Medicare Part A – Hospitalization Benefits

What is Medicare Part A?

Original Medicare Part A helps pay for services during overnight stays in the hospital. Examples are surgeries, tests, etc., and needed supplies. Medicare Advantage Plans must give you at least the same coverage as Original Medicare.

In General, What Does Part A Cover?

In general, Part A helps pay in the following scenarios:

  • Inpatient Hospital care
  • Skilled nursing facility care
  • Nursing home care (as long as custodial care isn’t the only care you need). Note that in most cases, Medicare does not pay for custodial care.
  • Hospice and Respite care
  • Home health services

How Do I Know if What I Need is Covered by Part A?

Generally, there are two ways to check to see if your test, item or service needs will be covered. Before assuming coverage:

  1. Talk to your doctor or provider and ask if your specific needs will be met.

  2. You can also find out if Medicare covers your item, service, or supply to determine probable coverage.

What if My Needed Services Are Not Covered by Medicare Part A?

If there is something the doctor believes will not be covered you’ll have to read and sign a notice saying that you may have to pay for the item, service, or supply. This notice is called the “Advance Beneficiary Notice of Noncoverage” (ABN). Similar ABNs cover Skilled Nursing Facilities, Home Health and the Hospital issued Notice of Noncoverage.

The aforementioned ABN details what Medicare won’t pay for, the reasons, and will give an estimate of costs. The whole purpose is to help you make an informed decision in case you have to accept responsibility for payment. It is not an official denial of coverage. You have the right to file an appeal if payment is for a claim is denied.

You’ll be asked to choose one of the following options and sign the notice to say that you read and understood it. Here are your options:

  1. Elect to get the items or services that Medicare may not pay for AND agree to pay if Medicare doesn’t. Your provider or supplier will submit a claim to Medicare for the items or services. If Medicare denies payment, you can still file an appeal.

  2. Elect to get the items or services that Medicare may not pay for AND agree to pay out-of-pocket costs at that time. IMPORTANT – you request that no claim be submitted to Medicare. You won’t be able to appeal because no claim will be filed.

  3. Elect NOT to not get the items or services. No claim is filed, and you aren’t responsible to pay since the service wasn’t provided. You won’t be able to appeal because no claim will be filed.

How Much Will Part A Cost in Premiums for 2013?

You usually don’t pay a monthly premium for Medicare Part A coverage if you or your spouse paid Medicare taxes while working.

If that describes you, you get “premium-free” Part A at 65 if:

  1. You already get retirement benefits from Social Security or the Railroad Retirement Board.

  2. You’re eligible to get Social Security or Railroad benefits but haven’t filed for them yet. Remember, you can be eligible for Social Security before turning 65 and choose not to receive it until later.

  3. You or your spouse had Medicare-covered government employment.

If you’re under 65, you can get premium-free Part A if:

  1. You’ve been receiving Social Security or Railroad Retirement Board disability benefits for 24 months.

  2. You have End-Stage Renal Disease (ESRD) and meet certain requirements.

If these conditions do not apply to you and you choose to buy Part A, costs can be up to $441 per month in 2013. Note that, in most cases, if you choose to buy Part A, you must also have Medicare Part B (Medical Insurance) and pay monthly premiums for both.

How Much Will Medicare Part A Services, Deductibles and Co-Payments Cost for 2013?

Not unlike other insurance, in addition to monthly premiums (if any), you must meet a deductible before benefits begin. A deductible is the amount you must pay before Medicare pays anything. The following summarizes the services, deductibles and Co-payments. Many people choose Supplemental Insurance, aka Medigap, to help bridge the difference between Medicare coverage and your final payment responsibility.

Inpatient Hospital Stay for 2013

You Pay:

  1. $1,184 deductible per benefit period.

  2. $0 for the first 60 days of each benefit period.

  3. $296 per day for days 61–90 of each benefit period.

  4. $592 per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime).

Skilled Nursing Facility Stay for 2013

You Pay:

  1. $0 for the first 20 days of each benefit period.

  2. $148 per day for days 21–100 of each benefit period.

  3. All costs for each day after day 100 of the benefit period.

Home Health Care for 2013

You Pay:

  1. $0 for home health care services

  2. 20% of the Medicare-Approved amount for Durable Medical Equipment (DME)

What if I Need Help With Medicare Costs?

Medicare is insurance. As such, it can carry a monthly cost (your premium); annual deductibles (the amount you must pay each year before the insurance pays), and; co-pays (what you pay each time you get a service). If you are on a limited income, Medicare has programs that can help you pay these costs. For more information, see programs below.

Program Description
Medicaid Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources.
Medicare Savings Programs Learn about programs in your state that help pay your premiums, and in some cases, your deductibles, coinsurance, and copayments.
PACE PACE is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility.
Save on drug costs If you meet certain income and resource limits, you may qualify for Extra Help from Medicare to pay the costs of Medicare prescription drug coverage.
Programs for people who live in U.S. territories There are programs in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa to help people with limited income and resources pay their Medicare costs. Programs vary in these areas.
Find your level of Extra Help (Part D) To check the level of Extra Help you’re entitled to, you’ll need to provide some information.
Insure Kids Now The Children’s Health Insurance Program (CHIP) provides free or low-cost health coverage for more than 7 million children up to age 19. CHIP covers U.S. citizens and eligible immigrants.
Supplemental Security Income (SSI) The Supplemental Security Income (SSI) program pays benefits to disabled adults and children who have limited income and resources. SSI benefits also are payable to people 65 and older without disabilities who meet the financial limits.

Medicare Hospitalization Benefits