We will talk about Part A of Medicare, what it’s benefits are and how much it costs.

Here is a 2-minute video explaining Part A, what it is, and how it works. You can continue reading to learn more details.

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What is Medicare Part A and what are it’s benefits and how much does it cost?

Medicare Part A is coverage for hospital (inpatient) care, skilled nursing care, hospice, and home health care.

Typically, anything major or catastrophic with someone’s health that requires them to be admitted to a hospital for treatment.

It is available to all legal residents of the United States if they meet the necessary requirements that make them eligible.

Turning 65 or getting approved for Disability are some of the most common ways to qualify.

Qualifying for Part A

If you or your spouse work the necessary “quarters,” then both of you may be eligible by the time either of you turns 65.

If you do not qualify for Disability, then you will have to wait until 65 to get the coverage started.

Part A does not cover all costs associated with care. Knowing what it covers not only helps in understanding what the risks are with having only Part A but also helps someone make an informed decision if they will need additional coverage to prevent high out of pocket medical bills.

Continue reading to learn about the different things Medicare Part A covers.

How much is Part A?

Part A is not free.

Chances are, though, that you’ve already paid for it.

There are a couple of different factors that play into determining the cost of Part A whenever you first become eligible.

Working the necessary “quarters” allows you to get Part A with no monthly premium because you have paid enough taxes into it while you (or your spouse) were working.

You can also pay a monthly premium if you do not meet the necessary requirements by the time you are eligible (usually when you turn 65).

Working 40 quarters or 10 years, will make Part A premium-free when you turn 65.

If you did not meet this requirement, Part A will cost you $458 per month (in 2020) if you have worked less than 30 quarters.

If you worked more than 30 but fewer than 40, your cost will be is $252 per month (in 2020).

Medicare’s website updates the monthly premium for Part A every single year. You can see what the monthly cost for it is by clicking here

Other ways to qualify for Part A

Continuing to work

If you did meet the necessary “quarters” requirement (40) over your lifetime, you will have a couple of options to qualify Part A.

The easiest way is to continue working.

Working until you have built up enough “quarters” will allow you to eventually build up enough credits to make Part A premium free.

It is not uncommon to see Seniors working well beyond the age of 65 until they finally qualify.

If you cannot work due to health reasons, you can apply for Medicare Disability to see if you qualify. You can search on how to apply for Medicare disability on the top of this page or on this site’s home screen.

Medicare Disability

There are a lot of resources on the internet that talk about how to qualify for disability.

Medicare Disability insurance is the same as traditional Medicare. Designed for people people who cannot work.

If you have been receiving disability insurance through Social Security for a minimum of 24 months you will qualify for Medicare.

You do not need to do anything to sign up. On the 25th month, enrollment is automatic.

We will talk about Part B benefits in a different post. You can search for more details about Part B on the top menu of this page.

Benefits through a Spouse

If you are or were married to someone who’s worked and has met their requirements for Medicare by working the necessary quarters, you may be eligible when you turn 65.

As long as your spouse has met the necessary quarter requirements, you may qualify because of your spouse’s work history, even though you did not.

Here are some of the requirements if applying through a spouse:

  • Married for at least 1 year and your spouse has met the requirement.
  • Married for at least 10 years but now divorced.
  • Widowed but married for at least 9 months and they met their requirements for Medicare. You have to be single to qualify for that spouse’s benefit.
  • Remarried, the same rules apply but now with your new spouse.

If you are not sure if you qualify and want to learn more, you can always call or visit your local Security Office.

You can search for a local Social Security Office by clicking here.

Enrolling into Part A

If you have met the necessary requirements, you will automatically be enrolled in Medicare Part A.

You can pay for it when you turn 65 if you have not met the requirements by applying for coverage through your local Social Security Office.

What if I am still working?

When eligible for Medicare Part A, remember, you will automatically be enrolled (usually when you turn 65).

If you have qualifying health insurance through an employer and decide you want to keep it, Part A becomes your secondary coverage.

We will talk about what is qualifying coverage in a different post. Use the search tool to learn more.

What does Part A cover?

Part A covers Hospital (inpatient) care, skilled nursing care, hospice, and home health care. Let’s look closer at each one of these and go into some of the details.

Hospital

All claims are covered by Part A in the hospital for any major health reasons if the hospital accepts Medicare, and you are admitted because it is medically necessary.

Some examples of things that are covered include:

  • meals,
  • general nursing,
  • drugs as part of treatment,
  • hospital supplies, and services,
  • semi-private rooms

Part A not 100% coverage and you will be responsible for a portion of the bill.

How much do I pay when in the hospital?

While in the hospital, your out of pocket costs are broken down into several different categories:

  • $1408 Deductible per benefit period (First 60 days)
  • $352 per day for days 61-90
  • $704 per for days 91+ until you use up all of your reserve days (60 days total over your lifetime).

Continue reading to learn about reserve days and benefit periods.

Skilled Nursing Care

Skilled nursing care is done by professional or technical personnel that treats, manage, or observes your condition while evaluating your care.

Part A covers Skilled Nursing Care.

As long as you have days left in your benefit period and if you have met the 3-day requirement of inpatient hospital care before you are admitted into a skilled nursing facility.

A benefit period starts the day you are admitted into a hospital and lasts for 60 days. However, you have to be inpatient at a hospital for a minimum of 3 days before you are eligible to have skilled nursing care coverage and admitted within the same benefit period.

If you are discharged from a hospital but are still with the benefit period you generally have 30 days to be admitted to an SNF and have coverage.

Some examples of Skilled Nursing Care include:

  • wound care
  • intravenous (IV) therapy
  • injections
  • catheter care
  • physical therapy
  • monitoring of vital signs and medical equipment
  • speech pathology
  • Physical Therapy
  • Meals

While in Skilled Nursing Care, I pay:

  • $0 for days 1-20 during the benefit period
  • $176 per day for days 21- 100 of each benefit period
  • all costs beyond day 100

Keep reading to learn about benefit periods.

Hospice

Hospice care is for those who are terminally ill and have a life expectancy of 6 months or less and prefer to have comfort care (palliative) instead of actively seeking treatment.

While in Hospice, I usually pay nothing.

However, if you decide to do hospice in your home or in a nursing home, Medicare will not cover you.

Generally, you have to be in the hospital to receive coverage.

If you need prescriptions, not to treat your condition, but manage your pain, you may end up paying a small co-pay (usually $5).

Home Health Care

Home Health care provides care in your home for your medical needs. It is less expensive than hospital care and is a great alternative that provides convenience and comfort of getting care in your home instead of a medical facility.

Your doctor will continually evaluate your situation to determine if you need to continue receiving HHC. In the event you decide to continue, even though your doctors say you should stop, you will pay all of the costs.

A doctor must certify that you are homebound before you can start receiving coverage and designed for short term treatment that allows you to get better and regain your independence as fast as possible.

Some of the things that home health covers include:

  • physical therapy
  • speech-language pathology
  • occupational therapy services
  • intermittent skilled nursing care

Home health care usually does not cost anything under Part A

However, you may be responsible for 20% of the Medicare-approved amount for durable medical equipment.

Part A: Total Out of Pocket

We went over all the different parts of Medicare, how it covers, and approximately how much you would owe if you find yourself needing care. Now, let’s recap about the total cost and the talk specifically about benefit periods.

If you find yourself in the hospital you will pay:

  • $1408 Deductible per benefit period (First 60 days)
  • $352 per day for days 61-90
  • $704 per for days 91+ until you use up all of your reserve days (60 days total over your lifetime).

In a Skilled Nursing Facility:

  • $0 for days 1-20 during the benefit period
  • $176 per day for days 21- 100 of each benefit period
  • all costs beyond day 100

Hospice and Home Health:

  • You pay nothing

If you want to know more about the different ways to help fill in some of the gaps that Medicare does not cover, search for Medicare Supplement or Medicare Advantage to learn more.

What is a “Benefit Period”?

Benefits Periods Play a vital role in determining your total out of pocket costs when receiving care or treatment.

They are designed to minimize your out of pocket and protect you from hospitals taking advantage of you and your situation.

It begins the day you are admitted into a hospital and continues for 60 continuous days after you stop receiving inpatient care.

If you use up one of your benefit periods, a new one will begin.

Let’s use an example of how to benefit periods work and how they affect out of pocket costs:

Susan was admitted to the hospital because of a heart attack. She spends 4 days there and receives all types of care that eventually gets hear strong enough to go home. When she finally gets her bill, she notices that she owes $1408. That is her Part A deductible.

45 days later, he goes back in for chest pain and spends another 3 days in the hospital. Because she is still within her benefit period, she will not owe anything for her second visit to the hospital because she is still within her benefit period.

90 days later she goes in with more chest pain. She spends 5 more days in the hospital. Her bill was $1408. That is her Part A deductible, again, that she has to meet because her benefit period started over.

If during any of her visits, she stays beyond the 60 days, either all at one time, or by being readmitted during the same benefit period, she pays the daily amounts listed above.

How to minimize Part A out of pocket expenses?

The easiest way is having some kind of secondary coverage that helps with the gaps in Medicare.

Medicare supplements, indemnity policies, and Medicare Advantage Plans all provide coverage that helps minimize the cost with Medicare.

Remember to use the search tool if you have any questions related to any of these topics we’ve covered.

Summary

As you see, Part A provides a lot of important coverage related to hospital expenses and is a vital part of your Medicare coverage.

If you have any questions about Part A or any other parts of Medicare, please use the search feature on top of this page or the home page. If you want more clarification, fill out the contact form, and submit your questions.

You can always call us at 888-209-5049 if you prefer to talk on the phone.