Medicare Part A – In Detail

Fast Facts – Part A

Enrollment:

  • You cannot be turned down because of medical history or pre-existing condition

Coverage:

  • You can go to any qualified hospital in the United States that accepts New Medicare Patients.
  • Coverage stops at the border

Hospital costs, Skilled Nursing, In-Patient

Part A Strengths:

  • Most people don’t pay a monthly premium (Those who worked 40 quarters as a W-2 Employee)
  • For those who have to pay a premium ranging from $227-$413/Month (2017)
  • Only $1,316 deductible (2017) is paid for a hospital stay of less than 60 days.
  • You can go to any qualified hospital in the United States that accepts New Medicare Patients.
  • Enrollment is easy. You cannot be turned down because of medical history or pre-existing illness

Part A Weaknesses:

  • Long hospitalizations can become expensive.
  • In stays of more than 60 days, between days 60-90 there is a required daily copay of $329.
  • Days 91+ are covered using lifetime reserve days (60 max per lifetime) with a required daily copay of $658.
  • Deductible is per hospitalization- Multiple hospital stays mean satisfying $1,316 deductible multiple times potentially.
  • Returning in-patient within 30 days for same illness is considered same hospital stay
  • Coverage stops at the border
  • No coverage outside of the U.S.

Home Health Services

Medicare covers medically-necessary part-time or intermittent skilled nursing care, and/or physical therapy, speech-language pathology services, and/or services for people with a continuing need for occupational therapy.

  • You pay nothing for Medicare-approved, covered home health care services
  • You pay 20% of the Medicare-approved amount for durable medical equipment (Part B)

Hospital Care (Inpatient Costs)

  • You pay a deductible of $1,316 (2017) with no additional copayment for days 1–60 each benefit period.
  • You pay $329 for days 61–90 each benefit period.
  • You pay $658 per “lifetime reserve day” after day 90 each benefit period (up to 60 days over your lifetime).
  • You pay all costs for each day after the lifetime reserve days.
  • Inpatient mental health care in a psychiatric hospital is limited to 190 days in a lifetime.

Skilled Nursing Facility Care

Medicare covers semi-private rooms, meals, skilled nursing and rehabilitative services, and other services and supplies that are medically necessary after a 3-day minimum medically‑necessary inpatient hospital stay for a related illness or injury.

  • You pay nothing for the first 20 days each benefit period.
  • You pay $164.50 per day for days 21–100 each benefit period.
  • You pay all costs for each day after day 100 in a benefit period.

Medicare DOES NOT cover long-term care or custodial care.

 

NO COST, NO OBLIGATION

Answers To Your Medicare Questions



What Services Are NOT Covered By Medicare Part A & Part B ?

Medicare doesn’t cover everything.
If you need certain services that Medicare doesn’t cover, you will have to pay for them yourself unless one of the following applies to you:
• You have other insurance (including Medicaid) to cover the costs.
• You’re in a Medicare health plan that covers these services.
• Even if Medicare covers a service or item, you will generally have to pay deductibles, coinsurance, and copayments.

Some of the items and services that Medicare Part A and Part B doesn’t cover include the following:
• Long-term care (also called custodial care)
• Routine dental care. Dentures
• Cosmetic surgery
• Acupuncture
• Hearing aids. Exams for fitting hearing aids
• Final Expenses
• Non-Medical Expenses Related To Care

Let us help you navigate the confusion