Inpatient coverage from hospital beds to hospice care
No one plans to end up in the hospital, but it’s reassuring for millions of enrollees to know that Part A covers so much of hospitalization expenses. It’s also comforting to know that most folks who are eligible for Medicare do not have to pay a Part A premium.Part A coverage – or “hospital insurance” – pays for a broad range of inpatient care in hospitals, skilled nursing facilities and critical access hospitals. And, while it does not include long-term care, Part A may cover some hospice or home health care. More specifically, the list of expenses covered by Part A includes:
‣ Inpatient care in hospitals that provide critical care, including a semi-private room (unless a private room is medically necessary), meals and prescription drugs. (Not included: private-duty nursing, a TV or phone in the room)
‣Inpatient facilities for rehabilitation and hospitals providing long-term care
‣Inpatient care in a nursing facility where skilled but not long-term care is offered
‣Hospice care and home health care services when medically necessary (home health care includes intermittent skilled nursing, physical therapy, speech-language pathology, some medical supplies and equipment)
‣Inpatient care in a religious nonmedical health care institution
‣Blood – If no free blood bank blood is available, Part A pays for patient’s blood after the enrollee pays for the first three units.
‣Inpatient mental health care in a psychiatric facility (limited to 190 days in the enrollee’s lifetime).
Medicare Part A – How to enroll
If you are receiving Social Security or Railroad Retirement Board benefits and live in one of the 50 states, the government automatically enrolls you in Medicare Part A at no cost when you reach 65. Look for your Medicare card to automatically arrive in the mail three months prior to your 65th birthday (or the 25th month of a disability, as you become eligible for Medicare after two years of being disabled and receiving Social Security Disability benefits).
Individuals who are not automatically enrolled in Medicare Part A have a seven-month window of time to enroll, beginning three months prior to the month they turn 65.
If you’re not eligible for premium-free Medicare Part A and you wait to enroll after the seven month window surrounding your 65th birthday, you’ll be subject to additional premiums for Part A (most people are eligible for premium-free Part A, but as an example, if you or your spouse haven’t paid at least ten years of payroll taxes, you’d have to pay for Medicare Part A).
Regardless of age, individuals suffering from ALS receive their Medicare Part A card through the mail the month their disability benefits begin. People with end stage renal disease (kidney failure) are also eligible for Medicare coverage, but must apply for it – enrollment is not automatic.
Medicare Part A – What’s the cost?
How much you pay for Medicare Part A coverage depends on your work history. If you or your spouse worked and paid into Medicare through payroll taxes for 10 or more years, you pay nothing each month for Part A.
There are some requirements to be aware of in terms of the length of the marriage if you’re enrolling based on your spouse’s work history. Also, since the Defense of Marriage Act was ruled unconstitutional in 2013, the Social Security Administration has begun processing premium-free Medicare A enrollments based on the work history of the enrollees’ same-sex partners.
If you or your spouse worked and paid into Medicare for between 7.5 and 10 years, you’ll pay $240 a month for Medicare A in 2019. If the work history was less than 7.5 years, the premium will be $437 a month (these amounts are only slightly higher than they were in 2015, when they were $224 and $407, respectively).
Medicare Part A pays the majority of the Medicare-approved charges for inpatient health care services. However, you must reach a deductible for each benefit period ($1364 in 2019, up from $1340 in 2018) before coverage kicks in, and there are flat dollar coinsurance charges that apply to extended hospital stays. If you’re in the hospital more than 60 days, you’ll pay $341 per day coinsurance for days 61 through 90 (in 2019), in addition to the deductible you already paid for that benefit period (if you are discharged from the hospital before 60 days, you only pay the deductible).
If you’re hospitalized for longer than 90 days, you have 60 lifetime “reserve days” that you can use — during those days, you’ll pay $682 per day (again, these are all 2019 amounts; they generally increase from one year to the next). Once the reserve days are used up, Medicare doesn’t pay any additional charges during that benefit period (a benefit period begins on the day you’re admitted to the hospital, and ends when you’ve been out of the hospital for 60 days). It’s rare for beneficiaries to be hospitalized more than 60 days, but not unheard of – which is why a Medigap supplement is an important part of full medical coverage in retirement.