Medicare Part A Cover, Application, Enrollment, and cost

Medicare Part A Hospitalization

Medicare Part A(Hospital Insurance) is the hospital coverage portion (inpatient and care following hospital stays) of Original Medicare (alongside Part B). It’s the federal government-sponsored health insurance program for U.S. citizens aged above 65 years (individuals who are disabled or with End-Stage Renal Disease (ESRD) can get it at any age).

What does Part A cover in Medicare

Inpatient Care in Hospitals

• Inpatient hospital care is limited to 90 days for each benefit period (Plus 60 additional days throughout your lifetime- after this, you’re expected to pay all costs).
• Inpatient mental Coverage is up to 190 lifetime days.

Skilled Nursing Facilities (limited stays)

• Medicare covers room, board, and administration of medications, tube feedings, and wound care for up to 100 days each benefit period.
• This is only available to enrollees who have been on in-patient coverage for at least three consecutive days within 30 days of admission to the Skilled nursing facilities and are in need of skilled nursing or therapy services.

Home Health Care

• Homebound Enrollees who need skilled care in their homes.
• Coverage is limited to 100 days or an unlimited amount of intermittent care.
• You need to have spent at least 3 consecutive nights as an inpatient to qualify for Part A coverage within 14 days of receiving home health care.

Hospice Care

An enrollee can elect to receive this care if it’s diagnosed by a provider that they are terminally ill. It’s covered for as long as your provider certifies it’s needed.

Other parts of Medicare may also cover some hospitalization costs. These may include:

• Part B (medical insurance) generally covers services that are offered before or after inpatient hospital care (doctor’s visits, outpatient care, home health care, durable medical equipment, and some other preventive services.)
• Part C (Medicare Advantage). They may provide coverage for services under parts A and B (Prescription drugs, Vision, hearing, and dental care).
• Part D-Medicare supplement insurance (Medigap). Typically provides coverage for out-of-pocket costs and fees associated with Part A and Part B (copayments, coinsurance, and deductibles).

Qualifying for Medicare Part A

Typically, Medicare Part A is available to:

• Individuals aged 65 or above
• Disabled
• Individuals with End-Stage Renal Disease (ESRD)

Those receiving Social Security or RRB benefits for at least 4 months before Medicare eligibility while residing in the United States (except residents of Puerto Rico-Must elect to be enrolled in Part B) will be automatically enrolled in both premium-free Part A and Part B.

All other Individuals automatically enrolled and must apply by contacting Social Security.

Apply Medicare Part A only

Sign-up for Medicare is usually done 3 months before an individual turns 65 years.

This can be done in 2 ways:

1. Signing up to get only Medicare coverage.

Generally, the process of enrollment is automatic, however, you can sign up for Medicare by:

• Putting a call to the Social Security Administration at 800-772-1213
• Visit your local Social Security office and sign up in person
• Going to Social Security Administration website and signing online

2. Making an application to begin receiving benefits from Social Security (or the Railroad Retirement Board).

Once the application is approved, Part A coverage is automatically allocated.

Individuals will elect to receive Part B coverage when applying for the benefits.

Medicare Part A enrollment deadlines are as below;

Initial Enrollment Period (IEP)

This happens when an individual turn age 65. Enrollment can happen as early as 3 months before your 65^th birthday, during the birth month, and up to 3 months after your 65th birthday.

Failure to register at this time usually exposes an individual to penalties.

General Enrollment Period (GEP)

This is the annual period between January 1 to March 31 that you can sign up for but may face penalties.

Special Enrollment Period (SEP)

Individuals can enroll outside the basic enrollment periods. To qualify for a SEP, certain Life Qualifying Events need to occur to necessitate changes in coverage.

Common examples include; moving out of the plan’s service area, moving into or out of a skilled nursing facility, psychiatric institution, rehab or long-term care facility, etc.

Applying for Medicare Part A online

Who is allowed to use the online Medicare application

You should use the online application if:

• Are within 3 months of your 65^th birthday or older.
• You need Medicare benefits but lack Medicare coverage.
• You don’t see the need to apply for the monthly Social Security retirement benefits immediately.
• Is residing in the U.S. or its territories or commonwealths.

There is no need to create a Medicare account when signing up. After signing up and getting a Medicare Number, then you can proceed to create a secure Medicare account.

How to make the application (normally takes 10 to 30 minutes):

1. Click ssa.gov/hlp/isba/10/isba-checklist.pdf to determine what’s needed for the application.
2. Go to socialsecurity.gov/medicare/apply.html to make the actual application. Select “Apply for Medicare Only.”
3. Check the “Related Information” links if you require more information.
4. Apply and complete the application.
5. Hit “Submit Now”. This will send an electronic application to Social Security. Use the application number generated to track the status of your application.

Your application will be reviewed, processed and you will receive the decision via mail.

What does Medicare Part A cost

Medicare does not cater fully to the cost of your care. You may be responsible for some portion of the Premiums ($0-$499), deductibles, coinsurances and copayments for Medicare-covered services.

It’s advisable to enroll in a supplemental or Medigap policy to help with the out-of-pocket costs.

Medicare Part A Premiums

The monthly premium costs for Medicare Part A will depend on how long an individual (or their spouse) has worked and paid Medicare taxes.

What is the Medicare Part A Deductible

This is the annual amount an enrollee pays out of pocket before Part A starts to pay. In 2022, the out of pocket cost is $1,556 ($1,600 in 2023) for each benefit period.

A benefit period starts the day an individual is hospitalized as an inpatient in a facility (Hospital or any other inpatient facility). It ends when you haven’t received in-patient care for 60 consecutive days.

Coinsurance and copayments

Coinsurance is the daily out of your own pocket payment an enrollee makes for Medicare-covered services after meeting their deductible.

The table below shows the range of coinsurance costs for Part A inpatient care in 2022:

As for in-patient care at a skilled nursing facility, coinsurance costs in 2022 will be a bit different:

Bottom Line

Apart from a few exceptions (like a private room), Medicare virtually provides coverage for all hospital services within the first 60 days of hospitalization ($0 coinsurance).

Enrollees should always ask providers if the care received is inpatient or outpatient on each day of stay as this affects their coverage and the costs.

You won’t pay deductibles or copayment Under Medicare Part A for:

• Hospice care; Enrollees will only meet minimal costs for medications and inpatient respite care.
• Home health care is as long as the eligibility criteria for coverage are met.