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Medicare Part A

Medicare Part A is the first part of what is referred to as Original Medicare (Part A and Part B).  Medicare Part A is often referred to as Hospital insurance because most of what is covers relates to services received in a hospital setting.  

Most people are enrolled in Medicare Part A automatically when they turn 65.  

What Medicare Part A Covers

Part A covers services received in the following settings:

  • Inpatient Hospital Care
  • Hospice Care
  • At home part time skilled nursing care
  • At home physical therapy
  • Inpatient care at a religious non-medical health care facility
  • Blood transfusions after the first 3 pints of blood

Premiums for Medicare Part A

If you have worked the past 10 years (40 quarters) and paid into Medicare, Medicare Part A will be free.  If you did not work, you can claim benefits through a spouse's  work history.  If you do not qualify through those options, you can pay for Medicare Part A.  The amount you pay will be determined by the number of quarters you have worked over your lifetime (while paying Medicare taxes).

For details on how to apply for Medicare Part A, please click on this link: How to enroll in Medicare

What You Pay with Medicare Part A

Medicare Part A does have portions that the responsibility of the beneficiary (you).  You are required to meet these amounts before Medicare Part A pays.  Beneficiaries often use a Medicare supplement (Medigap) plan to cover the out of pocket exposure of Medicare Part A and Medicare Part B.

 Your Costs with Medicare Part A

What you pay (2016)

  Inpatient Hospital Stay*

 

  Deductible

 $1,288

     Days 1-60

$0

     Days 61-90

$322 per day

     Days 91 and beyond

$644 per day (limited at 60 reserve days over lifetime)

   Skilled Nursing Facility (Rehab)**

 

     Days 1-20

$0

     Days 21-100

$161 per day

     Days 101 and beyond

You pay all

* Benefit period begins the day you are admitted as an inpatient. This period ends when you haven’t received any inpatient care (including Skilled Nursing Facility Care) for 60 days in a row. After 60 days, a new benefit period will start and the deductible must be meet again. There is no limit on the number of benefit periods.

**If your break in skilled care lasts more than 30 days, you need a new 3 day hospital stay to qualify for additional SNF care. If your break in skilled care lasts for at least 60 days in a row, your benefit period of 100 days resets.

How to cover the gaps in Medicare Part A

The out of pocket exposure with Medicare Part A is significant.  In order to avoid that exposure, many seniors will choose a Medicare supplement (Medigap) plan to cover those holes in Original Medicare.  To learn more about the peace of mind a Medicare supplement plan can provide, click on this link: What is a Medigap Plan.