MEDICARE PART A
Your 65th birthday is rapidly approaching, retirement is looming, and your Medicare choices are pretty overwhelming. What plan or options are right for you? The Medicare system can be challenging to navigate and understand. Making the wrong choice could end up costing you more than you can afford in the long run.
Knowing your options can help you make the best possible decision. Since Medicare Part A is a Federal program, it is available everywhere, and you can’t be turned down. But to determine if it’s the right plan for you, it’s important to know what Part A covers and what it costs.
If your spouse is the one turning 65 first, you will still need to review your options as a family, since the Medicare plan you choose could impact your budget over the long term. If you are a caregiver to someone over 65, then carefully considering that senior’s options, overall health and healthcare needs can help you make the best choices for him or her.
What is Medicare Part A, and how does it work with the other Medicare parts? Understanding the different components of Medicare can help you decide if this plan, which is designed to cover your hospitalization costs, is right for you.
What is Medicare?
More than 55 million people turn to Medicare each year for health insurance. When you turn 65, you qualify for the affordable Medicare program, but you have several choices from there. Original Medicare consists of Part A and Part B, and different alternative and supplemental options allow you to select the best plans and coverage for your needs.
Learning more about your Medicare options is essential. Our easy-to-use guides are designed to give you insight and help you determine which options are right for you.
The first two components of Medicare, Part A and Part B, are considered “Original Medicare.” Part A, which we will discuss here, covers hospital care. Part B is a partner component and covers your doctor visits. You can find everything you need to know about Part B in our comprehensive guide.
Medicare Part A and B work together to cover many of your medical needs, but not all of them. You’ll still have some healthcare costs if you choose only these plans. An optional Medicare supplemental insurance plan can help you cover some additional expenses and prescription medications. These plans, Medicare Part C (which replaces Part A and B and is sometimes called Medicare Advantage) and Medicare Part D, are described in detail in our user-friendly guides.
You are eligible for Medicare if you are a U.S. citizen and 65 years of age or older. If you are younger than 65 but have an eligible disability, you could receive Medicare coverage as well. You can’t be turned down for Medicare Part A, even if you have a pre-existing condition or a past history of illness.
Medicare Part A
While you should know about all of your options, learning more about one of the most popular Medicare plans, Part A, will help you decide if this model is the right choice for you.
What is Medicare Part A?
Medicare Part A is health insurance designed specifically for hospital stays. Part of Original Medicare, it is paired with Part B to create comprehensive coverage. Part A is the same wherever you live in the United States; you’ll receive the same coverage and options regardless of your geographic location.
What Does Medicare Part A Cover?
Medicare Part A is designed to cover the costs associated with hospitalization or a hospital stay. While this form of Medicare will help with many of your expenses, you will still have to contribute towards your costs and hospital bills.
Medicare Part A and You
Medicare Part A covers a portion of any hospital stay expenses you incur. But what does that mean for you, and what can you expect from this plan?
For Medicare Part A users, the plan covers your inpatient hospital stay costs, any skilled nursing care you require after your hospitalization, and even some level of care if you are homebound. Part A also covers hospice care if needed.
Be aware of some coverage limits before choosing this plan, however. If you are in the hospital or in a nursing facility for over 90 days, then you may have to pay some of the costs. While your hospital stay is covered, you may still incur expenses. You’ll need Part B for doctor fees and services, as they are not covered by Part A.
Other Hospital Services and Medicare Part A
Personal services like phone calls, WiFi rental, and other non-medical needs do not fall under Part A coverage. Medically required services may be covered while you are in the hospital; assistance with bathing, eating or dressing could be covered if this help is considered medically necessary. A private room won’t be covered unless it is medically necessary.
What Fees Are Charged for Medicare Part A?
A senior choosing Medicare Part A could be responsible for a variety of expenses, including the following items:
- Monthly Insurance Premiums: If you have made Social Security contributions for at least 10 years, you will have no monthly premium costs for Medicare Part A. You are also not required to pay a monthly premium if your spouse meets the 10-year Social Security requirement. If you have not made Social Security contributions, or have not made them for the full 10 years, you may be required to pay up to $413 per month for coverage in 2017.
- Deductibles: Medicare Part A has a deductible of $1316 per hospital stay for 2017.
- Co-Pay: If you are in the hospital for more than 60 days, you may have to pay a co-pay fee of up to $329 per day. For stays longer than 90 days, that figure rises to $658 per day.
When Can You Enroll in Medicare Part A?
Your first opportunity to enroll in Medicare (unless you are disabled) is just before your 65th birthday. The actual dates for initial enrollment are different for every senior, since the timing is determined by your birthday month. If you are already on Social Security, then enrollment is automatic.
Your Initial Enrollment Period, or IEP, is a seven-month window of time that begins three months before you turn 65. It then includes your actual birthday month and the three months following your 65th birthday. Ideally, you should enroll in the program as early as you can to avoid coverage delays.
If you have a November birthday and are turning 65 in 2017, then your IEP will begin in August of 2017 and run through February of 2018. Applying in August will ensure you have plenty of time to finalize your coverage before you actually turn 65.
Review your Medicare Enrollment Options Annually
Once you have chosen your initial coverage, you will have a chance each year to make changes if you need to. Your health and needs could change over the course of the year, so making adjustments to your coverage could help you save money. If you wish to change to Medicare Part A after you are already enrolled in Medicare, you can do so during the annual open enrollment period. Each year from October 15th to December 7th, you can make changes to your Medicare plan. In some cases, you can make changes outside of this time period; retiring or moving to a different area may require you to change your Medicare plan.
What Hospital or Provider Can I See with Medicare Part A?
Any facility in the U.S. that accepts new Medicare patients, and is qualified to treat patients under Medicare Part A, can see you. One of the benefits of choosing Original Medicare, which includes both Part and Part B, is that you can continue to see the doctor of your choice. Not all doctors accept Medicare Advantage (Part C), however, so you may need to change doctors if you opt for this plan.
Is it Time to Learn About Medicare?
The best time to learn about Medicare Part A and your other options is well before your 65th birthday. Consider your current health, any concerns you have about your overall health and wellness, and any chronic conditions you have. While there is no way to predict an emergency, Part A coverage may help if you have been treated in the hospital in the past, or have a chronic condition that could require hospitalization.
Is Medicare Part A and B enough coverage for you? It might not be if you also take prescription medications. A supplemental plan may be needed to help offset the cost of your medicine.
Extra Help Paying for Medicare Part A
If you are worried about affording Medicare, there are several income-based assistance options available to you, including:
- Extra Help: The amount of Extra Help available will depend on the amount of money you make from all sources, including retirement and any assets you have beyond your home. While eligibility levels vary, if you make less than $18,000 as an individual or less than $24,000 as a couple, you could qualify for assistance.
- State Medicaid: This can help pay for your costs not covered by Medicare if you are on a limited income. Medicaid is state-based and varies depending on where you live.
- Medicare Savings Program: Designed to help you pay deductibles, premiums and co-insurance if you use Medicare Part A or B, this program can help offset your costs if you qualify.
Carefully reviewing both Medicare Part A and B and Medicare Advantage (Part C) can help you determine which plan is best suited to your needs. Understanding your healthcare options and plans will put you in control of your own healthcare and allow you to make proactive decisions about your medical care and well-being.