Individual And Group Benefit Solutions

Medicare Part A

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/

Current Medicare Part A information for year 2020

Services 2020What you pay
HOSPITALIZATION*
Semiprivate room and board, General Nursing, and miscellaneous services and supplies First 60 days
$1408 Deductible for each benefit period
61st through 90th day$352 per day of each benefit period
91st day and after:
While using 60 lifetime reserve days.
Days 91 and beyond: $704 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime
Once lifetime reserve days are used: You pay all costs
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$176 per day of approved amounts
101st day and after You pay 100% of the cost
BLOOD
First 3 pints 100%
Additional amounts$0
HOSPICE CARE
You must meet Medicare’s requirements, including a doctor’s certification of terminal illness.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’re responsible for.

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

Enroll in a Medicare Supplement Plan

Enroll in a Medicare Advantage Plan (MA or MAPD)

Enroll in a Medicare Prescription Drug Plan (PDP)

 
 
MAPD and PDP Plans
 

 

 

 


 

 
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.