What is Medicare Part A?

Medicare Part A is the Hospital Coverage portion of “Original Medicare.”

Medicare Part A covers an “Admitted Hospital Stay.” Medicare will cover semi-private rooms, drugs, nursing, meals and Hospital services associated with the stay. Medicare does not cover the cost of a private room, TV or phone, private duty nursing and personal care items like toothbrushes and razor blades. Hospital Part A also covers time in a Skilled Nursing Facility (SNF). The SNF will be available after an admitted Hospital Stay.

Skilled Nursing services include–

Meals, Skilled Nursing Care, Semi-Private Rooms, Physical, Speech, and Occupational Therapy, Medications and Medical Supplies, Ambulance, and Dietary Counseling.

Medicare Part A Costs-

Most individuals, when nearing retirement age, have worked more than 10 years, or 40 Quarters in Government Speak and will not have to pay monthly for Hospital Part A; it will be Free. It’s important because any time worked that adds up to less than 40 Quarters will result in a monthly premium, and you’ll have to pay for your Part A Hospital coverage. For example, in 2024-
-If you worked between 30 to 39 Quarters, then your Part A premium will be $278.00 per month.
-If you worked 29 Quarters or less, your Part A premium will be $505.00 monthly.

Hospital Part A offers coverage for an Inpatient Hospital stay and time spent in a Skilled Nursing Facility following an Inpatient Hospital stay. An Inpatient Hospital stay is broken down into 60-day benefit periods. If you have to return to the Hospital for the same condition within 60 days, the cost share will not apply. The costs are as follows:

Days 1- 60- Individuals will be responsible for a $1632 deductible.
Days 61- 90- $408.00 Per Day
Days 91- 150- $816.00 Per Day (Utilizing the 60-day Lifetime Allowance)
Days 151 and beyond- All Costs
Skilled Nursing Facility-
Following an Inpatient Hospital stay, Medicare will cover 20 days. The costs are as follows:
Days 1- 20- $0 per day
Days 21- 100- $205 per day
Days 101 and beyond- All costs

Summary– While Medicare does pay for a large part of an admitted hospital stay there is no provision to limit an individuals annual cost. Multiple Hospital stays can amount to thousands of dollars and an appropriate Medicare Health Insurance plan should be put in place to control costs. Ask your Medicare Advisor for help with your options.

Choosing the Right Medicare Coverage

Selecting the best Medicare coverage depends on factors like your healthcare needs, budget, and preferred providers. You can choose between:

Original Medicare (Parts A & B): Allows you to see any doctor or
hospital that accepts Medicare but does not include prescription drug
coverage (Part D) or additional benefits.
Medicare Advantage (Part C): Offers bundled coverage with
potential extra benefits but may require using a network of providers.
Medigap (Medicare Supplement Insurance): Helps cover
out-of-pocket costs not covered by Original Medicare, such as
copayments and deductibles.

Key Medicare Enrollment Periods

It is crucial to enroll in Medicare at the right time to avoid penalties and ensure continuous coverage:

Initial Enrollment Period (IEP): A seven-month window starting
three months before your 65th birthday month.
General Enrollment Period (GEP): From January 1 to March 31
each year for those who missed their IEP.
Annual Election Period (AEP): From October 15 to December 7,
allowing you to switch or enroll in Medicare Advantage and Part D
plans.
Open Enrollment Period(OEP): From January 1 to March 31 for
those who missed AEP and want to make certain changes.
Special Enrollment Period(SEP): Can be used anytime during the
calendar year for those that meet certain criteria such as moving to a
new service area.

Finding Help with Medicare

Understanding Medicare can be complex, but you don’t have to do it alone. Licensed Insurance Brokers, Medicare.gov, and state health assistance programs can provide guidance tailored to your specific needs.

By taking the time to explore your Medicare options, you can make informed decisions that ensure you receive the healthcare coverage that best suits your lifestyle and budget.

Do I have to sign up for Medicare?

It depends upon your current coverage. If you are employed and your employer has over 20 employees then you can delay signing up for Medicare and avoid penalties.

Does Medicare cover Prescription Medications?

No, You will have to enroll in a stand alone Part D plan or a Medicare Advantage Plan(Part C) to get coverage.

I want to be able to go to any doctor/hospital, are there networks with Medicare?

There are no networks with Medicare and most doctors and hospitals accept it. However, Medicare does not cover 100% of services so a Medicare Supplement or Medicare Advantage plans is advisable.

Mike Miligi- Owner

For over 10 years, Mike has been assisting Seniors and other Medicare-eligible individuals in understanding the ins and outs of Medicare and Medicare Health Insurance options, including Medicare Advantage Plans(Part C), Medicare Supplement Plans(Medigap), Prescription Drug Plans(PartD), and Dental and Vision programs.

Mike is Licensed in seven States and Certified with 11 Insurance Carriers. He has helped thousands of individuals decide on the best course of action for their particular Health Insurance needs. Because Mike is an Independent Medicare Health Insurance Broker, he works for the client, not the Insurance Carriers, and is able to provide his clients with accurate and unbiased Health Insurance options.

Mike recertifies with CMS(The Centers for Medicare and Medicaid Services) annually, regularly completes Continuing Education Courses required by individual State Insurance Departments, and keeps abreast of industry trends and standards to offer his clients the most up-to-date information.