Medicare Part A
There are four parts to Medicare and the letters can seem confusing as to what covers what. The first part is Part A. It’s hospital insurance. The way I remember this is thinking about houses–an A-frame house, to be more specific. That’s right, stuff that’s long-term under the roof is what Part A mostly covers. I will outline simply what is covered and put what is NOT covered in Red Text.
The first coverage happens once you are admitted to the hospital. Note that most of this is per benefit period (see the definition page for text in purple). In 2016, the per benefit period deductible is $1,288. After this is paid, Medicare Part A covers your stay in the hospital 100% for up to 60 days. Days 61-90, Medicare will pay all but $322 per day. Days 91-150, Medicare will pay all but $644 per day. After day 150, you are responsible for 100% of the bill.
Now if you’re like me, you like seeing things in different ways, so I will provide another way of looking at it:
Hospital Inpatient Benefits:
- There is a $1,288 deductible that has to be paid per benefit period. After this is paid:
- For the first 60 days, Medicare will pay the remainder at 100%
- Days 61-90, Medicare pays all but $322 per day
- Days 91-150, Medicare pays all but $644 per day
- Days 151 and over, you pay 100%
Of course, there are pages and pages explaining all the ins and outs in complete detail, but this is the basic bare-bones information that everyone should understand about in-patient benefits.
Next under Part A is Skilled Nursing Care. This isn’t to be confused with custodial care. If you need this care and want it to be covered, you must have had a hospital stay of at least three consecutive days. The start of skilled nursing care must occur within 30 days of this three-day stay. After that, Medicare Part A will cover your skilled nursing care at 100% on days 1-20. Days 21-100, Part A will cover all but $161 per day. After day 100, you are responsible for 100%. Now let’s look at the same information another way:
Skilled Nursing Care
- Medicare requires a three-day hospital stay.
- Skilled nursing care must start within 30 days of this stay
- You must require skilled nursing care 7 days per week or skilled therapy service at least 5 days per week.
- After this, Medicare covers:
- Days 1-20 Medicare Part A covers 100%
- Days 21-100, Medicare Part A covers all but $161 per day
- Days 100 and beyond, you are responsible for 100%.
In addition to these benefits, Medicare Part A covers the following:
- Blood–Medicare pays 100% after the first 3 pints.
- Home health care–Medicare pays 100% of medically necessary skilled care and medical supplies
- Hospice–once you meet their requirements–considered to have 6 months or less to live by a doctor.
- Medicare will pay 95% of approved expenses.
- You are responsible for a 5% co-payment and a $5 co-payment for prescriptions.
As far as premium, for the most part, you don’t have to worry about paying a monthly premium. There are situations where you would, but for most of us, this has been paid for all our working lives (that’s what the “Medicare tax” line is on our pay stubs).
This is basically Medicare Part A made Simple. It’s not an exhaustive list by any means. You can find complete details at Medicare.gov.
Let’s look at Part B Next.