What Is Medicare Part A?

What Is Medicare Part A?
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What Is Medicare Part A?

What Is Medicare Part A?
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With nearly 61 million people using Part A medical insurance to cover their inpatient treatments and costs, Medicare Part A is the most common type of Medicare coverage in the U.S.

As part of our guide to Medicare in 2021, we’ve created this article to help you learn more about Medicare Part A and how you can use it to your benefit.

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Medicare and Medical Insurance

Medicare reduces medical insurance costs for older Americans, disabled groups, and people who suffer from chronic conditions like ESRD (End-Stage Renal Disease).

Medicare Parts Explained:

  • Medicare Part B refers to outpatient preventive services and medically necessary services.

  • Medicare Part C (Medicare Advantage) consists of private plans that cover Part A, B, and D medical costs.

  • Medicare prescription drug coverage is known as Medicare Part D.

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(Source: Pexels)

Where Does Medicare Part A Fit into Medicare?

Part A, sometimes known as hospital insurance, relates to any medical costs that relate to hospitalization or in-hospital treatment. These can include surgeries, blood tests, hospital stays, and meals in the hospital.

For example, suppose you're admitted because of a fall and stay longer than two days. In that case, this expense will fall under Part A medical costs.

It will also be a Part A expense if a doctor or nurse treats you with pain tablets, anti-inflammatories, or other prescription drugs while you are there. Medicare prescription drug coverage (Part D) will apply if you are an outpatient.

However, if you decide to see your local doctor before going to the hospital, that cost would fall under Medicare Part B medical insurance (outpatient services).

If you receive X-rays because of your injury but don’t stay in the hospital for a prolonged period, this will be considered an outpatient procedure and covered under Part B.

The most important thing to remember is that Medicare Part A expenses all have to do with inpatient care in a hospital setting for a prolonged period. 

It can also cover long-term care at a skilled nursing facility. So if you require rehabilitation in a professional setting, these expenses would fall under your Medicare Part A coverage.

Original Medicare, Medicare Advantage, and Medicare Part A Coverage

Original Medicare is a  federal government service offering enrollees coverage for Part A and Part B expenses. 

You can choose to join either Part A (hospital insurance), Part B (outpatient medical insurance), or both plans when you sign up for Original Medicare.

Medicare Advantage plans cover Part A, B, and D costs and are provided by private health insurance companies.

When you sign up for a Medicare Advantage plan, you’ll automatically be enrolled in the Medicare program by your health care company.

If you’re unhappy with the service or coverage you’re getting, you can always switch Medicare Advantage plans and Original Medicare without risking your Part A cover.

Here is a list of some treatments and procedures to help you tell the difference between inpatient and outpatient services:

Inpatient Care (Medicare Part A) Outpatient Care (Medicare Part B or Part D)
Hospital stays for an extended time. Consulting with your local doctor at their practice.
Medication administered by a health professional. Self-administered prescription drugs.
Surgeries that require hospitalization. A check-up by a medical professional.
Childbirth. Bloodwork, X-rays, MRIs, and mammograms.
Rehabilitation services or a stay at a skilled nursing facility. An appointment with a physiotherapist.
Serious illness that needs monitoring in a hospital. Some cancer treatments, like chemotherapy, which don’t require hospitalization.

What Will Medicare Part A Cover?

Medicare Part A will cover your inpatient medical costs if you are admitted to a hospital that accepts Medicare patients.

Once you're admitted, any test, item, or service that relates to your treatment will be paid through your Medicare Part A and Medicare Part B medical insurance.

Part A expenses include meals, semi-private rooms, general nursing, and prescription medication provided to you as an admitted patient.

The government-run Medicare site offers a helpful resource to determine whether Medicare will cover your treatment and under which part of Medicare (A, B, or D) the cost will fall.

Key Point - Who Determines Which Costs Are Covered by Medicare?

It's always best to speak with your health care provider, insurance company, or the Centers for Medicare and Medicaid Services (CMS) to see if a test, item or service is covered.

You may save yourself thousands of dollars in medical costs and liability for significant medical expenses by asking ahead.

Medicare coverage is guided by:

  1. Federal and local laws.
  2. The national Medicare policy that covers Part A, B, and D expenses.
  3. The coverage decisions made by your Medicare provider or insurance company.

Key Point - Medicare Part A Deductibles and Coinsurance

Deductibles are the costs that Medicare enrollees have to pay before Original Medicare or Medicare Advantage covers the cost of medical treatment. The Medicare Part A deductible is set at $1556.00 for 2022, but this may change for your next coverage period (2023).

Coinsurance or copayments are the amounts you will have to pay for the treatment you’ve received. For Part A expenses, there are set amounts that you will have to pay for each day you spend in the hospital.

Medicare Part A Costs

Most people think that Medicare will cover all of their medical expenses. The truth is that frequently they are shocked to find they owe the hospital thousands of dollars for the treatment they received.

Things can get a little tricky when determining your overall coverage and liability for medical expenses because of deductibles and coinsurance.

For example, if you were to go in for a hip replacement surgery and your treatment cost amounted to $40,000.00 you would have to pay your deductible fee ($1484.00) before your Medicare Part A covered your bill.

If you stayed in the hospital for longer than 60 days, you would also be liable for the coinsurance amount of your medical expenses ($371.00 per day).

Medicare Part A Coinsurance Amounts for Hospital Admissions

Days Admitted Coinsurance Amount (Per Day)
1-60 $0.00
61-90 $389.00
91+ $778.00*
Beyond Lifetime Reserve Days All costs.

*Per each Lifetime Reserve Day (A maximum of 60 days over your lifetime).

(Source:https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance)

Getting into a situation like this can be worrying for many retirees. In many cases, people take out Medigap cover to ensure that they aren't left with expensive hospital bills covered by Medicare Part A. 

Medicare Supplement Plans (also known as Medigap) are medical insurance plans that cover shortfalls in Original Medicare cover. They work in the same way as other health care plans, charging a monthly fee for medical insurance on your Part A, B, and D expenses.

Key Point - Medicare Coverage and Your Healthcare Provider

By law, doctors only have to treat you if there is a life-threatening situation or a medical emergency.

Some medical professionals don’t provide services to Medicare enrollees or charge rates that Medicare won’t cover.

Check with your health care provider and insurance plan before you receive the treatment. You may save yourself thousands of dollars in medical costs and liability for significant medical expenses by asking ahead.

Case Study: Hospitalization with a Severe Illness

You've fallen ill with pneumonia or another severe disease.

Depending on the severity of your condition, you may need several weeks in the hospital, medical interventions, prescription drugs, and constant care.

In terms of Medicare, if you are admitted on formal medical recommendation your treatment in the hospital would fall under Part A expenses.

You will first have to pay the deductible cost for the year ($1556.00) and the coinsurance amount if you are admitted for longer than 60 days. In this example, let's say that you are released from the hospital after 62 days of treatment.

If, before your formal admission, you received medical care from your doctor, the cost of their services would fall under Part B expenses. It would not be covered by Part A. You would have to pay 20% (Part B coinsurance amount), and Medicare would cover the rest.

If you're on an Original Medicare plan and don't have Medigap insurance, you would pay the $1556.00 Part A deductible (for your 2022 cover period) and a Part A coinsurance charge ($389.00 per day). 

You'd also have to pay your Part B deductible ($170.10) and cover 20% of your doctor's service costs.

Total Hospitalization Costs with Original Medicare Cover:

Hospital Admission (for 62 days) - $778.00 Part A Deductible -  $1556.00  Part B Coinsurance - $30.00 (20% of $150.00) Part B Deductible - $170.10 Total Costs: $2534.10

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(Source: Pexels)

Key Point - Medicare Enrollment Periods Explained

General Enrollment Period - You can enroll for Medicare Part A from January 1st to March 31st. 

Open Enrollment Period - You can enroll for Medicare Part A, switch plans, or leave a plan between October 15th and December 7th. This is usually restricted to one occasion per person.

Initial Enrollment Period - If it's your first time enrolling for Medicare Part A or B, you can register three months before or after the month of your 65th birthday.

Special Enrollment Period - You can enroll for Medicare up to eight months after your employment ends if you are older than 65 and previously had employer health care coverage.

How Do I Enroll for Medicare Part A?

Enrolling for Medicare can be confusing at the best of times, and most people don't know where to start.

The first thing to check is whether you’re eligible to sign up. If you turned 65 in the past four months, or are turning 65 in the next three months, you can enroll as a Medicare member.

There are two ways you can do this—either through the Social Security Agency or a Medicare Advantage provider.

If you want to register for Original Medicare (Part A and B coverage), you can visit the Social Security website and register through their online portal or contact your nearest Social Security office to get assistance.

If you want to sign up for a Medicare Advantage plan (Part A, Part B, and Part D), you should contact a Medicare Advantage provider. They will register you for Medicare when you join their scheme.

Suppose you suffer from a preexisting condition such as hypertension or diabetes. In this case, you can still enroll for Medicare Part A at no extra cost. By law, both private Medicare companies and Original Medicare must register you.

There are two opportunities to enroll in Medicare each year. The General Enrollment Period runs from January 1st to March 31st. The Open Enrollment Period starts on October 15th and ends on December 7th.

Still unsure? PolicyScout can offer guidance on applying for Medicare Part A and help you access the top Medicare Advantage providers in your area. We've done the research on which plans and companies have the best options.

Key Point - Medicare Part A Premiums

If you haven't paid Medicare taxes for at least forty quarters (ten years), you'll have to pay a monthly premium to join a Medicare Part A plan. Here's what you might expect to pay:

  1. Less than 39 quarters - $274.00 p/m.
  2. Less than 30 quarters - $499.00 p/m.
  3. No contributions towards Medicare - Up to $499.00 p/m.

What Does It Cost to Enroll in Part A?

For most people, signing up for Medicare Part A hospital insurance is free. If you register at the right time and have contributed Medicare taxes for forty financial quarters (ten years), you won’t have to pay anything to enroll.

But if you haven’t contributed towards Medicare through payroll taxes, you’ll have to pay a permanent monthly premium that will cover the cost of you voluntarily joining the plan. 

If you don’t enroll for Medicare when you are eligible, you will also have to pay a penalty fee for each month you weren’t on Part A.

The penalty for late enrollment is 10% of your current Part A premium. This amount is added to your monthly premium for double the length of time you didn't enroll while eligible.

For example, if you turn 67 and decide to enroll for Medicare Part A you would pay your monthly premium plus the 10% penalty for four years.

If you are 75 and want to enroll for the first time for Part A, you will have to pay a monthly premium plus a 10% penalty for twenty years.

Key Point - It’s Essential to Enroll Once You Become Eligible for Medicare Part A

If you don’t register for Original Medicare within the seven-month window, you may be liable for a penalty or higher premiums.

However, you can still speak to the Centers for Medicare and Medicaid Service or your Medicare Advantage provider to see if they will reduce or remove your penalty.

What Do I Do If I Haven’t Paid Medicare Taxes?

Speak with a professional to find out about your risks, costs, and options. If you haven't paid your Medicare taxes or are uncertain about your Medicare status, you may be liable for a higher premium or a penalty fee.

One thing you can do immediately is see if you qualify for a lower Part A rate if your spouse paid Medicare taxes.

Even if you don’t want to enroll in Medicare, there are a few ways medical coverage can help lower your medical costs. 

Our knowledgeable staff are ready to answer your Medicare Part A questions and help you get the best deal on your Medicare cover. 

There are other options available to you if you can’t afford Medicare or don’t want to join a Medicare Advantage plan. 

If you'd like to learn more about Original Medicare, Medigap hospital insurance, and Medicare Advantage, email us.

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(Source: Pexels)

How You Can Get Total Coverage for Medicare Part A Expenses

People often find that their out-of-pocket expenses begin to grow as their level of care increases with age. 

It’s important to know that Medicare won’t cover the total cost of surgeries, medication,  hospital stays, or consultations with medical specialists. It usually falls on you to pay the difference in what is covered by your Medicare plan.

If you’re worried about expensive medical bills and your overall medical liability, our suggestion would be to get added protection.

You can get help with your medical coverage by signing up with a Medigap Plan, a Medical Savings Plan, or a comprehensive Medicare Advantage plan from a reputable company.

Medigap and Medical Savings Plans are health cover policies that will pay for costs that your Original Medicare plan doesn’t cover. Send us an email if you’d like to discuss your Medigap options and find the best Medigap providers in your state.

How Do I Find Out More about My Inpatient Health Care Coverage?

Many resources are available if you’d like to learn more about inpatient coverage and Medicare Part A. You can read all about Medicare through our Medicare Hub or check out our Medicare Part B and Part D coverage guides.

If you’d like to get professional assistance with signing up for a Medicare Advantage plan, our consultants will happily answer your questions and provide you with the best options in your state.

We’ve built up a database of the best Medicare Advantage providers across the U.S. and can suggest which medical insurance plans would suit your needs. Feel free to send us an email or contact us on 1-888-912-2132  to find out more.

FAQs about Medicare Part A

How do I know if my medical costs fall under Medicare Part A or Part B?

The quickest way to determine whether an expense is covered by your Part A or Part B plan is to ask your physician, nurse, or health care provider. They are required by law to tell you whether Medicare will pay a procedure, service, or expense.

How do I enroll for Medicare Part A?

If you want to sign up for Original Medicare, simply visit the Social Security Agency's online enrollment portal. If you'd like to sign up for a Medicare Advantage plan, contact us to find a preferred Medicare Advantage provider in your state.

Where can I find the best Medicare Advantage plans that cover Part A expenses?

PolicyScout has put together a comprehensive list of Medicare providers to save you the time and hassle of finding the right company for your unique circumstances. Speak with us to find out more.

Does Medicare Advantage replace Part A?

Medicare Advantage will cover your Part A expenses, so it can be seen as a replacement for Original Medicare Part A.

What is the cost of enrolling in a Medicare Advantage plan that covers Part A expenses?

Prices will depend on your plan and other factors. Still, you can expect to pay anywhere between $250 - $500 per month for a Medicare Advantage plan covering Part A and B expenses.

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