Medicare Part A is the hospital insurance for Medicare. It provides any medically necessary visits to the hospital. Most people are automatically enrolled in Medicare Part A within three months of turning 65.Some, however, are not. We will go over enrollment, coverage, price, and other issues in this article.
How to get Medicare Part A. For most people, they are automatically enrolled in Part A when they turn 65 as long as they have enough work credit. Basically, work credits are the number of years you worked factoring in the amount of tax you paid into Medicare and Social security. If you have sufficient work credits and are 65 or older you will be automatically enrolled in Part A. You will not have any premiums to pay, enrollment is free though there are other costs.
Paid coverage. If you do not have enough work credits and you’re over 65 then you will have to manually apply at your local Social Security Administration office. You will also be required to pay a monthly premium. To give you some context in 2011 your monthly Medicare Part A premium would be $248 a month if you (or your spouse) had between 30 and 39 work credits. If you had less than 30 work credits your monthly premium in 2011. If you wait more than one year after turning 65 to enroll in Part A paid coverage you will have to pay 10% more in your monthly premiums.
What does Medicare Part A cover? Medicare will pay most of the cost that results from an independent hospital stay as long as it is prescribed by a licensed physician, it must be reasonable and medically necessary care, and it must be at a Medicare-approved facility. You can find what hospitals are Medicare-approved at Medicare.gov.
Things not covered. Medicare Part A will not cover things that aren’t medically necessary. Personal convenience items such as television in your hospital room, phone access, radio, a private duty nurse, or a private room (that isn’t medically necessary) will not be covered.
What will Medicare Part A pay? What Part A will cover requires some special attention. First, you must pay the deductible amount, as of 2011 the deductible is $1,132. After that, the basis of Part A payment is a benefit period. A benefit period is any hospital stay up to 90 days. After the 90 days, you will be required to pay 100% of your hospital costs unless a new benefit period begins. A new benefit period begins after 60 days have passed since your last hospital stay. One month in the hospital separated, for example, by 20 days is not enough, another hospital stay at that time will be counted with your 1 month.
From 1 to 60 days Medicare Part A will cover 100% of all covered costs at your hospital stay. From 61 days to 90 days you will be required to pay a daily coinsurance towards your hospital costs. In 2011 this coinsurance was $283 each and every day you’re in the hospital
Reserve days. If you’re caught over the 90 days you can use what are called “reserve days” as a last ditch effort. Instead of paying the entire cost of your hospital stay you would instead pay a daily coinsurance reduced by Medicare. In 2011, the required coinsurance during a reserved day is $566. This is still an exorbitant amount. What’s more, you only have 60 reserve days over your entire lifetime. Once you use a reserve day, it’s gone forever.
What about other types of facilities, like Skilled Nursing? Medicare Part A will pay for other hospital-like facilities usually because they are cheaper. These include skilled nursing facilities, home health care agencies, and hospice care. Skilled nursing coverage is almost the same as a hospital since much like a hospital, skilled nursing care provides a high level of observation and care. Part A coverage, however, will not cover a stay at a skilled nursing if all that is needed are “custodial services” such as bathing, help moving around, cooking, cleaning, etc. Even if these custodial services are related to your medical condition. Home health care on the other hand is cheaper, at your home, and will be covered 100% by Medicare Part A.
What about foreign hospitals? For those seniors who enjoy traveling be aware that Medicare Part A (or Part B for that matter) does not cover hospital care outside of the United States. If you are injured in a foreign country you’re on your own in paying your hospital bills. There are some exceptions. The first general exception is if the nearest hospital is a foreign one. This usually happens when you live in say a small town right on the border of Canada. If the closest hospital is a Canadian one, Medicare will cover your hospital stay. The other exception is if you are traveling through Canada to get to Alaska then you will be covered even if you stay a foreign hospital.
You can get around this Medicare loophole by purchasing a travel insurance. You pay one premium and are covered for the period that you are traveling abroad. Some Medigap policies also cover foreign travel as well as some Medicare Advantage plans.
Medicare Part A and B are also called Original Medicare, or fee-for-service. Even with Medicare coverage expect to pay upwards of 50% of your medical costs in part to the numerous exceptions and 20/80 system imposed by Medicare. Be certain to have a firm understanding of what exactly your benefits include so you’ll be ready when the bill comes!
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