What Does Medicare Part A

How To Find A Medicare Advantage Plan

Seniors interested in a Part C plan can find a list of Medicare Advantage plans and their plan details by comparing plans online or calling to speak with a licensed insurance agent.

Beneficiaries who are eligible for Medicare can also browse insurance providers websites for plans, compare costs at their states health exchange website or speak with a Medicare planner about options available locally. Seniors can also call a plan representative or broker and ask about Medicare Advantage plans.

Medicare Part A Will Pay For Most Of The Costs Of Your Hospital Stay After You Pay The Part A Deductible

By Bethany K. Laurence, Attorney

Medicare Part A is also called “hospital insurance,” and it covers most of the cost of care when you are at a hospital or skilled nursing facility as an inpatient. Medicare Part A also covers hospice services. For most people over 65, Medicare Part A is free.

The following list gives you an idea of what Medicare Part A pays for, and does not pay for, during your stay in a participating hospital. However, even when Part A covers a cost, there are significant financial limitations on the length of coverage, as you’ll see below.

How Do You Enroll In Medicare Part A

Signing up for Medicare Part A depends on your situation. In some cases, youre enrolled automatically, and in others, you must apply. If youre already receiving benefits from Social Security or the Railroad Retirement Board for at least four months before you turn 65, youll be automatically enrolled. If thats not the case, you can apply online at ssa.gov/medicare.11

If you have Lou Gehrigs disease, end-stage renal disease, or youre under 65 and you have a disability, find out about enrollment here.12

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Medicare Part A Costs

Premium. Most people do not pay a monthly premium for Part A coverage because of Medicare taxes paid by them or their spouse. For those who do have to pay, the costs for 2018 are $422 per month for those who paid less than 30 quarters worth of Medicare taxes. If you paid between 30 and 39 quarters, your premium would be $232.

Deductible. The Part A inpatient deductible for 2018 is $1,340 per benefit period. This is the amount out-of-pocket that you must pay in full before your Part A benefits kick in.

Coinsurance. Part A includes a coinsurance for inpatient services that scales based on the duration of your stay. Up to 60 days in a benefit period are free. Beyond that, youll pay $335 per day until you reach 91 days, at which point the daily coinsurance increases to $670.

How To Sign Up For Medicare Part A

Many people are automatically enrolled when they qualify, while others have to sign up for it. In general, it depends on whether you’re receiving Social Security benefits. You may, for example, be enrolled automatically in Medicare Part A and Medicare Part B if you:

• Have received benefits from Social Security or the Railroad Retirement Board for at least four months before you turn 65.
• Have received Social Security benefits for at least 24 months.
• Have amyotrophic lateral sclerosis , also called Lou Gehrig’s disease. You will automatically get Medicare Parts A and B when your disability benefits start.

If you have end-stage renal disease , you’re eligible for Medicare and can enroll in Parts A and B or in a Medicare Advantage Plan. If you choose Original Medicare , you will need both parts to get the full benefits available with Medicare to cover certain dialysis and kidney transplant services. If you’re interested in a Medicare Advantage Plan, be sure to check that the healthcare providers you currently see or want to see in the future, are in the plan’s network.

If you aren’t automatically enrolled in Medicare and you’ll be eligible when you turn 65, you should sign up through Social Security during your initial enrollment period. This is a seven-month period that:

• Starts three months before the month you turn 65.
• Includes the month you turn 65.
• Ends three months after the month you turn 65.

Enrollment can be done online, by phone, or at a Social Security office.

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What Medical Services Does Medicare Part A Cover

Part A covers a variety of hospital-oriented expenses, including:

• Inpatient hospital care: Includesa semi-private hospital room, hospital meals, general nursing,drugs used to treat you during an inpatient stay, supplies, and hospital services that are part of your hospital treatment.

• Skilled nursing facility care: It must be medically necessary for you to receive therapy and nursing that can only be provided by healthcare and related technical workers. Custodial care isnt covered if its the only care you need.

• Hospice care: If your care team has certified that your life expectancy is 6 months or less, Part A covers you as you work with a team of specially trained professionals and caregivers who will help to provide you with comprehensive care for your terminal illness. This also can include support for family caregivers, but inpatient respite care may come with a 5% out-of-pocket cost.

• Home health care: Includes services like part-time or intermittent skilled nursing care, physical or occupational therapy, injectable osteoporosis drugs for women, and medical social services.

Costs And Funding Challenges

Over the long-term, Medicare faces significant financial challenges because of rising overall health care costs, increasing enrollment as the population ages, and a decreasing ratio of workers to enrollees. Total Medicare spending is projected to increase from $523 billion in 2010 to around $900 billion by 2020. From 2010 to 2030, Medicare enrollment is projected to increase dramatically, from 47 million to 79 million, and the ratio of workers to enrollees is expected to decrease from 3.7 to 2.4. However, the ratio of workers to retirees has declined steadily for decades, and social insurance systems have remained sustainable due to rising worker productivity. There is some evidence that productivity gains will continue to offset demographic trends in the near future.

The Congressional Budget Office wrote in 2008 that “future growth in spending per beneficiary for Medicare and Medicaidthe federal government’s major health care programswill be the most important determinant of long-term trends in federal spending. Changing those programs in ways that reduce the growth of costswhich will be difficult, in part because of the complexity of health policy choicesis ultimately the nation’s central long-term challenge in setting federal fiscal policy.”

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What Does Medicare Part A Cost

Most people dont have to pay a monthly premium for Part A. If you or your spouse have worked 40 quarters while paying Medicare taxes, you receive Part A without the cost of a monthly premium.

However, there are costs related to Part A, like deductibles and coinsurance. These costs are part of the cost-sharing agreement between you and the plans carrier.

How Do I Sign Up For Medicare Part A

If you need to manually enroll in Medicare Part A, you can do so through Social Security or the Railroad Retirement Board . You can sign up in a few different ways:

• Online: Visit the Social Security website to apply for Medicare Part A and/or Part B.
• : Call Social Security at 1-800-772-1213 . Representatives are available Monday through Friday, from 7AM to 7PM.
• In-person: Visit your local Social Security office to apply.
• If you worked for a railroad, contact the RRB to apply at 1-877-772-5772. . You can call Monday through Friday, 9AM to 3:30PM, to speak to an RRB representative.

You may be subject to a late-enrollment penalty if you do not enroll in Medicare Part A when you are first eligible to do so. If you do not automatically qualify for Medicare Part A, you can do so during your Initial Enrollment Period, which starts three months before you turn 65, includes the month you turn 65, and lasts for three additional months after you turn 65.

If you dont sign up during your Initial Enrollment Period, you may be able to sign up during the General Enrollment Period that takes place every year from January 1 to March 31 your coverage would start on July 1.

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What Is Covered Under Medicare Part B

Together with Part A, Part B forms what is called Original Medicare. It is estimated that at the end of 2016, 67 percent of people using Medicare were enrolled in the original Medicare program.

Part B covers a variety of medically necessary outpatient services. Medically necessary service is determined if it is necessary to effectively diagnose or treat a health condition.

Definition Of Medicare Part D

Part D is an optional Medicare benefit that helps pay for your prescription drug expenses. If you want this coverage, you will have to pay an additional premium. Private insurance companies contract with the federal government to offer Part D programs through the Medicare system. For this reason, different plans include different prescription drugs and have different associated costs. Its important to review multiple plans before deciding which plan to buyor if youll buy one at all.

You can buy Medicare Part D only if you also have either Medicare Part A and/or Medicare Part B.

To join a Medicare Advantage plan that offers prescription drug coverage, you must have both Part A and Part B. Not all Medicare Advantage plans offer drug coverage.

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Should I Sign Up For Medical Insurance

With our online application, you can sign up for Medicare Part A and Part B . Because you must pay a premium for Part B coverage, you can turn it down.

If youre eligible at age 65, your initial enrollment period begins three months before your 65th birthday, includes the month you turn age 65, and ends three months after that birthday.

If you choose not to enroll in Medicare Part B and then decide to do so later, your coverage could be delayed and you may have to pay a higher monthly premium for as long as you have Part B. Your monthly premium will go up 10 percent for each 12-month period you were eligible for Part B, but didnt sign up for it, unless you qualify for a “” .

If you dont enroll in Medicare Part B during your initial enrollment period, you have another chance each year to sign up during a general enrollment period from January 1 through March 31. Your coverage begins on July 1 of the year you enroll. Read our publication for more information.

What Does Medicare Part C Cover

A Medicare Part C plan will cover the same medical services as Original Medicare. That means plans will cover doctors, hospital care and many other types of health services. Coverage includes:

• Inpatient care

• Long-term care
• Lab tests, X-rays and diagnostics

Keep in mind that even though Part C coverage may be similar to Original Medicare, there are key differences that will affect your access to care and how much you pay for medical services.

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When To Enroll In Medicare Part B

Most people get Medicare Part B when they are 65. If you havent registered for Part B, now is the time to decide whether you want to register.

During Medicares general enrollment period , you can enroll in Part B and your coverage will begin on July 1.

The decision to enroll in Part B is an important one. It depends on what kind of coverage you have now. It is also important to consider the penalty for late registration in Part B this lifetime penalty is added to your monthly Part B payment and increases the longer you wait to register.

If you only have Medicare Part A , adding Part B can help you get the most out of your Medicare coverage. Part B helps cover:

• Services from physicians and other healthcare providers
• Outpatient clinics
• Durable medical equipment
• Many preventive services

And if you have Part B, you have more options for getting additional coverage, such as prescription medications, vision, hearing, dental, and more.

Why Do I Need To Buy A Private Health Plan

Private Medicare health plans like Medicare Advantage or Medicare Cost plans cover everything Original Medicare does, and usually include more coverage for services you might need. Plus, they can include extra perks and benefits.

Find out more in the article, 4 reasons to buy a private health plan.

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What Isnt Covered By Medicare Part C

Medicare Advantage plans must provide at least the same amount of coverage as Original Medicare. Once a plan meets the minimum requirements, its up to the insurer to determine if additional services are covered.

Depending on the plan selected, Medicare Part C may not cover prescription medications. If it doesnt, you must have other prescription drug coverage. If you have a HMO or PPO, you are not allowed to purchase a separate Part D prescription drug plan. Although insurers are allowed to cover more services than Original Medicare does, not all Part C plans pay for routine dental care, hearing aids, or routine vision care.

If you are in need of inpatient care, Medicare Part C may not cover the cost of a private room, unless its deemed medically necessary. A private room is medically necessary if putting you in a semi-private room would endanger your health or the health of someone else. For example, if you have an infectious disease, Medicare Part C will cover a private room to ensure you remain isolated and prevent the disease from spreading to other patients.

When Can You Sign Up For Medicare Part A

Medicare Part A enrollment comes with a seven-month Initial Enrollment Period for signup. This includes the three months before and after the month you turn 65, plus the month of your birthday. For instance, if you turn 65 in April, your Initial Enrollment Period stretches from January through July.13

If you arent automatically enrolled, you can sign up for Part A any time during or after your Initial Enrollment Period starts, and your coverage start date will depend on when you enroll.14

If you must buy Medicare Part A, you miss your initial enrollment and arent eligible for a Special Enrollment Period , you can sign up for Part A during the General Enrollment Period , which is January 1 and March 31 each year. There are a variety of reasons you might get a SEP, including losing employer health coverage.15

There is no late enrollment penalty if you sign up during a SEP. However, if you must buy Part A, and you didnt buy it when you were first eligible, you may pay higher premiums for a period of time when you do sign up.16

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What Original Medicare Doesn’t Cover

Original Medicare doesn’t cover everything. With a few exceptions, Original Medicare doesn’t include coverage for prescription drugs. It also does not cover health care benefits you may have been used to getting with an employer plan such as dental, vision, hearing health care or wellness items like fitness memberships.

What Else Do You Pay For When You Have Medicare Part C

When considering your Medicare expenses, there are two costs to consider in addition to your monthly premium.

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When Will You Receive Your Medicare Card

Once enrolled, youll receive a Medicare card that you will need to present to healthcare providers. If you are automatically enrolled in Medicare at age 65, youll get your card in the mail three months before your 65th birthday. If youre disabled and qualify for Medicare that way, youll get a card in the mail three months before your 25th month of disability benefits.19 If youre eligible for Medicare because you have ALS, you can get your card the same month your disability benefits start.20 If you must enroll in Medicare, youll get your card in the mail about two weeks after you sign up.21

You dont have to sign up for Medicare annually, but each year youll have the chance to review your coverage. This is especially important if you know theres a surgery in your future or your prescription drug needs are changing, so make a note in your calendar each year to go over your options.

What Does Medicare Advantage Pay For

Part C providers are required by law to offer all of the benefits enrollees would otherwise have with Original Medicare Parts A and B. All of the same inpatient and outpatient services are included in any Part C package, though insurers may offer extra services some seniors are willing to shop for.

Services not covered by Original Medicare include routine dental and vision benefits, hearing aid services and routine foot care. Some MA plans do offer some or all of these services, though they may potentially charge a higher monthly premium or larger coinsurance/copays.

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