Medicare Part A Benefits
We’ve said that Part A covers inpatient services, but let’s dissect what that includes.
Part A benefits include:
Individuals must meet their Part A deductible prior to coverage. After the deductible has been met, Part A will pay for 80% of the expenses. However, there are limits on how many days are covered.
The first sixty days of inpatient stay are paid in full after the deductible. Days 61-90 will cost the beneficiary $371 each day. After that, Medicare offers coverage for sixty extra lifetime reserve days.
After day 90, beneficiaries will pay $742 each day. When the lifetime benefit has been exhausted, Medicare offers no coverage and the beneficiary must pay entirely out-of-pocket.
Once the beneficiary has been out of the hospital for 60 consecutive days, a new benefit period begins. This means that the deductible must be met again prior to any coverage.
Who is eligible for Medicare Part A?
To be eligible for Medicare Part A, an individual must be a U.S. citizen or a legal immigrant with a minimum of five years of residency. Individuals who fall into one of those categories are eligible for Part A when they turn 65 years old. If an individual is eligible for Part A, they are also eligible for Part B.
Individuals who have been receiving disability benefits for 24 months are also eligible for Medicare, regardless of age. These individuals will automatically be enrolled in Medicare at the start of their 25th month on disability.
Individuals with Amyotrophic Lateral Sclerosis (ALS) will automatically be enrolled in Medicare with no delay. Individuals with End-Stage Renal Disease (ESRD) are eligible upon diagnosis, but enrollment is not automatic.
How much does Medicare Part A cost?
Most individuals receive premium-free Part A, so they do not pay anything for this coverage. To be eligible for premium-free Part A, an individual must have worked and paid Medicare taxes for ten years or 40 quarters. (This does not have to be consecutive years or quarters.) If an individual has met this requirement, Part A is premium-free.
For those who have not met the requirement, the premium for Part A will depend on how many years or quarters were worked. If an individual has worked thirty quarters (7.5 years) and paid Medicare taxes during that time, the premium for Part A is $259 each month. Those who have worked and paid Medicare taxes for less than thirty quarters will pay the maximum premium, $471 each month.
How much is the Medicare Part A deductible?
Currently, the Part A deductible is $1600. Individuals will begin paying the deductible when they are admitted as a hospital inpatient. The benefit period starts at this time and continues until the individual has stayed out of the hospital for 60 days. Skilled nursing facilities also count as part of the benefit period.
After 60 days of being hospital-free, the Part A benefit period resets, and so does the Part A deductible.
Avoiding the Part A Deductible
Many individuals want to know if they can avoid paying the Part A deductible when they become an inpatient. Hospitals are prohibited from denying treatment based on an individual’s ability to pay. This protection has been made available from The Emergency Medical Treatment & Labor Act.
Individuals are not required to pay the Part A deductible prior to receiving care. Once the Part A benefits are exhausted some facilities may require a prepayment plan. This also applies to individuals who do not have any form of health insurance, though the specific policy will vary by hospital. Each hospital employs a billing specialist that can assist individuals with payment plans.