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What does Medicare Part A Cover?

  • If and when you end up in the hospital because you have a major medical need the bulk of your Medicare insurance coverage falls under Medicare Part A. Most people consider Part A as their hospital insurance coverage, however it provides more coverage than just hospitalization care. 

In addition to your hospital coverage, Medicare Part A also cover you for you for the following medical needs:

  • Hospice care
    • Palliative care
    • Counseling
    • Social Services
    • Short-Term respite care
    • Pain management
  • Skilled nursing facilities
    • Semi-private room (a room you share with other patients)
    •  Physical and Occupational Therapy (If needed to meet your health care needs)
    • Social Services
    • Medications
    • Counseling
  • Home health care

All of these coverages and more are provided to you for you when your Doctor determines you have a medically necessary need.  

Part A of your Medicare coverage is a vital coverage you will one day need as it provides you with life saving coverage.  Some of your largest medicare bills happen when you are dealing with a health concern that falls into one of these categories of coverage.  

Medicare Part A

How Much Does Medicare Part A Cost?

While many believe that Medicare as a whole is completely free this is not actually the case.  In some instances you may be required to pay a portion of your Part A premium if you have not paid enough into Medicare throughout your years of working.  

Most Medicare beneficiaries will not be required to pay any additional premium towards their Medicare Part A coverage.   As long as you have worked for 10 years (which is equal to 40 quarters) in your lifetime, you will generally pay no additional premium towards your Part A Medicare insurance coverage. 

You might be asking why is so a few people pay for Part A and most do not.  For those who do not pay anything, these are for those individuals whom they or their spouse paid their payroll taxes into Medicare each time their employer paid them their salary.  You may not have known that a portion of the payroll taxes you paid covered your Part A insurance premiums.

Please keep in mind that it did not take care of the other Medicare Parts, so you may have an additional premium for Part B, Part C and and/or Part D.

If you do not have 40 quarters, you can pay for Part A in order to have this important coverage. Premiums in 2021 are $471 per month if you have less than 30 quarters or $259 per month for people with 30 – 39 quarters.  This information is available on Medicare.gov as well for your review.  

Read more about the cost of Part A on our Medicare costs page

Medicare Part A Cost

When do I enroll in Medicare Part A?

If you have not already done so, I would recommend going to our Start Here tab. This page will be your best place to go for how to enroll into Medicare. 

That being said, if you are already taking Social Security income, you should be enrolled into Medicare Part A automatically.  Two to three months prior to turning 65 you should receive your red, white, and blue Medicare card showing your Part A effective date. 

If you plan to keep working past the age of 65, you may or may not need to sign up for Part B and Part D coverage.  If your card does not show a Part B effective date next to it like your Part A coverage you will need to have this added if you will not have creditable insurance coverage in place through an employer sponsored plan. 

If you already receive Social Security benefits and your Medicare card does not show up in the mail automatically, we highly encourage you to call the Social Security office at 1-800-772-1213 to find out why.

Medicare no longer uses your Social Security Number as your Medicare Number.  This is to help prevent Identity theft.  You will be assigned a specific number from Medicare that looks similar to the picture next to this information.

If you are part of another large majority of Medicare Beneficiaries who are not receiving Social Security income benefits or Railroad Retirement income benefits,  you will need to be proactive and sign up for Part A, Part B, and Part D coverage three months before age 65. One of the easiest ways to sign up is through the  Social Security website

Medicare Supplement Plan F

What happens after I apply for Medicare Part A?

Once the Social Security Administration receives your Medicare application for Part A and Part B coverage, they will

  • Review your application and contact you if they need additional information for the application or if they need to see any supporting documents
  • Process your application once they have all of the necessary information and needed documents; and
  • Upon full review they will mail you a decision letter

 

We recommend that you go enjoy a little time outdoors while you wait for the your local Social Security office to send you your approval letter.

What are the Medicare Deductibles and Copays under Part A

Under Original Medicare (with no Medicare Supplement / Medigap or Medicare Advantage Plan in place) Your Medicare Part A coverage will pay for the majority of the cost. However, you will have some cost-sharing as well that you are responsible for.  Not matter how much you plan writing these checks to cover this cost is always painful.

The Centers for Medicare and Medicaid Services (CMS) has the responsibility of calculating our portion of the cost for Medicare Part A.  This includes the cost associated with your deductible and coinsurance.  Please keep in mind these figures are only dealing with your Part A Medicare benefits.  In 2021, your portion that you will pay:

  • $1,484 deductible for each benefit period
  • Days 1-60: $0 coinsurance for each benefit period
  • $371 per day for days 61 – 90 of a consecutive hospital stay
  • $742 per day for days 91 – 150 of a consecutive hospital stay
  • Any and all costs for day 150 and beyond

 

For skilled nursing facility stays, Medicare covers day 1 – 20 at 100%. Starting on day 21 you will be charged a daily copay in plan year 2021 for days 21- 100 of $185.50. On day 101 and beyond you will be responsible for 100% of the cost.

Fortunately, both Medigap policies and Part C Medicare Advantage plans will help cover most of these costs. If you purchased a Medigap policy Plan G your skilled nursing facility cost would be covered at 100% for all 100 days.  While a Medicare Advantage plan can have lower daily co-pays than the $185.50 amount. It is important that you review your specific plan summary of benefits to ensure you know your true cost.  Unfortunately neither the Medigap or Medicare Advantage plan will provide any additional coverage beyond day 100.

To get help with your Medicare insurance needs or learn more about Medicare hospital coverage, call our insurance experts at (562) 735-3553 for a FREE consultation!

Part A coinsurance

Does Medicare cover Long Term Care Insurance?

Long Term Care Insurance is not included as part of your Medicare coverage.  You are highly encouraged to consider exploring this coverage well in advance to actually needing it.  

90% of the time clients reach out to us a day, week, or month before they are faced with putting their loved one into a long term care facility.  At this point we have to tell our clients that unfortunately we do not have a insurance carrier that will provide this needed coverage based on your current situation.

We encourage our clients to explore this coverage option at the same time they are signing up for Medicare.  You will need to be healthy and have no major medical. conditions at the time of application.  This will also help you obtain a more competitive price when we shop for your Long Term Care insurance coverage.

Because we are a full service Insurance Agency we can help you find an insurance option that makes sense for you to explore and obtain.  Let us know how we can help you with your Long Term Care needs.

What's New for Medicare in 2021

I am already enrolled in Part A how do I enroll into Part B?

Many of our clients are only enrolled into Part A when they first come to us.  One of the main reasons they don’t enroll into Part B is because they still have credible health insurance coverage through an employer health plan.  

Once you are ready to enroll into Part B of Original Medicare, we recommend going to the Social Security website and downloading their enrollment application.  Following is a link to this form CMS Form 40B.

Once you receive your new Medicare Card showing your Date of Enrollment into Part B, you are now able to give us a call and sign up for either a Medicare Supplement Plan / Medigap plan or a Medicare Advantage Plan.  

You’re required to be enrolled into both Part A and Part B coverage before you can sign up for either a Medigap plan or a Medicare Advantage plan.

Want Medicare Insurance Agent to explain in a one-on-one setting? Get help from our Medicare insurance experts today at (562) 735-3553.

Sign up for Medicare Part B