Original Medicare has two parts, Part A and Part B, that cover different things. Part B is what we traditionally think of as medical insurance. Part B covers outpatient services, anything that falls outside of a facility. Today, I am going to spend some time talking about Part A of Original Medicare. If you want to learn more about what part B covers, check out our other blogs that break down what Part B consists of. Let’s dive into Part A of Original Medicare!
What do I have to pay to get Part A? If you have paid FICO tax for 40 quarters aka 10 years, does not have to be consecutive, you qualify for premium free Part A. You will have to pay for part A of original Medicare if you have not worked 40 quarters. If you are an individual that has worked 38 quarters when you are turning 65 or becoming eligible for Medicare, you may want to look at working the final 2 quarters to get premium free Part A. What if you have worked 40 quarters, but your spouse has not? Well, they can still get premium free Part A through you! It is important to note that if you do have to pay for Part A of Medicare, you will have to pay the premiums every month until you get to 40 quarters. That could potentially be for the rest of your life!
Part A of Original Medicare helps cover inpatient care in a hospital, inpatient care in a skilled nursing facility, hospice care, home health care, and impatient care in a religious non-medical health care institution. It is important to note that Part A does not cover custodial or long-term care. If you are concerned about those types of care, you will need to look at different insurances. Copayments, coinsurance, or deductibles may apply for each one of these services. If you are in a Medicare Advantage plan, have a Medicare Supplement plan, or have Medicaid through your state; your copayments, coinsurance, or deductibles are going to be different or may be covered in full.
Let’s break down the Part A covered services in detail:
- Blood: If a hospital gets blood from a blood bank at no charge, you will not pay to replace it. If a hospital must buy blood for you, you must either pay the hospital costs for the first 3 units of blood you get in a calendar year or someone else can donate blood.
- Home health care: Medicare will only coverage home health care if it is: medically necessary part-time or intermittent skilled nursing care, physical therapy, speech pathology, or continued occupational therapy services. Part time is defined as less than 8 hours a day or less than 28 hours a week. Another criterion to have your home health care covered by Medicare is if you have trouble leaving your home without help because of illness or injury, leaving your home isn’t recommended because of your condition, or you normally can’t leave your home due to it being a major effort.
- Hospice: To have Part A cover your hospice care, a doctor must determine you are terminally ill, meaning your life expectancy is 6 months or less. Part A pays for comfort care not treatment for your illness. This includes drugs for pain and symptoms, any durable medical equipment for pain relief, aide and homemaker services, and any other services to manage pain and other symptoms as well as spiritual and grief counseling for you and your family. You can receive these services in your home, or a Medicare approved facility.
- Inpatient hospital care: Medicare Part A covers semi-private rooms, meals, general nursing, drugs, and other hospital services and supplies as part of your inpatient treatment. If you have Part B also, it generally covers 80% of Medicare-approved amounts for doctors’ services you get while in the hospital. You will pay a deductible set by Medicare and no coinsurance for days 1-60 of each benefit period you are in the hospital. After that you will have a coinsurance for days 61-150. Once you use up your lifetime days you will be liable for all costs. It is important that if you are in the hospital that you ask if you are admitted or not, that will determine what you pay or how much you will pay. If you are held under observation for more than 24 hours, you must get a “Medicare Outpatient Observation Notice.” This notice will give you the reason why you are being held as an outpatient rather than being admitted, so you know how much you are liable for.
- Religious non-medical health care institution: Medicare Part A will only cover inpatient, non-religious, non-medical items and services, like room and board. Medicare will not cover the religious portion of this type of care.
- Skilled nursing facility care: Medicare covers semi-private rooms, meals, skilled nursing and therapy services, and other medically necessary services and supplies in a skilled nursing facility. Medicare will only cover these services after a 3-day minimum inpatient hospital stay for an illness or injury related to the hospital stay. You will pay nothing for the first 20 days of each benefit period, a coinsurance amount per day for days 21-100 of each benefit period, and then all costs each day from 100 and beyond.
As you can see, Part A has a lot of services it covers. However, you must be aware of the costs of those services. These costs are going to change year over year. If you want to know about these costs in more detail or want to find a way to minimize or eliminate these cost, talk to a license insurance professional in your area to put together a plan!