Medicare Part A: The Ins and Outs of Hospital Coverage

Hospitalizations are often followed by a barrage of bills and statements. Only the initiated can hope to understand them. This is when energy is needed for recuperation, recovery and care-giving. You don’t want to spend it figuring out what’s covered and what’s not. So here’s a little primer on Medicare Part Ato help you prepare ahead of time.

 Part A covers hospital care, but…

Did you know that you can spend the night in the hospital and not be an inpatient?

It’s true. This is important because it can affect how much you may pay out-of-pocket for your hospital care. It can also affect whether Medicare will pay for any skilled nursing care you may need afterward.

You are an inpatient only after you are admitted to the hospital by doctor’s orders. If you are in the hospital for observation, for example, you may or may not be admitted.

You must be in the hospital at least three days to qualify for covered follow-up care in a skilled nursing facility. Your last day in the hospital is the day before you leave. The day you go home doesn’t count.

When you are in the hospital, it’s important to ask whether you have been admitted.

Part A charges a deductible, and…

The Part A deductible, $1,156 in 2012, is charged per benefit period. A benefit period begins the day you go into a hospital or skilled nursing facility. It ends when you have been out for 60 days in a row.

You may be in the hospital more than once during one benefit period. For example, you may leave the hospital and then be re-admitted. If you’re re-admitted within 60 days, then it’s the same benefit period. In this case, your coverage continues. If you are re-admitted after 60 days, it’s a new benefit period. You will be charged another deductible. There is no limit on the number of benefit periods that Medicare will cover.

Part A fully covers 60 hospital days, then…

After the deductible, you pay $0 for up to 60 days of hospital care during one benefit period. If you are in the hospital for more than 60 days, then you will start to be charged a copay.

You must pay a copay for hospital days 61 through 90 during one benefit period. In 2012, the copay is $289 per day.

Starting with day 91 in the hospital, you can begin to draw on your “lifetime reserve days.” Lifetime reserve days are like a “bank” of extra hospital days covered by Medicare. You have 60 extra covered days in your “account” that you can use over your entire life. You must pay a copay for the lifetime reserve days you use. The copay is $578 per day in 2012.

Here’s one final note about coverage. Most doctor services are covered by Medicare Part B, even when you’re in the hospital.

Part A is premium-free, if…

Most people qualify for premium-free Part A benefits. You qualify if you or your spouse paid into Social Security for at least ten years while working. If you don’t qualify, you will have to pay a premium. In 2012, you will pay up to $451 a month. If you don’t sign up for Part A when you are first eligible, you may be charged a penalty.

–This information is provided by Medicare Made Clear – Are you a senior age 65+ looking for Medicare Supplemental Insurance? Call 909-790-7748. We will explain your options and find the right plan for you.