Medicare A

Part A of Medicare, which Medicare identifies as Hospital Insurance, is part of Original Medicare passed by Congress in 1965. Medicare does not pay 100% of all Part A medical expenses, so it is especially important to know how it works.

What’s Covered Under Part A?

Part A covers four specific categories of medical treatment:

1. In-patient hospital bills,
2. Skilled nursing facility charges;
3. Home healthcare services and,
4. Hospice care.

Just remember these four categories and you’ll be able to separate Part A from Part B and D.

The easiest categories to understand are home healthcare services and hospice care. Both of these expenses are paid 100% by Medicare.

I believe everyone has some understanding of hospice care. It is end of life care when medicine can no longer cure a terminal illness. This care is covered in a facility as well as in your home.

Home healthcare is very basic care typically provided in your home by a home healthcare aide. This care consists of such things as changing bandages and dressing surgical incisions, etc. Home healthcare is most likely to occur after hospital confinement.

In-patient hospital bills and skilled nursing facility charges are a bit more complicated to explain. So, let’s begin with skilled nursing facilities, also commonly referred to as rehab hospitals.

Skilled Nursing Facilities

Skilled nursing facility admissions are covered for a maximum of 100 days for each admission. The first 20 days are paid at 100%. During calendar year 2023, beginning on day 21 you will be required to pay $200 per day for the balance of any stay. If you remain confined beyond 100 days, you will be required to pay ALL of the daily costs at that point.

Most skilled nursing facility admissions are for less than 20 days. Unless you are admitted for a disabling type of condition, such as a stroke, your stay is likely to be less than 20 days. But your costs are significant if your stay lasts beyond 20 days.

Also, in order for Part A to cover a skilled nursing facility stay, Medicare rules require that you be confined as an in-patient in a hospital for at least three days immediately prior to admission to a skilled nursing facility.

The rules and costs for skilled nursing facilities are subject to change every year on January 1st. The provision that the first 20 days be paid at 100% hasn’t changed for many years. However, it is highly likely that the cost per day beginning on the 21st day of any admission will increase each year. Whenever Medicare publishes changes to this coverage, I will post new videos advising of any changes.

In-Patient Hospital Bills

Now, let’s discuss in-patient hospital bills. When you are admitted to a hospital and you are enrolled in Part A, the only medical expense eligible to be paid by Part A are the charges billed directly and exclusively by the hospital.

Charges billed by medical providers other than the hospital–such as physician’s charges for surgery, anesthesia, or consultations–will not appear on the hospital bill, and consequently, Part A will not pay those expenses. While there will be charges from medical providers other than the hospital, those charges will be paid by Part B.

Hospital bills for in-patient services incurred during calendar year 2023 will be paid 100% by Part A  AFTER a benefit period deductible of $1,632. It is possible, if you have more than one in-patient admission during a year, that you may have to pay more than one benefit period deductible.

Benefit Periods

I find the best way to explain a benefit period is by example. Let’s assume you are admitted to the hospital as an in-patient on February 1st. That admission begins a benefit period. You now owe the hospital $1,632 for that benefit period, whether you are there for one day or one month.

Now, let’s say you are released from the hospital on February 5th, and you are admitted again on Feb 28th. Sixty days have not elapsed since your release date of Feb 5th, so you remain in the same benefit period, and you will not have to satisfy a new benefit period deductible.

However, if you are admitted to a hospital again more than 60 days after February 5th, a new benefit period begins, and you owe a new $1,632 deductible.

Benefit periods are not affected by the reason for the admission. In the example I just gave, if you are admitted to a hospital with a heart problem on Feb 1st and two weeks later you are admitted again, this time with a gallbladder problem, the benefit period that started Feb 1st continues and there is no new benefit period deductible owed by you.

Just remember, the day you are released from a hospital, if 60 days elapses before you are admitted again, a new benefit period begins and you will owe a new benefit period deductible.
Part A rules stipulate if you are confined as an in-patient longer than 60 consecutive days, for each day beyond the 60th day, there are significant additional expenses you will owe.

Don’t be too concerned with the possibility of these additional expenses. I have been licensed to sell health insurance by the Florida Department of Insurance for 46 years. During that time, I have represented thousands of insureds through group health insurance and Medicare. Only once during those 46 years have I witnessed anyone who was confined more than 60 consecutive days, and that was more than 35 years ago.

While it is possible this could happen to you, it is also highly unlikely. You will learn there are plans available to you that will cover most, if not all these additional costs. We can talk about those plans once you have a command of Part A, B and D.

Premiums

For the overwhelming majority of those eligible for Part A, there is no monthly premium. If you are eligible for Part A and you or your spouse have worked and paid Medicare payroll taxes for 40 quarters, which totals to 10 years, you qualify for Premium Free Part A.

However, if you or your spouse have worked less than 40 quarters, you will not qualify for Premium Free Part A and you will pay a monthly premium of $274 (if the work record is between 30 and 40 quarters) or $499 (if the work record is less than 30 quarters).

You may find it helpful to review the explanation of skilled nursing facilities and hospital bills again. Take your time.

We’re By Your Side

My goal is to make understanding Medicare as easy as possible.

Getting through your Golden Years solely on Medicare Parts A, B, and D is possible, but it isn’t your only option and it could be more expensive than available alternatives!

If you have questions, please feel free to contact me at my email address kenbrown@floridamedicarespecialists.com. I will respond to your questions as soon as possible. Or you can call (407) 497-6287.