Medicare Part A Costs
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Medicare Part A covers nursing care, room, and meals in a hospital or skilled nursing facility (such as a rehab center or a nursing home); home health services; and hospice care. The following sections describe the possible out-of-pocket costs that you may pay for those services.
Note: The costs in the following sections apply if you’re enrolled in the traditional Medicare program. They’ll likely be different if you’re in a Medicare health plan such as a HMO or a PPO.
You don’t pay premiums for Part A coverage if you or your spouse paid enough in Medicare payroll taxes to earn at least 40 credits (sometimes called quarters) while working.
If you don’t have enough credits through your own or your spouse’s work record, you can buy Part A services by paying premiums for them: in 2013, $243 a month if you have 30 to 39 credits and $441 if you have fewer than 30 credits. These amounts tend to go up a little each year.
Part A doesn’t have an annual deductible but rather applies a deductible to each hospital benefit period. This unit of time begins when you’re first admitted to a hospital and ends only when you’ve been out of the hospital for 60 days.
Huh? Yes, this timeline is a weird concept. All you need to know here is that the deductible for each hospital benefit period is $1,184 in 2013 (it goes up a little each year) and that after you’ve met it, Medicare picks up the whole tab for up to 60 days.
Co-payments (hospital and skilled nursing facility)
If you stay in the hospital for more than 60 days in any one benefit period, you’re charged a daily co-pay for each day from the 61st to the 90th. In 2013, the co-pay is $296 a day, but this amount increases a little each year.
If you still need to remain in the hospital after 90 days, you can choose to draw on some of your lifetime reserve days. These days require a hefty co-pay — $592 a day in 2013 — and they’re limited to 60 days for the rest of your life. After these reserve days are exhausted, you must pay full costs.
If you’re admitted to a skilled nursing facility (SNF) after being in the hospital for the required three days, Medicare picks up the whole SNF tab for the first 20 days, and you pay nothing.
After that, you pay a daily co-pay ($148 in 2013) for the next 80 days. If you need to be in the facility longer than 100 days in any one benefit period, you’re responsible for the full cost.
You can’t use your lifetime reserve days to extend coverage in a SNF.
Co-payments (home health care and hospice care)
If you qualify for home health services, Medicare pays a home health agency for your care; you pay nothing. If you need or want a service that isn’t covered under the agency contract, you have to pay for it yourself — either in full or as a regular 20 percent Part B co-pay.
If you receive hospice services from a Medicare-approved agency, you pay almost nothing for this care. Two exceptions exist:
If you need prescription drugs to control the symptoms, such as pain, of your terminal illness, you pay up to $5 per prescription.
If you need to enter a nursing home for a short time so that your caregiver can catch a break, you’re expected to contribute 5 percent of the cost.
Medicare places no annual upper limit on your expenses in Part A. But if you have a Medigap policy or other supplemental insurance, it may cover Part A’s hospital deductible and co-pays.