Medicare is a federal health insurance program in the United States that provides health coverage to individuals who are 65 years old or older, as well as those with specific disabilities or medical conditions. The program is administered by the Centers for Medicare and Medicaid Services, which categorizes services under four parts: Part A, Part B, Part C, and Part D. It is important for beneficiaries to understand what each part covers as each part covers different services.
The focus of this article is on Medicare Part A coverage for 2023 and why it is crucial to have a clear understanding of the benefits provided by this program. Understanding the coverage provided by Medicare Part A can help beneficiaries make informed decisions about their healthcare needs and expenses.
What is Medicare Part A?
Medicare Part A is the hospital insurance plan that covers inpatient hospital stays, hospice care, skilled nursing facility care, and home health care. Employees and their employers fund it through payroll taxes. To receive these benefits, you must fulfill specific requirements. Watch this video to know more about Medicare Part A.
Credits: Wesley Evans
Eligibility requirements for Medicare Part A
Most people who are 65 years old or older and have worked and paid Medicare taxes for at least ten years are eligible for Medicare Part A. They are entitled to this coverage without paying any premiums.
However, people who are under 65 years old may also be eligible for Medicare Part A if they have certain disabilities or medical conditions.
The enrollment process for Medicare Part A
When a person turns 65, they are automatically enrolled in Medicare Part A if they are currently receiving Social Security or Railroad Retirement Board payments.
However, those not receiving these benefits must enroll in Medicare Part A by contacting the Social Security Administration.
Learn more about how to apply for Medicare. Check out below!
Credits: Wesley Evans
What Medicare Part A Covers in 2023?
With few exclusions, these are what Medicare Part A covers the following services:
Inpatient hospital care – Medicare Part A covers inpatient hospital stays, including semi-private rooms, meals, and general nursing care. It also covers necessary hospital services, such as laboratory tests, X-rays, medications, and medical supplies.
Skilled nursing facility care – It covers skilled nursing facility care for up to 100 days per benefit period. It includes room and board, nursing care, physical therapy, and other services.
Hospice care – Medicare Part A covers hospice care for people with terminal illnesses and a life expectancy of six months or less. It includes medical and support services, such as pain relief, counseling, and respite care.
Home health care – After being discharged from an inpatient hospital stay, if you require care from a home health aide, this is of what Medicare Part A covers medically necessary home health care services. It includes skilled nursing care, physical therapy, and speech-language pathology services. It also covers medical equipment and supplies, such as wheelchairs and oxygen.
Blood transfusions – Medicare Part A covers blood transfusions received as an inpatient in a hospital or skilled nursing facility.
Inpatient mental health care – It also covers inpatient mental health care in general or psychiatric hospitals.
Medicare Part A provides coverage for emergency room visits only if a doctor admits the patient to the hospital as an inpatient. However, if the doctor does not admit the patient and discharges them from the emergency room without hospital admission, Medicare Part B or private insurance may cover the costs.
It’s important for beneficiaries to understand the hospital admission criteria and to confirm coverage with their insurance provider before seeking emergency care.
How Much Does Medicare Part A Cost for 2023?
Part A premiums
Most people do not pay premiums for Medicare Part A, as they or their spouse paid Medicare taxes for at least ten years while working. However, those who do not have enough work history to qualify for premium-free coverage will pay a monthly premium.
For those who have worked and paid Social Security taxes for at least 30 quarters, the monthly premium for health insurance will be $278 in 2023, which is only $4 more than last year. But, if you are an elderly uninsured person with less than 30 quarters of coverage or a disabled person who has exhausted all other benefits, the total price of health insurance will be $506 per month in 2023, which is $7 more than in 2022.
Deductibles and coinsurance for Part A services
Beneficiaries are responsible for paying a deductible for each benefit period. In 2023, the Part A deductible will be $1,600 per benefit period. After the deductible is met, beneficiaries may still have to pay coinsurance for certain services.
Beneficiaries must pay a coinsurance payment of $800 per day for lifetime reserve days in 2023 ($778 in 2022) and $400 per day for the 61st through 90th days of hospitalization in 2023 ($389 in 2022). The daily copay for extended care services for beneficiaries residing in skilled nursing facilities will be $200.00 in 2023 ($194.50 in 2022).
How Medicare Part A costs may change in 2023
Medicare costs, including premiums and deductibles, are subject to change each year. Beneficiaries should stay informed about any changes to their Medicare Part A coverage.
Limitations and Exclusions of Medicare Part A Coverage
Medicare Part A coverage has some limitations and exclusions, and these include the following:
Services not covered by Medicare Part A
While Medicare Part A covers many hospital and medical services, some are not. For example:
most dental care
eye exams for glasses or contact lens
long term care
Call 800-MEDICARE (800-633-4227) to find out if a service is covered under the various levels of Medicare.
If you or a loved one is in the hospital, a case worker who can assist with issues about Medicare coverage will typically be assigned to you.
Limits on coverage for certain services
There are also limits on coverage for certain services under Medicare Part A.
For example, there is a limit on the number of days that Medicare will cover a stay in a skilled nursing facility, and there are limits on coverage for home healthcare services.
Out-of-pocket costs for services not covered by Medicare Part A
Beneficiaries may still be responsible for paying out-of-pocket costs for services not covered by Medicare Part A.
For example, they may need to pay for dental or vision care or for long-term care in a nursing home. Beneficiaries must plan for these costs and consider additional insurance coverage, such as Medicare Supplement Insurance (Medigap) or Medicare Advantage plans.
Who is eligible and not for Medicare Part A?
At age 65, individuals who are receiving Social Security payments will be automatically enrolled in Medicare Parts A and B. However, those who are not yet receiving Social Security will need to sign up for Medicare actively. Most individuals 65 years old or older who have worked and paid Medicare taxes for at least ten years are eligible for Medicare Part A. Individuals who are under 65 years old may also qualify for Medicare Part A if they have specific disabilities or medical conditions, such as End-Stage Renal Disease (ESRD).
Unfortunately, persons who are not US citizens or permanent residents and those who have not worked or paid Medicare taxes for the requisite number of years may not be eligible for premium-free Medicare Part A.
In conclusion, Medicare Part A is a hospital insurance plan that covers inpatient hospital stays, hospice care, skilled nursing facility care, and home health care. Eligibility is mainly based on age and having worked and paid Medicare taxes for at least ten years. Beneficiaries should be aware of what Medicare Part A covers, as well as its limitations and exclusions. Part A premiums, deductibles, and coinsurance are subject to change each year, and it is important to stay informed about any changes. It is also essential to understand hospital admission criteria and confirm coverage with the insurance provider before seeking emergency care.
If you have any questions or would like further assistance regarding Medicare, you can schedule a phone call to discuss your Medicare options in more detail.
If you live in Southern California, you may also search for my recommended Medicare Advantage plans and carriers at this Plan Finder tool.