Medicare Part A

MAPD and PDP Plans 

Medicare Part A is also referred to as Hospital Insurance.

Medicare Part A  (Hospital Insurance) covers hospital services, including semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. This includes the care you get in these facilities:

This includes the care you get in these facilities

Acute care hospitals

Critical access hospitals

Inpatient rehabilitation facilities

Long-term care hospitals

It also includes inpatient care as part of a qualifying clinical research study and inpatient mental health care given in a psychiatric hospital or other hospital.

What's NOT covered

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

When should I enroll in PART A?

You should enroll in Part A as soon as you are eligible.  The majority of people are not eligible till they turn age 65.  If you are receiving Social Security or Railroad Retirement Disability Benefits for more than two years you may also be eligible.

 

How much does PART A cost?

For the majority of  people there is no cost to enroll in Part A.  However, if you or your spouse have not worked at least 10 years in a medicare tax paying job you may have a premium for Part A.

IMPORTANT NOTE: Not enrolling in Medicare when you are first eligible will likely result in a permanent penalty and a serious lapse in coverage.  If you have already missed your initial enrollment period we can help you minimize the penalty and get temporary health coverage.

How do I enroll in PART A?

If you are currently receiving Social Security Income or Railroad Retirement Income you will likely not need to do anything and will be automatically enrolled when you turn 65 or are in your 25th month of disability.  However, if you are not receiving either of the previously mentioned funds you will need to contact Social Security via phone, in-person, or online.  To enroll online visit the Social Security website https://www.ssa.gov/medicare/

Okay, I’ve been enroll in PART A and PART B now what?

If you stop with just PART A and PART B coverage you will be responsible for:

  • Part A and Part B deductibles

  • Part A and Part B co-insurance and co-pays

  • 100% of the cost of your prescription and drug costs (a few exceptions for hospital settings and Dr’s office)

The out of pocket cost to you could be unlimited if you stopped here, but fortunately you have options:

  1. Enroll in a Medicare Supplement Plan

  2. Enroll in a Medicare Advantage Plan (MA or MAPD)

  3. Enroll in a Medicare Prescription Drug Plan (PDP)

Below is a basic chart of what Medicare Part A covers.

Current Medicare Part A information for year 2017

Services 2017 Medicare Pays
HOSPITALIZATION*
Semiprivate room and board, General Nursing, and miscellaneous services and supplies First 60 days
 

 

All but $1316 deductible

61st through 90th day All but $329 a day
91st day and after:

While using 60 lifetime reserve days.

 

All but $658 a day

Once lifetime reserve days are used: $0
SKILLED NURSING FACILITY CARE*

You must meet  Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital.

First 20 days

 

 

 

 

All approved amounts

21st through 100th day All but $164.50 a day
101st day and after $0
BLOOD

First 3 pints

 

$0

Additional amounts 100%
HOSPICE CARE

You must meet Medicare’s requirements, including a doctor’s certification of terminal illness.

All but very limited co-payment/coinsurance for outpatient drugs and inpatient respite care
*A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and skilled care in any other facility for 60 days in a row

As you can see Medicare Part A covers a lot, but there are still gaps that you are responsible for.

MAPD and PDP Plans

 

 

 

 

 

 


(Click image to print or save chart for future reference)

Medicare Part A Chart 2017

IMPORTANT NOTE: This page is intended to provide individuals with some basic “Need to Know” information. For a more comprehensive understanding please see the Official “Medicare and You” guide from the Centers for Medicare and Medicaid Services.