What Are My Medicare Part A Benefits?
Summary: Medicare Part A covers most hospital care and inpatient care you’ll receive after hospitalization, including skilled nursing facilities. If you end up in the hospital after a fall, heart attack, stroke, or pneumonia, you’re probably hoping you have good coverage under Medicare. Medicare Part A covers most hospital care and inpatient care you’ll receive after hospitalization. This article explores your Medicare Part A costs, benefits, and types of coverage.
What does Medicare Part A cover?
It helps to think of Medicare Part A as your hospital, or inpatient, benefit. In general, if you have a covered inpatient stay in a hospital or skilled nursing facility, Medicare Part A covers your costs.
Your inpatient benefits under Part A typically include the cost of a semi-private room, meals, prescription medications, and medical supplies and services. Medicare Part A typically does not cover personal items such as shampoo or telephone.
Medicare Part A also covers some home health services if your doctor certifies you as homebound. Covered home health services may include:
- Short-term, intermittent skilled nursing care
- Physical, occupations, and speech-language therapy
- Medical social worker services
- Intermittent hands-on home health aide services
Note that Medicare Part A does not cover long-term care or custodial care in a nursing home or other care facility.
Part A also generally pays 100% of your hospice care services if you sign a statement choosing hospice instead of treatments to cure your disease, your hospice doctor and your regular doctor certify that you’re terminally ill, and you accept palliative care instead of care to cure your illness. Your only costs under Medicare Part A hospice care include a $5 copayment for certain prescription drugs and a 5% coinsurance amount for inpatient respite care.
Does Medicare Part A cover mental health?
Medicare Part A also typically covers inpatient mental health care. You can get care at either a specialized psychiatric hospital or a general hospital offering inpatient mental health care.
According to the American Hospital Association, there are 620 nonfederal psychiatric hospitals in the USA, a portion of which accept Medicare Part A. There are also 5,262 community hospitals, some which may have a psychiatric unit and accept Medicare Part A patients.
Medicare Part A only pays for 190 inpatient days in a psychiatric hospital over your lifetime. However, if your doctor believes you need more inpatient mental health days, Medicare may pay for additional days in a general hospital.
What are my costs under Medicare Part A?
Most people qualify for premium-free Medicare Part A, so unlike Medicare Part B, you won’t have a monthly premium if you have a qualifying work history. If you or your spouse worked for at least 10 years (40 quarters) and paid Medicare taxes, you typically won’t owe a Part A premium.
There is a Medicare Part A deductible, which applies for each benefit period as opposed to the calendar year. This is different from the Part B deductible, which is paid once each calendar year. A benefit period begins the first day of a qualified inpatient hospital or skilled nursing facility stay and ends after you have not received Medicare-covered inpatient care for 60 consecutive days. You may have several benefit periods in a calendar year, and owe the Medicare Part A deductible more than once. In 2019, the Part A deductible is $1,364.
You also have daily coinsurance amounts on inpatient stays of 61 or more days. In 2019, the daily coinsurance amount for days 61 through 90 is $341. You pay a $682 daily coinsurance amount on lifetime reserve days and 100% of your charges once your reserve days are exhausted.
How can I get help with my costs under Medicare Part A?
There are two options for limiting your out-of-pocket costs under Medicare Part A. The first is to choose a Medicare Advantage plan instead of Original Medicare. You don’t lose any benefits by enrolling in Medicare Advantage, and you get a cap on your out-of-pocket costs. Since these are private insurance plans that have contracts with Medicare, you should check the benefits brochure for any plans you are interested in to find out your costs and out-of-pocket cap.
The second option is to purchase a Medicare Supplement Insurance Plan. These are private plans that cover some or all of your out-of-pocket costs under Medicare Part A and Part B. You pay a separate monthly premium for the coverage, but the plan picks up your share of covered Medicare expenses. If you think you want coverage with a Medicare Supplement Insurance Plan, you should buy one when you are first eligible and have guaranteed issue rights. If you wait, you may have to pass medical underwriting and the insurer may refuse to sell you a plan.
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