What Is Medicare Part A? - dummies

What Is Medicare Part A?

By Ryan P. Zacharczyk, CFP®, MBA CRPC

Medicare Part A is the hospital insurance portion of Medicare. Part A requires no premium for eligible beneficiaries. Part A should not be considered as maintenance or ongoing care, but more emergency, acute care. Part A, like all aspects of Medicare has limitations, co-pays, and deductibles that should be supplemented with a Medigap policy.

Coverage for Part A is determined by benefit periods. Benefit periods begin on the day when the beneficiary checks into the hospital and ends when beneficiary has gone 60 days in a row without a stay at a hospital or skilled nursing care facility. The benefit period then resets. There is no limit to the number of benefit periods a beneficiary is eligible for.

Part A covers the following:

  • Hospital

    • Days 1-60 — $1,132 deductible.

    • Days 61-90 — Medicare covers all costs, but daily co-insurance of $283.

    • Days 91 — 150 – Lifetime reserve days, patient continues to pay daily co-insurance.

    • Days 150+ — Not covered by Medicare.

  • Skilled nursing facility

    • Need must be certified by a doctor.

    • The patient must be hospitalized at least 3 days in a row prior to transfer.

    • The patient enters the nursing facility within 30 days of hospital discharge.

    • Must receive skilled nursing care or rehab on a daily basis.

    • Days 1-20 — Medicare pays 100% of the covered amount.

    • Days 21-100 — Medicare covers all cost but daily co-insurance of $141.50.

    • Days 101+ — Not covered by Medicare.

  • Home health care

    • Need must be certified by a doctor.

    • The patient must be homebound.

    • Medicare must approve of the agency providing care.

    • No deductibles or co-insurance, if eligible for care.

  • Hospice Care

    • Patient must be medically certified to have life expectancy of 6 months or less.

    • If patient lives beyond 6 months, Medicare may extend coverage.

    • No deductibles or co-insurance if eligible for care.