When you’re first eligible for Medicare, usually when you turn 65, you have an Initial Enrollment Period to sign up for Part A. You usually don’t pay a monthly premium for Medicare Part A (Hospital Coverage) if you or your spouse paid Medicare taxes for 40 quarters, or ten years, while working. This is sometimes called “premium-free Part A.” Most people get premium-free Part A.
In general Medicare Part A covers
- Hospital care
- Skilled Nursing Facility Care
- Home Health Services
- Nursing Home Care (as long as custodial long-term-care isn’t the only care.)
If you are admitted as an inpatient in a hospital or Skilled Nursing Facility Medicare Part A pays for your stay after a $1,316 deductible that must be met for each hospital benefit period.
Q1: So what’s a hospital benefit period?
A: This period begins the day you’re admitted as an inpatient in a hospital or Skilled Nursing Facility (SNF) and ends when you haven’t received any inpatient hospital care (or skilled care in a SNF) for 60 consecutive days. For example, you were admitted and released from a hospital on days 1 and 4. After 60 consecutive days of NOT being in the hospital, that would be day 64, the benefit period ended. If you were admitted to the hospital of SNF on day 65 a new benefit period would start and, yes, a new $1,316 deductible would apply.
Q2: After the $1,316 deductible, is there a daily copay?
A: The $1,316 deductible covers the first 60 days of hospital confinement cost or 20 days of skilled nursing facility eligible expenses. After these periods, in patient hospital and skilled nursing facility co-pays apply to hospital stay days 61-150 and skilled nursing facility stay days 21-100. (See below)
Q3: Is there a health plan to help cover those hospital and skilled nursing deductible and daily co-pays?
A: Yes. A Medicare Supplemental Insurance plan, often known as “MediGap,” can help with the Medicare Part A deductible and daily co-pay expenses. As a reminder, Medigap policies generally don’t cover long-term care, vision vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
♦ In New York State, the Department of Financial Services posts the current monthly premiums for Medicare Supplement plans by zip code. Click here or call me at 518-346-2115 for assistance.