Medicare Part A (Hospital Insurance)

Once you are Medicare Part A Beneficiary, you qualify for Medicare approved inpatient hospital coverage.

What is Medicare Part A?

Medicare Part A is referred to as Hospital Insurance. Part A is one of the two parts which are consider Original Medicare (Parts A and B). Coverage for Part A includes Inpatient hospital stays, skilled nursing facilities, hospice care, certain types of nursing home care and doctor ordered home health services are all under the Medicare Part A coverage umbrella.

Medicare Part A
In 1965 the president and congress enacted Medicare under Title XVIII of the Social Security Act. Individuals not automatically enrolled in Original Medicare may go directly to the Social Security Website and apply for Medicare benefits. Medicare Part A is the minimum required essential coverage that satisfies state and federal law for health care coverage.

Original Medicare now covers more than 50 million Americans

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Medicare Part A Coverage

Medicare Part A is generally referred to as Hospital Insurance. In addition to Medicare hospital benefits, Part A covers Home Health Services, Skilled Nursing Facilities and Hospice. As with any insurance program, certain medical requirements must be met for coverage and certain restrictions apply. For instance, Nursing Home care cannot be used solely for custodial care.

Generally your healthcare provider or doctor will know if a specific medical treatment or service is covered by Original Medicare. For those services or supplies not covered, you will be asked to sign a notice explaining that the service or supply is not covered by Medicare and that you’ll be responsible for the full cost.

As with any insurance coverage, certain limitation’s apply and coverage is based on specific criteria.

* Inpatient Stays Only
** Skilled Nursing Care cannot be for custodial only
*** Home Health Services are Limited to certain criteria

Medicare Eligibility for Part A

Part A Eligibility

Check your Medicare eligibility in Medicare Part A using the list below. Medicare is generally available to individuals Age 65 or older, disabled and those with End Stage Renal Disease (ESRD).

• The list above is for reference purposes. Please make sure to verify your information and eligibility with the Centers of Medicare and Medicaid services.

Medicare Eligibility Check

Are you eligible for Medicare benefits? You have resources to help you verify Medicare eligibility! Check your eligibility online by using Medicare.gov’s Eligibility and Premium Calculator. This generic questionnaire does not ask for you or your spouse’s social security number.

The Medicare eligibility check simply asks your date of birth, number of years worked while paying Medicare taxes and if you currently receive group health benefits through you or your spouse’s current employer. Additional questions about your spouse will be asked if you have not paid Medicare taxes for at least 10 years.

In addition to performing a Medicare eligibility check, you may also calculate your Medicare premiums based on marital status, previous income and if you worked at least 10 years in a Medicare taxable job.

How much does Medicare Part A cost?

Part A – Monthly Premium

For most Medicare eligible individuals, Medicare Part A is premium free. Premium free Part A is generally available if you or your spouse paid Medicare taxes for at least 40 quarters (10 years). In 2017, those individuals that paid Medicare taxes for 30-39 quarters must pay $227 Part A monthly premium. For those who paid less than 30 quarters owe $413 a month for Part A coverage.

Are you in a higher income tax bracket? If so, please see Income Related Monthly Adjustment Amount (IRMAA).

Medicare Part A – Deductibles and Coinsurance

  • $1,316 Hospital Deductible (per benefit period*, not an annual based deductible)
  • Inpatient Hospital Stays..
  • … Days 1-60: $0 Coinsurance per day
  • …Days 61-90: $329 Coinsurance per day
  • …Days 91 and beyond: $658 Coinsurance per Each “Lifetime Reserve Day”
  • …Beyond Lifetime Reserve Days: Your Liability: All Costs

* A benefit period starts the day of hospital admission and ends 60 days in row without inpatient hospital care. For example, a Medicare beneficiary enters inpatient hospital care on May 15th and is released May 20th. May 20th begins the 60 day portion of the benefit period. May 15th through the 20th is 5 days, plus 60 days in row without inpatient care equals 65 days. After the 65 days have elapsed a new deductible is required and coinsurance days restart.

Your Skilled Nursing Facility Costs under Original Medicare

• Days – 1-20: $0 for each benefit period
• Days – 21-100: $164.50 Coinsurance Per Day for Each Benefit Period
• Days 101 and Beyond: All Costs

Do I Need an Licensed Health Agent?

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