Medicare is the U.S. government program that provides health care coverage for people aged 65 or older. Depending on an individual’s needs, there are variations/add ons to the program that need to be understood in order to best take advantage of the program. Those “parts” are very specific and need some explanation.
To learn more about the basics of Medicare, check out Medicare Explained: Simplifying an Important Federal Insurance Program
In this article, we will unpack Medicare Part A.
Most seniors who are already taking their social security benefits will be automatically enrolled in Medicare Part A which covers stays in the hospital, skilled nursing facilities, hospice care facilities, and some home health care expenses.
What Does Medicare Part A Cover?
One of the most important tasks that every baby boomer must face is planning on how to pay for health care services. Unfortunately, this is not as straightforward as it sounds, since Medicare coverage is based on factors beyond a simple list of services covered.
Both federal and state laws impact what services are covered. Medicare also weighs in on these determinations as well. Add to these influencers local companies statewide designated to process claims, and it is easy to see why many boomers struggle with knowing what will be covered and what will be denied.
Medicare Part A is responsible for covering hospital expenses as an inpatient. There are some conditions that must be met for Medicare to pay.
- You must be admitted to the hospital based on doctor’s orders
- The hospital must accept Medicare payments.
- The Utilization Review Committee may have to approve your hospital stay (in some situations)
While Medicare does not pay for a private hospital bed, it does cover a semi-private room and meals. Drugs, hospital services, nursing services, and supplies associated with inpatient treatment are also covered.
Mental health services are also covered as part of Medicare coverage. There is a 190-day lifetime cap on the amount of days that mental health services are covered in the hospital.
Inpatient hospital care stays in acute care hospitals, inpatient psychiatric facilities, critical access hospitals, inpatient rehabilitation facilities and long-term hospitals are all covered by Medicare.
It is not uncommon for physicians to recommend health care services that are not covered by Medicare. For this reason, it is always a good idea that patients ask questions about coverage prior to accepting services if possible.
What Does Medicare Part A Not Cover
Knowing what Medicare Part A doesn’t cover is just as important as knowing what it does cover. Since it can be easy to misinterpret guidelines as different people weigh in on these important facts with their own interpretation, the more information seniors have, the better. With so much money at stake, seniors are forced to navigate this financial minefield that has the potential to jeopardize their financial health.
It is important to remember that many of the services not covered by Medicare Part A are covered by Medicare Part B. Most seniors sign up for Medicare Part B for this reason.
Below is a list of expenses not covered by Medicare Part A.
- A private room, unless deemed necessary
- A TV or telephone in the room
- Private nursing care
- Personal hygiene items like razors or slippers
- Skilled nursing facility services
- The first 3 pints of blood
- Nursing home care
- Assisted living facility charges
- Physicians’ services
What You Have to Pay
Baby boomers must establish a savings account designated to pay the deductibles and coinsurance required by Medicare. One of the worst mistakes that many seniors make is believing that Medicare will cover all of their health care costs.
Seniors should expect to pay the following costs associated with their Medicare coverage.
1. A deductible of $1,484 is associated with each benefit period.
2. For days 61 to 90, there is a $371 coinsurance charge per day charged in every benefit period.
3. For day 91 and each day after, there is a $742 coinsurance charge for each lifetime reserve day relative to each benefit period. (This lasts as long as 60 days past your lifetime coverage offered.)
4. When the lifetime reserve days have been used, then all costs must be paid by the enrollee.
How To Enroll in Medicare Part A
There is a 7-month enrollment period for seniors to sign up for the first time for Medicare Part A. For eligible boomers who worked at least 10 years over their lifetime paying Medicare tax, Medicare Part A is a free benefit.
The 7-month period for signing up extends to the three months following your birthday month. Effectively, the three months prior to your birthday, your birthday month, and the three months after your birthday month makes up the initial enrollment period.
The date your coverage begins is determined by the date you sign up for coverage. If you sign up late for Part A, then coverage is retroactive six months, but not earlier than your first month of eligibility.
It is important to understand the negative impact of signing up for Medicare Part B late. If you wait to sign up for Medicare until your birthday or the three months following your birthday, then it can create a coverage gap which means you will be charged a late enrollment penalty related to your Part B coverage. This is not a one-time penalty, since you will be charged the penalty for as long as you have Part B health coverage.
Signing up for Medicare is a rite of passage for seniors. Baby boomers who are turning 65 soon need to sign up for Medicare Part A before their actual birthday. Most boomers will also want to sign up for Part B at the same time since they are closely related and there are financial advantages to signing up for both parts as early as possible.