Part A Costs and Coverage

Description

Part A Premium – Most people do not pay a premium for Part A as this benefit has been earned through work and payment into the medicare system. For those that do not have at least 40 qualifying working quarters through themselves or a spouse, in many cases, a premium is charged to the beneficiary. 

Costs

Quarters
40             –  $0

30-39       – $232/mo

>30          – $422/mo

Part A Hospital Coinsurance and Deductibles – The first sixty days in the hospital come with a deductible. Whether you stay 1 or 60 days the deductible will apply.  After that, there is a daily coinsurance amount for each day seen.  Actual cost to the patient will vary based on any secondary medicare plans such as Medigap or Medicare Advantage and the coverage details in the summary of benefits 

Days              Coinsurance
1-60            –  $1,340

61-90          – $335/day

91-150        – $670/day

Skilled Nursing Facility (SNF) – This is considered rehabilitation.  Services offered here are physical, occupational, and speech therapy.  A beneficiary is not guaranteed any length of stay in this type of environment.  Therapy notes are sent up daily to Medicare showing the progress that a patient is making.  Medicare then makes a determination of whether or not to continue to pay for therapy.  It is important to note that in many cases Medicare will stop paying for therapy within the first 20 days.

Days              Coinsurance
1-20            –  $0

21-100       – $167.50/day

100+          – All Costs 

Home Health – Includes a wide range of services ranging from physical, occupational and speech therapy to wound care done in the home setting.  The goal is treat the injury or illness without the need to stay in a skilled nursing facility.  Many times this type of care is given after a stay in hospital or rehab as continued services with the goal of keeping the patient from returning to a healthcare institution.  

Cost –  $0 – supplies and durable medical equipment associated with the care will be billed to Part B and may result in additional costs. 

*Some Home Health providers bill Medicare Part B for outpatient services.  This would result in costs associated with your plans benefits.

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