Medicare is the federal, taxpayer-funded health insurance program for people who are age 65 and older, as well as younger people with certain health conditions and disabilities. It has four parts: A, B, C, and D. Understanding Medicare can be confusing because each part has different coverage options and costs. This guide covers Part A, in particular.
What is Part A?
Part A is known as the hospital insurance portion. It helps cover some of the costs associated with various types of inpatient healthcare facilities. Some people who already receive Social Security benefits are automatically enrolled in Part A when they become eligible. Others have to sign up for it on their own.
What Does Part A Cover?
Typically, Part A covers short-term, inpatient healthcare such as :
- hospitals
- skilled nursing facilitie
- inpatient rehabilitation centers
- hospice
- mental healthcare facilities
- home healthcare
- qualifying clinical research studies
It is critical to know whether your care is classified as inpatient or outpatient because the distinction can affect your costs.
What Doesn’t Part A cover?
Long-term care, such as a nursing home or assisted living facility, is not covered by Part A. In addition, Part A does not cover private rooms unless it is a medical necessity. Part A also doesn’t cover personal care items, like shampoo or other extras such as cell phone or television charges.
What Are the Costs for Part A?
Costs such as premiums, deductibles, copays, and coinsurance may apply if you need care. These costs usually change each year.
1. Premiums
A premium is a monthly payment for health insurance. Part A premiums are based on the number of quarters that you have paid into insurance. If you worked 40 or more quarters before becoming eligible, your premium is $0. If you worked less than 40 quarters, however, then you must pay a premium. Many people refer to Part A as free, but that is usually because most beneficiaries have paid into insurance for 40 or more quarters. If you don’t qualify for free Part A premiums and you don’t buy Part A coverage when you are initially eligible, you may be subject to a late enrollment penalty of 10%. This penalty has to be paid monthly for twice the number of years that you didn’t have Part A coverage.
2. Deductibles
A deductible is an amount that beneficiaries must pay before the insurance begins to help cover the costs. The Part A deductible covers the costs for the first 60 days of inpatient care in a benefit period. As of 2021, the Part A deductible is $1,484 for the benefit period.
3. Copays and Coinsurance
In insurance, a copay is a fixed amount that policyholders pay for a particular service. Coinsurance is the percentage that policyholders must pay after they pay the deductible. At a hospital, for example, Part A covers the first 60 days of the hospital stay. Between days 61-90, there is a daily coinsurance of $371. After day 90, Part A provides a lifetime allotment of 60 reserve days. The daily coinsurance then increases to $742 from day 91 until the 60-day reserve ends. Once the 60 days reserve period ends, Part A will not provide any more coverage during that benefit period.
4. Part B
When enrolling in Part A, you can also enroll in Part B, which covers outpatient care such as doctor’s appointments. Like Part A, you are automatically enrolled in Part B if you receive Social Security benefits. Part B has its own higher premiums, so those who don’t receive it automatically are not necessarily required to have it. However, you must enroll in Part A and Part B before enrolling in Part C and Part D according ClearMatch Medicare.
How to Enroll in Part A
If you already receive social security or disability benefits, you will automatically be enrolled in Part A when you are eligible. All others can sign up online or by phone at 1-800-772-1213. Due to the pandemic, most social security offices remain closed or have limited hours.
There are important enrollment deadlines to keep in mind:
- Initial Enrollment Period: This is a 7-month period that includes: 3 months before your birth month, the month of your birth, and 3 months after your 65th birthday.
- General enrollment period:You can enroll in Part A during this time if you didn’t enroll during the initial enrollment period. Currently, the general enrollment period is January 1-March 31 of each year. If you enroll during the general enrollment period, your coverage begins on July 1. If you qualify for a Special Enrollment Period, you can enroll for Part A at a later time without penalties.
Understanding each part will help you gain a better understanding of what type of healthcare is covered under your policy, as well as the costs associated with the care.
Article Submitted By Community Writer
