Medicare Part A

ELIGIBILITY

You are eligible for Medicare if:
  • you are 65 years or older, and
  • you are a citizen or permanent resident of the United States who has lived in US for at least 5 years
  • If you are not yet 65, you might also qualify for coverage if you have a disability or End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).  You are entitled for Medicare after you get disability benefits from Social Security for 24 months.
  • Your age is the main determining factor. You do NOT need to retire or receive Social Security benefits in order to be eligible for Medicare.
  • Many Medicare beneficiaries are dual-eligible, i.e. they are qualified for both Medicare and Medicaid.

BENEFITS

  • Inpatient hospital care (such as critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals)
  • Inpatient care in a skilled nursing facility (not custodial or long term care)
  • Hospice care services
  • Home health care services

PREMIUM

  • Most people age 65 or older don’t have to pay a monthly payment (called premium) for Part A because they or their spouses paid Medicare taxes while they were working – 40 or more quarters of Medicare covered employment

1. INPATIENT HOSPITAL STAY

DEDUCTIBLE

  • $1,316.00 (per benefit period) (Year 2017)

COINSURANCE

  • $329 per day for days 61-90 of a hospital stay. (Year 2017)
  • $658 per day for days 91-150 of a hospital stay (Lifetime Reserve Days). (Year 2017)
  • All costs for each day beyond 150 days

Medicare covers:

  • Up to 90 days of inpatient hospital services in each benefit period
  • An additional 60 lifetime reserve days
A benefit period begins when you are admitted to the hospital and ends when you have been out of the hospital for 60 days, or have not received Medicare-covered care in a skilled nursing facility (SNF) or hospital for 60 consecutive days from your day of discharge. Medicare provides 60 lifetime reserve days of inpatient hospital coverage following a 90-day stay in the hospital. These lifetime reserve days can only be used once — if you use them, Medicare will not renew them. Very few people remain in a hospital for 150 consecutive days. In the rare event this does occur, most Medicare Supplement policies would cover additional days

2. SKILLED NURSING INSURANCE

  • $164.50 per day for days 21 through 100 each benefit period. (Year 2017)
  • All costs for each day after day 100 in each benefit period

There are gaps in coverage concerning Medicare Part A.  For this reason many seniors purchase a Medigap (LINK) plan to protect against charges Part A does not cover.