Chances are if you’re a U.S. citizen age 65 or older, you have Medicare Part A. Medicare Part A represents your inpatient health coverage, and makes up one half of Original Medicare. Original Medicare provides health insurance to millions of Americans, and it’s divided into two parts. The other half is Medicare Part B, which covers your outpatient health services.
Who Qualifies for Medicare Part A?
In order to be eligible for Medicare Part A, you must either be a U.S. citizen or a permanent legal resident that’s lived in the country for at least five consecutive years. You also need to meet at one of the two following requirements:
- You’re 65 years of age or older
- You’ve been receiving Disability benefits for 24 months (less if you have ESRD or ALS)
You’ll be automatically enrolled in Part A if you’re eligible to receive Social Security benefits (even if you’re not drawing them) four months before you turn 65, or if you’re on Disability. You can confirm your Part A start date on your Medicare card, which you’ll get in the mail three months before your 65th birthday (or your 25th month of disability). Otherwise, you’ll need to proactively sign up, which you can do online at the Social Security website.
What Does Medicare Part A Cover?
Medicare Part A covers the treatment that you receive as an inpatient. For example, if you receive major surgery and need to spend a few nights in the hospital, your treatment would fall under Part A. In general, Medicare Part A coverage includes:
- Inpatient care in hospitals
- Inpatient rehabilitation facilities
- Skilled nursing facilities
- Home health care services
- Hospice care
Your provider must accept Medicare, and your treatment must align with Medicare’s guidelines in order for your claim to be approved (for instance, your treatment must be medically necessary). Fortunately, most healthcare providers accept Medicare, which means that you have access to a nation-wide network.
What are the Part A Medicare Costs?
Most people are able to receive Medicare Part A without paying a premium. If you don’t qualify for a free Part A, you’ll need to pay a premium of up to $458 a month in 2020.
In order to be eligible for premium-free Part A, you must be both:
- 65 or older
- Eligible to receive monthly Social Security or RRB (Railroad Retirement Board) benefits
Even if you don’t pay a premium, you’ll still be responsible for some out-of-pocket Medicare Part A costs. Medicare Part A doesn’t pay the entire bill for the services that it covers. Instead, Part A typically only pays up to 80%, which leaves you with a 20% coinsurance. For example, your coinsurance under Medicare Part A for an inpatient hospital stay is as follows:
- Days 1-60: $1,408 deductible*
- Days 61-90: $352/ day
- Days 91 +: $704/day for each lifetime reserve day. You only have 60 lifetime reserve days, after which you’re responsible for the full cost.
*The Medicare Part A deductible($1,408 in 2020) resets each benefit period. A benefit period begins when you haven’t been admitted as an inpatient for 60 days in a row. This means that you could be responsible for the Medicare Part A deductible several times in a year.
Medicare Part A offers exceptional coverage, but for many people, the out-of-pocket costs can be overwhelming. Fortunately, you don’t need to pay them on your own. You have options for additional insurance that will help cover the gaps in Original Medicare. Additional insurance will protect you from large bills so that you can have peace-of-mind knowing that you’ll be able to afford the treatment that you need.
GoMedigap does not offer Medicare plans. To apply for Medicare Part B, you must contact Social Security by calling 1-800-772-1213 or visiting SSA.gov.
Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.