If you are entitled to Part A and 65-years old, you will be enrolled in Part A.
What is covered in Part A?
There are three factors that govern if Part A claims will be paid. Federal and state laws, national coverage decisions made by Medicare and local coverage decision made by each state that process claims.
Part A covers Inpatient hospital care, Skilled Nursing care, Nursing home care, Hospice care and Home Health care.
Part A Eligibility
There is no charge for Part A coverage because either your or your spouse paid FICA taxes for at least 40-quarters (10-years) while working.
For those who do not qualify for Part A, there is a monthly premium of $458 per month if they did not pay taxes for less than 30-quarters. For those who paid taxes for 30-39-quarters the premium is $252 per month.
Persons not eligible for Part A and who did pay the premium will have a late enrollment penalty of up to 10%.
Inpatient Hospital Deductible and Coinsurance
Most Medicare Advantage and Cost plans will pay Part A deductibles as part of the plan. Medigap or Supplemental plans, depending on the plan riders, may or may not cover deductibles. If you have Original Medicare, you will pay for deductibles.
$1,408 for each 90-day benefit period
$0 coinsurance for days 1-60 benefit period
$352 coinsurance per day for days 61-90 benefit period
$704 coinsurance per day for days 90 and beyond
Disabled person turning 65-years old and who are receiving Social Security benefits will automatically be enrolled in Part A and Part B. Persons under 65-years old will be enrolled after they are on disability for 2-years. Persons with ALS or End-Stage-Renal disease will get benefits the month their disability benefits start.
Most Medicare Advantage and Cost plans will charge a co-pay after day 21.
If you do not have a Medicare policy and only have Original Medicare, and you need nursing services for a medical condition that is a hospital-related medical condition treated during your qualifying 3-day inpatient hospital stay, or had a condition that started while you were getting care in a hospital-related medical condition and require skilled nursing, then you will pay the coinsurance.
$0 for days 1-20 for each benefit period
$276 per day for days 21-100 for each benefit period
All Cost per day for days 101 and beyond