This article provides an overview of Medicare Part A (Hospital Insurance), including coverage, costs and enrollment periods.
PART A (Hospital Insurance) - Overview
Medicare is a comprehensive healthcare program, distinctly segmented into four parts – Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage plans) and Part D (Prescription Drug plans).
Let us discuss Part A (Hospital Insurance).
Medicare Part A provides coverage for inpatient hospitalization, skilled nursing care, hospice care and some home health care. It does not include custodial care or long-term care. Part A pays only hospital bills and not physician fees. You should check whether your doctors, providers, and suppliers accept assignment (covered under Part B).
Part A covers your stay in semi-private rooms, meals, nursing, drugs which are part of your inpatient care, and other hospital services and supplies. However, you will have to pay extra for private-duty nursing, a private room, and personal care items. You are also eligible for treatment in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities and mental health care. Coverage may vary for each of these so make sure you understand what is covered by Medicare.
Duration of hospital stay
To get Part A coverage in a hospital, your doctor has to certify that you have to be admitted to a hospital for two or more nights to treat your illness or injury. The average stay in a hospital is typically ten days, but Medicare has kept a fairly high limit on the number of days you can stay in a hospital for treatment.
In any ‘benefit period,' also called ‘spell of illness,' Part A covers your stay in a hospital for a total of upto 90 days, which may or may not be continuous. If need be, you can stay up to an additional 60 ‘lifetime reserve’ days, each of which may be used once only in a patient’s lifetime.
Out-of-pocket Costs (during 2019)
Most people qualify for premium-free Part A. If you or your spouse have worked and paid social security taxes for less than 40 quarters, you may have to pay a premium of up to $437 per month.
Part A has a deductible of $1,364 per ‘benefit period.' For hospital stays during a benefit period, there is no copay for the first 60 days and $341 per day for the next 30 days. 91st day onwards the copay is $682 per day for each ‘lifetime reserve’ day. You bear all costs once the 60 lifetime reserve days have been used up.
Enrollment and Signup
You are automatically enrolled if you are getting Social Security or Railroad Retirement Board benefits.
Initial Enrollment Period (IEP). You can enroll in Part A during the 7-month period that begins three months before the month you turn 65 and ends three months after.
If you sign up for Part A and/or Part B during the first three months of the IEP, your coverage will typically start the first day of your birthday month. If you enroll in Part A and/or Part B the month you turn 65, or during the last three months of the Initial Enrollment Period, the start date for your Medicare coverage may be delayed by one to three months.
Special Enrollment Period (SEP). If you delayed enrolling in Part A because you or your spouse were still employed and had a group health plan, you could enroll anytime while you are still covered by that group health plan or during the 8-month SEP that begins after the employment ends or the coverage ends, whichever happens first.
General Enrollment Period (GEP). You can also enroll in Part A and/or Part B between January 1st and March 31st of each year, called the GEP. Your coverage won't start until July 1st of that year, and you may have to pay applicable late enrollment penalties.
Annual Election Period (AEP). If you are already enrolled in Medicare, this is the time when you can change your Medicare health or prescription drug coverage plans. You may also switch between Medicare Part A/Part B and Medicare Advantage (Part C) or make other changes. The AEP runs from October 15th through December 7th of every year for coverage beginning January 1st of the following year.
Click here to learn more about Medicare, its various Parts, different enrollment periods and your costs.
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Last Updated: 08-09-2019