare beneficiary requires medical care in a hospital, skilled nursing facility, nursing home, hospice, or home health care type of settings. The coverage includes:
- Inpatient Hospital care: Might include semi-private rooms, meals, nursing services, and prescription drugs needed for your treatment. Part A hospital coverage may consist of inpatient care you receive in long-term care hospitals, inpatient mental health hospitals, acute care hospitals, and critical access hospitals.
- Skilled Nursing Facility care: May include semi-private rooms, meals, skilled nursing care, prescription medications, medical supplies and equipment, and ambulance transportation (if medically necessary). You may be covered if your doctor has decided that daily skilled nursing care is medically necessary.
- Nursing Home care: This care may be covered for a limited time if deemed medically necessary. Medicare Part A only covers nursing care if skilled care is needed for your condition, per a doctor’s instructions. You must require more than just custodial care (help with daily living tasks, such as bathing, dressing, etc.) to be deemed medically reliant.
- Hospice care: May include doctor services, nursing care, durable medical equipment, medical supplies, and other services if you are terminally ill and your doctor has determined that you have six months or less to live.
- Home Health services: May include at-home skilled nursing care, physical therapy, occupational therapy, and other services for a limited period when intermittent skilled nursing care or therapeutic services are deemed medically necessary. Part A may cover part-time home health care if you are homebound, and you get these services through a Medicare-certified home health agency.
What are the Costs for These Medicare Part A Services?
Most people are eligible to receive Medicare Part A without a monthly premium. To qualify for premium-free Part A, the Medicare beneficiary or their spouse needs to have worked the necessary amount of time under Medicare-covered employment, usually ten years or 40 quarters, and have paid Medicare taxes while working. However, your Part A coverage might include other costs, even after Medicare has helped pay its share. These cost-sharing responsibilities that are the Medicare beneficiaries’ out-of-pocket expenses that can potentially be the responsibility of the covered Medicare beneficiary include copayments, deductibles, and coinsurance, all of which can change from year to year. These costs obligations might depend on the type of medical service you’re receiving and how often and will be based on the cost-sharing schedule, according to the services rendered.
Eligibility for Medicare Part A
You’re typically eligible for Medicare Part A if:
- You’re 65 or older and a United States citizen or permanent legal resident of at least five straight years.
- You’re disabled and receiving some Social Security disability benefits for 24 months
- You have end-stage renal disease
- You’re diagnosed with amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)
Most beneficiaries don’t pay a premium for Part A if they’ve worked at least ten years and paid their Medicare taxes during that time. Those who aren’t eligible for premium-free Medicare Part A still can enroll in Part A and pay the premium. Beneficiaries who delay their enrollment after they first become eligible for Part A might be subject to the late enrollment penalty once they sign up.
Part A Cost-Sharing in 2021
Inpatient Hospital Care:
- Part A deductible: $1,484 for every benefit period
- Part A coinsurance: is $0 coinsurance for the very first 60 days of each benefit period
- $371 a day for the 61st to 90th days of each benefit period
- $742 a day for days 91 and beyond per each lifetime reserve day of each benefit period (you get up to 60 lifetime reserve days)
- After lifetime reserve days are used up: You are responsible for all the costs
Skilled Nursing Facility Care:
- $0 for days 1 to 20 for each benefit period
- $185.50 a day for the 21st to 100th days (skilled nursing facility coinsurance of each benefit period)
- Days 101 and beyond: You are responsible for all the costs
How and When You Should Enroll in Part A coverage
A person is required to enroll in Medicare Part A when they first become eligible for coverage. Not enrolling in Part A can become an issue later if you desire to enroll later. If someone is still working and has coverage through their employer group health plan, it’s always a good idea to sign up for premium-free Part A when first becoming eligible.
Generally, a person is entitled to Medicare on the first day of their 65th birth month. Being entitled does not automatically enroll an individual. You’ll be automatically registered if you are already receiving your Social Security benefits. If not, you will need to enroll via Social Security at https://www.ssa.gov/benefits/medicare/ or call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You also could visit a local Social Security office that you can find using this link Office Locator.
A Medicare-eligible beneficiary can apply for Medicare three months before their eligibility, the month of eligibility, and three months after. This is known as the seven-month Initial Enrollment Period.
Aside from eligibility when you turn 65, a person may also be eligible for Medicare because of a specific disability specified by the Social Security Administration. Most Social Security disability recipients are eligible for Medicare after 24 months of being eligible for Social Security Disability benefits. Still, there are a few exceptions that do begin the benefits sooner. These situations are unique and can occur if a person has End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).
For more information on Medicare Part A, and how to enroll, give Healthcare American a call today!
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