Medicare is the healthcare insurance plan that is provided by the federal government once you reach the age of 65. This period of time is generally correlated with retirement and the acceptance of Social Security benefits. However, retired or not, you are able to apply for Medicare coverage three months prior to your 65th birthday, which marks the beginning of your Initial Enrollment Period. Individuals under the age of 65 who have been receiving disability benefits through the Social Security Administration or the Railroad Retirement Board after 24 months are also eligible for Medicare, along with individuals diagnosed with ESRD. The standard Medicare coverage is known as Original Medicare insurance, which is made up of Part A and Part B. Part A insurance is designed to primarily cover inpatient care and services.
What does Medicare Part A Include?
Part A is primarily designed to cover inpatient expenses. This care can be received in a hospital, in a skilled nursing facility, or in hospice care. Long-term care facilities do not always fall under Medicare Part A coverage, so you should be sure to check with your insurance agent if this applies to you.
Medicare Part A may be used if you are formally admitted to a hospital for a procedure and you will be required to spend a few days in the hospital afterwards for recovery. In addition to the procedure and the stay, Part A will also cover any other costs you incur while you are at the hospital, including medications, therapy, any medical equipment you use, and meals.
How Much Does Medicare Part A Cost?
For those who qualify for Medicare insurance, Part A is often associated with no premium charge. This allows you to receive coverage with no out of pocket costs if you do not require any care. You will qualify for premium-free Part A as long as you or your spouse has worked for at least 40 calendar quarters, or the equivalent of 10 years. During these years in the workforce, you would have been contributing to Medicare through tax payments.
However, if you have not worked for at least 10 years, you may be subject to a premium fee, which is paid on a monthly basis. Only around one percent of Medicare recipients pay a premium fee for Part A. If you have worked for between 30 and 40 quarters, your fee will likely be around $252 per month in 2020. For those working fewer than 30 months, your monthly premium payment will likely be around $458.
If you have Part A coverage, you will also be subject to paying your associated deductible payment. This amount is set per benefit period, and it often increases slightly each year. For 2020, the deductible amount for each period has been set at $1,408. This is the amount that you will be forced to pay out of pocket each hospital stay before Medicare Part A will take over. Benefit periods begin on the day you are admitted to the hospital and then reset after you have not received any hospital care for 60 days in a row.
After you reach your deductible, Medicare will pay all associated costs in full for the first 60 days of your stay. During days 61 to 90 of inpatient care, you will be responsible for a daily coinsurance payment of $352 per day. After your 90th day, you will enter lifetime reserve days, which are associated with a $704 daily coinsurance payment.
Where Should You Use Medicare Part A?
If you are seeking care, it is important to ensure you are attending a Medicare-approved facility and that the procedure or testing you are looking for is covered by Medicare insurance. If you visit a physician or a facility that is not in network or is no longer participating in Medicare, your insurance may deny payment, forcing you to pay out of pocket for the entirety of the cost. If you are ever unsure as to whether or not your insurance plan will cover a procedure or is accepted at a certain facility, it is best to check with your plan to prevent unwanted additional costs.