What is Medicare Part A? Try This Helpful Guide

Would you like to learn about Medicare Part A? Stay tuned to know everything about Part A of Medicare.

The US federal government administers Medicare – a health-insurance program. This is a program that aims to fund the medical expenses of citizens. The CMS (Centers for Medicare & Medicaid Services) oversees this program. The CMS is a division of the US Department of Health and Human Services (HHS).

 

This article will highlight the first part of the Original Medicare program, that is, Medicare Part A. We will start by discussing what Medicare Part A is. After that, we will discuss its coverage, benefits, and enrollment criteria. So, let’s get started!

What is Medicare Part A?

Part A is one of the four main components of Medicare, and  it covers essential inpatient hospitalization. It is also referred to as ‘hospital insurance.’ Because Medicare Part A does not cover the entire cost of your hospital stay, you will most likely be responsible for a part of the payment.

In specific cases, you will have to pay a deductible before receiving healthcare. After that, Medicare will cover all your expenses for up to 60 days in a hospital. Likewise, Medicare Plan A will pay 100% of your costs for up to 20 days in a skilled nursing facility. Following that, you pay a fixed fee up to the most significant number of days covered. Moreover, your Medicare Part A benefits cover some of the expenditures for 90 days in a hospital. 

Other than that, Medicare also provides some “lifetime reserve days.” These are days when you spend more than 90 days in a hospital. You get a total of 60 reserve days throughout your life.

Under Part A, you don’t need to get authorization from your primary care doctor to receive healthcare. You can walk to the hospital any time to need care.

Do you have to Pay a Premium to Receive Healthcare under Medicare Part A?

Part A of Original Medicare does not demand a monthly premium to receive healthcare. You’re generally entitled to premium-free Part A if you are eligible. But how to know if you qualify? Check if you fall under the categories mentioned in the eligibility criteria. Otherwise, you’ll have to pay a monthly fee.

What are the Eligibility Criteria to Receive premium-free Medicare Part A Healthcare?

To receive premium-free Medicare Part A healthcare insurance, you must fall into either of these categories besides being an Ohio resident:

• Are over 65 years of age and have worked for at least ten years (forty quarters). Additionally, you must have paid your Medicare taxes during that tenure.

• You have received Social Security Disability Insurance for more than two years.

• The doctors diagnosed you with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis.

Medicare Part A and B: Know the Difference

Many people consider Medicare Part A and Part B the same. Both these are two separate parts of the Original Medicare program. 

Here comes the myth buster: these plans are different in terms of their coverage and premium requirements. And you deserve to know the difference! Listed below are the significant factors that differentiate Medicare Part A from Part B:

1. Nature of Insurance

Part A: This is referred to as “hospital insurance.” It covers medical care within the hospital. These expenses include inpatient hospital care, skilled nursing faculty care, hospice care, surgery, lab tests, and home healthcare.

Part B: Medicare Part B is also termed as “medical insurance.” It’s plan funds medical care outside the hospital. However, you can’t get your healthcare expenses covered by the Medicare Part B plan like that. You must present proof declaring that your treatment is essential. This indicates that a doctor must proclaim that extensive treatment is critical to curing a disease or medical condition.

2. Coverage

Part A: This covers inpatient medical help. The amount Part A funds for these treatments is dependent on various factors. The type of facility you stay in, the duration of your stay, and your previous deductible payment record are some governing factors.

Part B: Medicare Part B covers outpatient medical help. Examples of such services include ambulance services, medical equipment like wheelchairs, blood work, etc. Moreover, Medicare also offers some preventive care services in Part B. This includes substance abuse management, mental health care, nutrition therapy, and diabetes and cancer screenings. Part B covers 80% of the entire outpatient expenses – the recipients have to cover the remaining 20% from personal funds.

3. Cost of Insurance Plan

Part A: Many people are eligible for premium-free Part A. This means that they don’t have to pay a Part A coverage premium. If you don’t qualify for the premium-free insurance, you’ll have to pay a premium for Part A.

The monthly premium for 2022 is $471 for people who paid into SS less than 30 quarters. Moreover, in some instances, coinsurance and a deductible of $1,556 for hospital inpatient care are extra expenditures with Part A.

Part B: A monthly premium is mandatory in the case of Medicare Plan B. The federal government set the usual premium at $170.10 in 2022. Additionally, this fee can be taken from your Social Security income to make the process easier. In 2022, the annual deductible for Part B was positioned at $233. Other than these costs, you’ll have to pay your coinsurance payments, which are 20% of your covered charges.

But, disabled and low-income people can apply for financial help with Part B premiums through the Medicare Savings Program. All the qualified applicants get free or reduced deductibles and coinsurance.

What Does Medicare Part A Cover?

Wondering what benefits you get by enrolling in Medicare Part A ? Take a look at this list of services that the Part A of Medicare covers for Ohio residents:

• Inpatient hospital care
• Skilled nursing facility care
• Nursing home care
• Hospice care
• Home health care

Details of the Services Part A Covers

Let’s discuss the needs and benefits of each of these services better to understand the Medicare Part A insurance plan coverage:

1. Inpatient Hospital Care

The Part A insurance plan recipients get inpatient hospital care when an official doctor approves of hospitalization to treat an illness or injury. However, to receive inpatient hospital care, the hospital must accept Medicare.

Inpatient hospital services Medicare Part A include:

• Semi-private rooms
• Meals
• General nursing
• Drugs inevitable to treatment
• Other hospital services and supplies necessary for treatment

Moreover, sometimes doctors prescribe medical services that Part A does not cover. In such cases, the patients will have to incur the cost of the therapies.

2. Skilled Nursing Facility Care

Under Medicare Part A, the insured party can receive skilled nursing facility (SNF) care under certain circumstances. For instance, if the medical practitioner suggests that the patient requires constant supervision of professional nursing or therapy staff.

Skilled Nursing Facility Care under Medicare Part A includes:

• Semi-private rooms
• Meals
• Skilled nursing care
• Physical therapy
• Occupational therapy
• Speech-language pathology services
• Medical social services
• Medications
• Medical supplies and equipment inevitable to treatment
• Ambulance transportation
• Dietary counseling
• Swing bed services

3. Nursing Home Care

If a patient improves their health, the doctor can discharge them once their conditions get stable. In some cases, the medical practitioner discharges a patient before being healed from injuries. The recipient of Part A will benefit from nursing home care when such a situation occurs! The nurse will provide services like changing sterile dressings at home in such cases.

However, nursing home care does mean custodial care. Likewise, custodial care like bathing, feeding, dressing, and using the bathroom are not included in Medicare insurance packages.

4. Hospice Care

Hospitals provide free-of-cost hospice care to those recipients of Part A who are terminally ill. This service aims at making patients living comfortably who have an estimated life expectancy of fewer than six months. Moreover, when patient decides to withdraw from pursuing further treatment for their illness, they sign a palliative care agreement and receive hospice care.

Hospice care coverage includes:

• Services necessary for pain relief and symptom management
• Medical, nursing, and social services
• Drugs for pain relief
• Medical equipment for pain management
• Homemaker and aide services

5. Home Health Care

When a patient is homebound, or the doctor advises that they obtain medical treatment at home, they will receive home health care services.

Home health care services offered to Part A recipients include:

• Part-time or intermittent skilled nursing care
• Physical therapy
• Occupational therapy
• Speech-language pathology services
• Part-time or intermittent home health aide services

Conclusion

Even though Medicare Part A doesn’t cover certain services acupuncture, cosmetic surgery, eye examination, dental care, foot care, etc., it covers the most effective treatments.

Moreover, the majority of Americans avail themselves of the opportunity to participate in the Medicare by earning and paying their taxes for a specified time. However, even if you don’t satisfy these conditions, you would still be able to enroll by paying a higher premium.

Get Help Now