Avila Medicare Solutions

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Medicare Part A:

Qualification, Coverage and Costs

Part A of Medicare is your hospital coverage, and together with Part B (medical coverage), they make up the Medicare Part A (hospital coverage). Original Medicare. Understanding each part in its entirety can become overwhelming, but this article will soak you, in an easy-to-understand way, on what Medicare Part A is, what it covers, who qualifies for this free part, and how to enroll.

Qualification and registration

Most people automatically qualify for Medicare Part A at age 65 if they are already collecting retirement benefits from the Social Security Administration or the Railroad Retirement Board. You may also qualify for Medicare Part A before age 65 if you have a disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis, better known as Lou Gherig's disease.

For most people, Medicare Part A is free, assuming you paid your Social Security taxes for 10 years or 40 quarters. If you don't qualify for premium-free Part A, you can buy it at a cost of up to $458 each month. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $458. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $252.

But if you are not already receiving Social Security or Railroad Retirement benefits, you must manually enroll in Part A no sooner than 90 days before your eligibility date, which is usually the first day of the month in which you turn 65. Enroll in Medicare Part A by contacting the Social Security Administration by phone at 800-772-1213 or online at www.ssa.gov. You may also contact one of our Avila Medicare agents for assistance with your Part A enrollment.

Coverage and costs

As mentioned above, Medicare Part A takes care of your hospital coverage, but what does it actually cover? This includes inpatient hospital care, skilled nursing facility care, hospice care, home health care, and some nursing home care. Approved nursing home care includes inpatient care in a skilled nursing facility that is not considered long-term care.

In more detail, with Medicare Part A, if you are hospitalized or need to stay in a mental health facility, you must first pay the Part A deductible of $1,484 per benefit period. This means that each time you are admitted to the hospital or mental health facility as an inpatient, you must pay the first $1,484. Once this deductible is met, your coinsurance is $0 for the next 60 days as an inpatient. If your inpatient stay lasts longer than 60 days, you will then have coinsurance of $ 371 per day from days 61-90 of each benefit period and $742 per day for each day after day 90 up to a maximum of 60 additional days. These additional 60 days are known as your "Lifetime Reserve Days" and, after these additional days, you will be responsible for all costs.

Part A covers you for up to 20 days at no cost when you are admitted to a skilled nursing facility, but on days 21 through 100, you will be responsible for a copayment of $185.50 per day, and after day 100, you will pay all costs. Among the things Medicare Part A also covers is hospice care stays with a coinsurance of $0, but you may have a copayment of $5 for any prescription drugs while in hospice care.

Finally, under Medicare Part A you also have no coinsurance for Medicare-approved home health care, but you must pay 20% of the cost of any necessary Medicare durable equipment.

What is not covered by Medicare Part A?

Among the things Medicare Part A does not cover are long-term care, most dental care, eye exams, dentures, cosmetic procedures, acupuncture, hearing aids and routine foot care.
As you can see, while Medicare Part A offers good coverage, it does leave you exposed to some costs, including the Part A deductible and various coinsurance and copayments. For this reason, many of our clients choose a Medicare Supplement or Medigap plan to help cover these costs and protect their income and savings. (To learn more about the different Medigap plans available, check out our video series at YouTube covering all available plans).

For more information about Part A enrollment or Medigap policies, please contact one of our authorized agents for a free consultation at 855-GO-AVILA. That is 855-462-8452. Or simply click the button below to request information now.

Do you have any doubts? Call us now.

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