Medicare Part A

For most people, Medicare Part A has a premium of $0 and a $1,364 deductible. However, if you have worked and paid Medicare taxes for less than 10 years (or 40 quarters), you may be required to pay a higher premium. Additionally, if you do not enroll in Medicare during the initial enrollment period (when you turn 65), you may be subject to a late enrollment penalty fee.

Medicare Part A Hospitalization Coverage

Your benefit period for hospitalization starts the first day you receive a Medicare-covered service as an inpatient in a qualified hospital.

The benefit period ends when you have been out of a hospital for 60 days in a row. If you enter a hospital again after that 60 days, a new benefit period will start.

Please not that if a benefit period lasts longer than 60 days, the co-insurance charges will increase, and increase again after an additional 30 days.

Typically, Medicare Part A covers the following services: Semi-private room and board, meals, nursing services, medications that are part of your inpatient treatment, and other hospital services and supplies.

Please note that Medicare Part A will not cover the costs for a private room (unless medically necessary), private-duty nursing, personal care items, or other charges such as TV and telephone usage while at a hospital.

Medicare Part A Skilled Nursing Facility Care Coverage

Under Medicare Part A, skilled nursing facility (SNF) stays are covered after a qualifying hospital inpatient stay for a related illness or injury. It must be certified by your doctor that you need daily skilled care that cannot be received at home, such as intravenous drugs or physical therapy.

To qualify for coverage, the hospital stay leading to SNF care must be a minimum of three days, beginning on the day you are formally admitted as an inpatient. The day you are discharged, and time spent under observation as an outpatient does not count towards the minimum three-day requirement.

To be receive coverage, the skilled nursing care must be provided at a Medicare-certified facility. Coverage includes the following services: semi-private room and board, meals, skilled nursing and rehabilitative services, and other services and supplies.

Also note that if your stay at a skilled nursing facility lasts longer than 20 days, you may be required to pay a daily coinsurance rate.

Medicare Part A Home Health Service Coverage

Medicare Part A will cover home health care services if your doctor deems them medically necessary and certifies you as home-bound. According to Medicare, you are considered “home-bound” if both of the following are true:

  • You cannot leave home under normal circumstances, and doing so would require substantial effort.
  • It is medically inadvisable for you to leave home without the help of another person, adequate transportation, and/or special equipment.

All home health care services related to your treatment will be covered in their entirety, with the exception of durable medical equipment if required, which has a 20% coinsurance.

Medicare Part A Hospice Care Coverage

Medicare Part A will cover hospice care if your doctor has certified that you have a terminal illness with an estimated six months or less to live. To qualify for hospice coverage, you must agree to give up curative treatments for your terminal illness. Medicare will still cover palliative (comfort-focused) treatment for your illness, along with related symptoms or conditions.

Medicare Part A hospice care is usually received in the patient’s home, but you may also receive hospice care from a Medicare-approved hospice facility if the home is deemed unsuitable.

Part A hospice coverage includes, but is not limited to: Pain relief, symptom management, medical, nursing and social services, drugs, certain durable medical equipment, and other services such as spiritual and grief counseling.

Please note that while you must give up any curative treatments for your terminal illness to in order to receive hospice coverage, you have the right to stop hospice care at any time. Talk to your doctor right away if you are considering going back to curative treatments.

Medicare Part A Blood Transfusion Coverage

Medicare Part A includes coverage for blood when furnished by a hospital or skilled nursing facility during a covered stay, with the following conditions:

If the hospital gets blood from a blood bank at no charge, you won’t have to pay for it or replace it.

If hospital buys blood for you, you must either pay the hospital costs for the first 3 units of blood you get in a calendar year, or have the blood donated by you or someone else. This “first 3” deductible can be met by either Part A (inpatient) or Part B (outpatient) coverage.

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Last Updated 11/26/2018