What is Medicare Part A?

Medicare can be a confusing animal. I think the best way to explain it is to break it up into parts.

So, what is Part A? You have probably seen the deduction for Medicare coming out of your paycheck. In my opinion, this is primarily funding Part A. I say that because when you become eligible for Medicare, Part A is free. (Well, kind of. You did already pay for it.)

There are some people who may not qualify for "free" Part A due to the fact they didn't work the required time to gain free Part A. There are a couple of ways you can qualify for Part A.

1. Work 40 quarters in the US and pay into Medicare during that time.

2. Marry someone who has worked 40 quarters in the US and paid into Medicare. This gives you Spousal benefits.

3. Certain disabilities will allow you to qualify for Medicare under a parent. (Call Medicare or Social Security to find out more.)

When you do qualify for Medicare, Part A is just one part of the Medicare puzzle. Part A is going to cover you when you are an inpatient in a hospital or skilled nursing facility.

This is how I remember it. The letter A is shaped like a roof. When you are inside the roof then Part A is paying. In this example, "the roof" is either a hospital or skilled nursing facility.

If you are admitted as an inpatient in a hospital, Part A will kick in.

Here are some things to remember. If you go to the Emergency Room and are held for observation for 24 hours, that is not an inpatient hospital stay. This can get tricky.

In order for Medicare to pay in a skilled nursing facility stay, you must have been an inpatient in a hospital for 3 - 24 hour periods. If you enter through the ER and they hold you for "observation" for 24 hours then admit you as an inpatient for an additional 48 hours, you were technically only an "inpatient" for 2 days, not 3.

Be sure that if you transition from a hospital to a skilled nursing facility you receive confirmation you have been an "inpatient" for 3 full 24 hour periods.

You also have a deductible to meet with each hospital admission. In 2018 the deductible is $1340. Because Medicare by itself doesn't have a Maximum Out Of Pocket limit, each time you are admitted, you will pay the deductible.

Once you have paid your deductible, the hospital will not bill you again unless you are in the hospital for more than 60 days. Once day 61 hits, you will start to pay a daily copay. Currently, in 2018, the daily copay rate is $335. This will happen until you reach day 90.

After 90 days in the hospital, Medicare will start to take from a Lifetime Benefit Pool of Reserve Days. Each Medicare Beneficiary is given 60 Lifetime Reserve Days. Once you use one of these days, it is gone forever. If you happen to use one of these days, the daily copay will go up. In the past 5 years, the number has traditionally double from the previous daily copay. In 2018, if you use a Lifetime Reserve Day, you will pay a $670/day copay.

Anything beyond the Reserve Days, Medicare will no longer pay. Medicare is designed for Acute Recovery Care. This means you are showing signs of improvement. You are getting better. Once you start to show signs that you are not getting better, Medicare can pull the plug on paying bills. That can even happen BEFORE the maximum number of days have been met.

Medicare does not pay for Long Term Care. So if you happen to run into a situation where you will need Long Term Care, Medicare will no longer pay for your stay in a hospital.


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