If you're 65 or older, then you'll probably win big with Medicare coverage. But the program can get complicated, with an alphabet soup of different types of coverage. In particular, traditional Medicare includes what's known as Parts A and B, while Part C is another name for Medicare Advantage and Part D provides help with prescription drug costs.
Rather than getting confused, though, it's smart to get the scoop on how all of Medicare's parts fit together. Below, we'll look at Medicare Part A and the hospital coverage that it offers.
The basics of Medicare Part A coverage
In general, if you have costs related to a hospital or a skilled nursing facility, then Medicare Part A will help pay for most of the costs involved. Medically necessary hospital stays will include a semiprivate room, meals, prescription drugs, and other treatment and medical services as well as support from nursing staff and doctors. For coverage to get triggered, your doctor must affirm that you need a two-day hospital stay. As long as you're expected to improve, then long-term stays in hospitals and hospital-provided nursing care remain covered, subject to maximum limits.
Part A also pays for skilled nursing facilities under certain circumstances. If you've had at least three days of inpatient hospital care in connection with the skilled nursing stay, then you can get coverage if your doctor agrees that you need the services that the skilled nursing facility provides. Note that Part A typically won't cover nursing homes and long-term care facilities that provide more custodial than medical care.
Outside of medical facilities, Part A covers home hospice care in connection with a medical condition that is expected to give you six months or less to live, with up to two periods of 90 days covered. Your doctor needs to verify your terminal condition. You can also sometimes get home-provided healthcare as part of a broader care plan if your doctor agrees that it's medically necessary.
Costs for Medicare Part A
Most people don't pay a monthly premium for Medicare Part A. If you or your spouse paid Medicare payroll taxes for at least 10 years, then Part A comes at no cost for most people. For those who don't have that long a work history, you'll have to pay premiums of $240 per month if you have 30 to 39 quarters of qualifying work or $437 per month for those with less than 30 quarters of work.
Regardless of whether you pay a premium, you'll also have to cover a deductible and copayment if you use your Part A coverage during a given year. For 2019, you're responsible for the first $1,364 of your Part A expenses as a deductible before Medicare starts making payments on your behalf. As you'll see below, copayments vary depending on the service involved.
Part A copayments
Different services involve different copayments, as you can see below:
- There's no copayment due for the first 60 days of a qualifying hospital stay.
- For days 61 to 90 of a hospital stay, you'll pay $341 per day.
- After 90 days, you have up to 60 lifetime reserve days, for which you'll pay $682 per day.
- Skilled nursing facilities have no copayment for the first 20 days.
- Days 21 to 100 of a skilled nursing stay have costs of $170.50 per day. There's no further coverage after day 100.
Be ready to cover your share
Medicare Part A is critical for helping older Americans pay for healthcare, but it doesn't cover everything. Knowing the premiums, deductible, and copayments you might owe is essential in order to make sure you have the financial resources to cover your share of your healthcare costs.