How Much Does Medicare Cost : Part A

It’s a common misconception that medicare is free for everyone in the country.  This couldn’t be further from the truth, and this oversight can often cause serious financial problems for people who are not prepared.  Read on to learn about how much does medicare cost!

What is Medicare

Medicare is a government run program that is designed to provide or supplement heath care services for those people over the age of 65 and:

• Certain people under 65 with disabilities

• People of any age with End-Stage Renal Disease (ESRD) (permanent kidney
failure requiring dialysis or a kidney transplant)

Original Medicare consists of Part A and Part B.  You can supplement your Original Medicare a few different ways.  For more information on these different parts of medicare, refer to our previous article that explains them in more detail.

One of the biggest questions we receive is about how much Medicare costs.  Much like other government programs, the answer is “it depends”.  Read on to learn more about typical costs associated with Medicare!

How much does medicare cost

How Much Does Medicare Cost - Medicare Part A Premiums

As we said, there is no one answer to the question “How much does Medicare cost?”.  Let’s first start with the premium.  If you or your spouse worked for over 10 years and paid into the social security system, there is no premium to pay, sometimes referred to as “Premium-free Part A.”  If you did not pay into the system, there are two premium levels:

7.5 to 10 Years (30-39 quarters): $252 a Month

Fewer than 7.5 Years (Less than 30 quarters): $458 a Month

Please note, these numbers are based on 2020 costs and are likely to change in the future. 

Medicare Part A Annual Deductible

Retirement should be a time to relax, not worry about medical costs.

How much does Medicare cost

Medicare Part A does not have an annual deductible. Instead there is a deductble that applies to each hospital benefit period. A benefit period starts when you enter a hospital or skilled nursing facility. It ends when you have been out of the hospital or facility for a minimum of 60 consecutive days. The current 2020 Part A deductible is $1408 (this often changes on an annual basis).

Medicare Part A Hospital Copayments & Deductibles

The Medicare Part A deductible applies once you are admitted into the hospital. This benefit period is for days 1-60.

  • $1,408 deductible for each benefit period .
  • Days 1–60: $0 coinsurance for each benefit period.
  • Days 61–90: $352 coinsurance per day of each benefit period.
  • Days 91 and beyond: $704 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime).
  • Beyond lifetime reserve days : all costs.

This differs from a skilled nursing facility where a copay will start after the first 20 days of being in the facility.

You will be responsible for the deductible $1,408 for a hospital stay. This is not an annual deductible, you pay this deductible once each benefit period. Your payment may change the longer you stay in the hospital.  There is no cap on the amount of times you may have to pay this deductible, you could be responsible for this deductible up to 6 times in one year.

Medicare Part A Skilled Nursing Facility Copayments & Deductibles

There is no deductible for a skilled nursing facility stay.

  • 3-Day Hospital Stay: You must have been at a hospital
    • For 3 days AND
    • Had come to a skilled nursing facility within 30 days of the hospitalization AND
    • Had been admitted to the hospital as an inpatient. Time in the emergency room or in what the hospital calls “observation status” does not count, even if you stayed overnight or longer.
  • Level of Care: You must also need skilled nursing care 7 days a week, or skilled therapy services 5 days a week.
  • Part A: Skilled nursing care is covered under Medicare Part A. You must have had Part A while you were in the hospital.

It is also important to remember Medicare will not cover purely custodial stays – meaning you cannot cloth, bathe, or feed yourself.

This is how much you can expect to pay based on your length of stay.

0-20 Days: $0
21-100 Days: $176 a Day
Over 100 Days:All Costs

Note:  During the COVID-19 pandemic, some people may be able to get renewed SNF coverage without first having to start a new benefit period. 

  • If you’re not able to be in your home during the COVID-19 pandemic or are otherwise affected by the pandemic, you can get SNF care without a qualifying hospital stay.

For more information:  https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care

Medicare Part A Home Healthcare Services Copayments & Deductibles

In order to have Medicare cover your home healthcare costs, you need to meet specific conditions.  For Original Medicare, there is a $0 cost for qualified services and 20% for Medicare-approved amounts for durable medical equipment (dme).

Medicare covers home healthcare services when a doctor certifies that:

  • You need medical care at home AND
  • You are homebound AND
  • You need skilled care from a nurse or a skilled physical, speech or occupational therapist.

Medicare will only cover home care services when your doctor:

  • Orders the care from a home health agency that Medicare approves, AND
  • Documents a face-to-face visit with you up to 3 months before or 1 month after the start of the service, AND
  • Signs a plan for your care.

Note:  During the COVID-19 pandemic, nurse practitioners, clinical nurse specialists, and physician assistants can now provide home health services, without the certification of a physician.  

Medicare Part A Hospice Care Copayments & Deductibles

Medicare only covers your hospice care if the hospice provider is Medicare-approved. To find out if a hospice provider is Medicare-approved, ask one of these:

  • Your doctor
  • The hospice provider
  • Your state hospice organization
  • Your state health department

Once your hospice benefit starts, Original Medicare will cover everything you need related to your terminal illness.

Verus Health Partners Can Help

At Verus Health Partners, we educate our clients.  Our goal is to ensure you have the proper coverage for your situation.  Contact us today to learn more about Medicare costs and how we can help you save money. You can follow us on Facebook for other helpful information.