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Medicare Part A and Part B not only cover different services, but present beneficiaries with different expenses and cost-sharing structures. Though all Medicare beneficiaries (even those with Medicare Advantage) pay the Part B premium each month, most qualify for premium-free Part A coverage.
Who Gets Premium-Free Part A Coverage?
If you or your spouse worked for 10 or more years (or 40+ fiscal quarters) and paid Medicare taxes, you qualify for premium-free Part A coverage. For individuals who worked and paid Medicare taxes for between 7.5 and 10 years (or whose spouse did so), Part A premiums will cost $259/month in 2021. For individuals who paid (or whose spouse has paid) Medicare taxes for fewer than 7.5 years, Part A premiums will cost $471/month.
Other Part A Costs
Monthly premiums aside, there are three primary expenses associated with Part A coverage: deductibles, copayments, and coinsurance. These costs are the same for all beneficiaries, however much they pay in premiums.
In 2021, the Medicare Part A deductible is $1,484. This means that beneficiaries are responsible for paying the first $1,484 toward eligible healthcare services during a hospital stay. After this point, the next 60 days of eligible services are covered in full. The deductible resets when a benefit period ends. This means that beneficiaries may need to meet the $1,484 deductible numerous times throughout a single year.
After a beneficiary has paid their Part A deductible, the copay will be $0 for their first 60 days in the hospital during the same benefit period. After 60 days, however, they will have to pay a daily copayment. From the 61st to the 90th day of their hospital stay, the copayment will be $371/day. At this point, beneficiaries will need to begin using their lifetime reserve days, during which the cost of the copayment doubles to $742/day. Beneficiaries have 60 of these to use throughout their lifetime. After they have exhausted these days, enrollees may be responsible for paying their entire bill after 90 days of inpatient care during a given benefit period.
After 20 days in a skilled nursing facility, beneficiaries must make a daily coinsurance payment of $185.50 until the 100th day of their stay. After the 100th day, Medicare no longer assists beneficiaries with payments.
Part A benefit periods begin the day a beneficiary enters a healthcare facility and lasts until the individual has not received inpatient care or skilled nursing care for 60 days. At this point, the benefit period resets.
For example, imagine a beneficiary is admitted to the hospital, stay for 30 days, and is readmitted just one week after being discharged. Though they’ve left the hospital, their initial benefit period has not ended. As far as their Part A coverage is concerned, their next day in the hospital is Day 31. They may not need to meet their deductible again, but they will be responsible for daily copayments after just 30 more days (Day 61).
Benefit periods have nothing to do with the particular facility a beneficiary is admitted to. Therefore, checking into a different hospital during the same benefit period will not trigger a new benefit period.