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Medicare Part A

Part A – Hospital Insurance; 

Covers

  • Inpatient care in hospitals
  • Inpatient care in a skilled nursing facility
  • Hospice care services
  • Inpatient care in a Religious Non medical Health Care Institution
Will cover if it is medically necessary;
  • Anesthesia
  • Chemotherapy
  • Room and Board
  • All meals and special diets
  • General nursing
  • Medical social services
  • Physical, occupational, and speech-language therapy
  • Drugs with the exception of some self-administered drugs
  • Blood transfusions
  • Other diagnostic and therapeutic items and services
  • Medical supplies and use of equipment
  • Respite care in hospice
  • Transportation services
  • Inpatient alcohol or substance abuse treatment
  • Blood
  • Clinical Trials (Inpatient)
  • Kidney Dialysis (Inpatient)
Does Not cover while admitted as an inpatient;
  • Private duty nursing
  • Private room
  • A television or telephone in your room or personal care items like razors or slipper socks
  • A private room unless medically necessary
  • Custodial care, assisted living, adult daycare, or reimbursement for family members
  • The first three pints of blood unless the blood deductible has been met

Costs;

1) There is a deductible of $1,156 (2012) per year.

Most people do not pay a monthly Part A premium due to qualifying through Social Security taxes paid throughout career. As long as beneficiary or spouse has 40 or more quarters of Medicare-covered employment completed by age 65 then Part A will have no premium for coverage.

For those that have not met the specific requirements there is still an opportunity to enroll;

  • The Part A premium is $248.00 per month for people having 30-39 quarters of Medicare-covered employment.
  • The Part A premium is $451.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.
2) For Skilled Nursing the costs are;
  • $141.50 per day for days 21 through 100 each benefit period.
  • Only covered if been a hospital inpatient for at least 3 days in a row
Medicare will only cover care you get in a SNF if you first have a “qualifying hospital stay.

3) There is a cost for an extended stay per incident past the 60th hospital stay

  • Days 61 – 90 will costs a beneficiary $289 per day
  • Days 90 – 150 will costs a beneficiary $578 per day
*Each beneficiary has an extra life time reserve of 60 days to use at their discretion*

Enrollment

The Initial Enrollment Period (IEP) is 3 months prior to your 65th birthday, the month of your 65th birthday and then the next 3 following months. During this time you will receive a Medicare Initial Enrollment Period package when your IEP starts and it is suggested that you sign up in the 3 months leading to your 65th birthday so Part B benefits won’t be delayed.

This is where you will receive your red, white & blue Medicare card and if you have any issue just call Medicare at  800 – MEDICARE (800 – 633 – 4227)

If you are still working at age 65  you may want to enroll in Part A when you turn age 65, but wait to sign up for Part B since there are premiums (see Should You Choose Medicare Part B While Working). Also note, If there is an opportunity to fund an HSA please re-consider accepting Part A, once enrolled you can NOT fund one.

If you didn’t sign up for Part A and/or Part B (for which you pay monthly premiums) when you were first eligible because you’re covered under a group health plan based on current employment, you can sign up for Part A and/or Part B as follows:

Anytime that you or your spouse (or family member if you’re disabled) are working, and you’re covered by a group health plan through the employer or union based on that work

Or

            During the 8-month period that begins the month after the employment ends or the group health plan coverage ends, whichever happens first

 

Note If you have COBRA coverage or a retiree health plan, by Medicare’s definition you don’t have coverage based on current employment. You’re not eligible for the special enrollment period when that coverage ends.

 

If you didn’t sign up for Part A and/or Part B (for which you pay monthly premiums) when you were first eligible, you can sign up between January 1–March 31 each year. Your coverage will begin July 1. You may have to pay a higher premium for late enrollment for Part B.