An Independent Medicare Health Insurance Agency

Medicare Part A

For your Hospital Coverage

This is hospital coverage, hospice, and skilled nursing care. For most people, this doesn’t cost you anything; it’s an entitlement program because you and your company have essentially already paid your portion through payroll taxes while you or your spouse were working. You get it at no cost if you or your spouse have been working for at least ten years and you’ve been a permanent, legal resident of the US for five continuous years. If none of the above applies (which is rare), you can buy Part A, and it will cost between $274 and $499 per month (in 2022), depending on how long you worked or your particular circumstance.

There are Part A deductibles you must pay before your insurance benefits kick in. However, it’s not an annual deductible (payable once a year); it’s a “Benefit Period” deductible. What’s the difference? Glad you asked.

According to Medicare, a benefit period begins the day you’re admitted as an inpatient in a hospital or Skilled Nursing Facility. The benefit period ends when you haven’t gotten any inpatient hospital care (or skilled care in a Skilled Nursing Facility) for sixty days in a row. If you go into a hospital or a Skilled Nursing Facility after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. In 2022, the deductible is $1,556 per benefit period, and this amount normally increases every year. However, there’s no limit to the number of benefit periods during any given year.

Got that? It’s not an annual deductible, so you actually could pay that deductible more than once during a calendar year.

After you’ve paid your benefit period deductible, after a certain number of days in a hospital or Skilled Nursing Facility, you’ll also have to pay a copay every day. Don’t worry about memorizing these numbers; just know they’re there and they change, but not drastically.

Medicare Part A Inpatient Hospital Coverage:

If you’re hospitalized, you’ll first pay your $1,556. That covers your hospitalization bills up to sixty days.

If you stay between 61-100 days, divide the deductible by four—you’ll be charged another $389 per day. (I agree with you, that’s quite a bit of money!)

If you stay beyond 100 days, divide the deductible by two—days 101 to 150 will cost you $778 per day.

Anything over 150 days, you’ll be on the hook for 100% of the charges. Yikes.

If you’re hospitalized for psychiatric care, the benefits are slightly different. You have a 190-day lifetime benefit and some coverage changes.

As mentioned above, Part A also covers Skilled Nursing Facility care. This is not Long-Term Care Insurance. Medicare does not cover Long-Term Care Insurance. It also does not include “custodial care,” which is care provided for things called “Activities of Daily Living.” These are essentially things you need to do to care for yourself, such as eating, bathing, and moving around.

As such, Skilled Nursing Facility care isn’t meant to be a long-term solution for patients. Think of it as an in-between step sometimes taken from the hospital to home, or from the hospital to a Long-Term Care facility.

Skilled Nursing Facility Coverage:

  • If you’re in for under twenty-one days, you’ll pay $0.
  • Days 21-100, you’ll pay up to $194.50 coinsurance per day (in 2022).
  • Days 100+ you’re on the hook for 100%.

What are the odds you will stay in a Skilled Nursing Facility for over 100 days? Very low. But even if you stay in for say, forty days, the quick math there is twenty days X $194.50 = $3,890. That’s in addition to anything you might owe from your prior hospitalization. Oh, one more thing. To get into a Skilled Nursing Facility, you’ll first have to be an inpatient at a hospital for three days. Yep, this means you’ll pay that deductible for the hospital stay in addition to the cost of the Skilled Nursing Facility care, so add the $1,556 on top of that number. This catches many people Bare-with-Medicare or who are on a Medicare Supplement plan by surprise. If there’s not a prior three-day stay in a hospital, Medicare won’t approve a Skilled Nursing Facility stay, which can financially expose you to the entire Skilled Nursing Facility bill.

Truthfully, a $1,556 deductible for a hospital stay is a pretty decent insurance benefit. Those of you coming off of an employer-sponsored plan probably had deductibles well above that when you were working. As we’ll cover later, this is less out of your pocket for an inpatient hospital visit than many Medicare Advantage plans will charge you. It’s the sixty-one or more days that should rightfully scare you.

Quick Math: if you stay hospitalized for 100 days, you’ll owe the $1,556 deductible if you haven’t already paid it, plus 40 X $389 = $17,116. Yikes! If you stay 150 days, it will be more than double that amount.

What are the odds you’ll be in the hospital for more than 100 days and still be alive? Probably pretty low. Still, in my opinion, this highlights one of the major “Frustrating Flaws” of Original Medicare, and it comes up time and time again. There is no “stop-loss” or “Maximum Out Of Pocket (MOOP).”

Related Services: Medicare Dental Plans, Medicare Supplement, Medicare Agents Near Me, Medicare Advantage, Prescription Drug Plans, Medicare Part B, Medicare Broker

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