What is Medicare Part A, what’s covered, and what are the limitations for coverage.
Part A is intended for hospital stays and the accompanying services provided. It also covers stays in a nursing home if certain criteria are met.
Upon turning age 65, most people qualify for Part A coverage automatically. If a person or their spouse worked and paid Medicare taxes, there’s no cost for a monthly premium for Part A. The reason for not automatically qualifying to Part A coverage is because someone didn’t work or didn’t pay enough Medicare taxes while working. For those who are disabled and return to work, Part A isn’t provided free. In these cases coverage can be purchased.
If someone already has a Medicare card (the red, white, and blue one), Part A coverage is indicated on the card as “HOSPITAL (PART A)”.
What is Medicare Part A – What’s Covered
Hospital care under Part A covers:
- Inpatient hospital stays
- Services associated with stay such as doctor’s charges, food, and tests
- Skilled nursing facilities (non-custodial)
- Home health care – under certain circumstances
For coverage in a skilled nursing facility, this must occur after a hospital stay of at least three days (and nights). It must also be for convalescence associated with the hospital stay. Medicare requires the care administered by the facility to be skilled. It does not cover non-skilled assisted living costs such as custodial, personal hygiene, cleaning, and cooking, housekeeping, etc.
Medicare Part A covers skilled nursing stays for up to 100 days. The full cost is covered for the first 20 days. The remaining 80 days require a co-payment. This is approximately $133 a day as of 2009. This 100 day requirement resets if the patient goes 60 days without receiving skilled care at a qualified facility. They would then qualify for another 100 day stay.
More information on Medicare enrollment and eligibility can be obtained from Social Security at 1-800-772-1213.
**2012 Update on Coinsurance & Deductibles**
The 2012 Medicare Part A deductible is $1,156 during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.
For each benefit period Medicare insured beneficiaries pay:
- $1,156 total for a hospital stay of 1-60 days.
- $289 per day for days 61-90 of a hospital stay.
- $578 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
- All costs for each day beyond 150 days.
Skilled Nursing Facility Coinsurance is $144.50 per day for days 21 through 100 each benefit period.