|  | Healthcare Industry | Health Insurance

How Does Medicare Plan A Work?

Medicare, the federal universal medical coverage program for individuals over age 65, consists of two parts, Medicare Part A and Part B. Part A covers major in-hospital events and related benefits. Participation is compulsory: All workers covered by Social Security contribute to the operation of Medicare through payroll taxes throughout their working lives. They also automatically receive benefits under Medicare Part A. If you paid into Medicare while working, you qualify for premium-free benefits. If not, premiums are $461 per month for Medicare Part A.



Medicare Part B is the voluntary part of Medicare. It covers supplementary medical insurance for physicians, services and medical supplies not covered by Part A. Those who enroll in Part B must pay a monthly premium, which is partially subsidized by the taxpayer.

  1. Inpatient Hospitalization Benefits - First 60 Days

    • Medicare Part A covers inpatient hospital stays, skilled facility care and limited home care. Medicare pays for all covered expenses for the first 60 days of care except for an initial deductible, $1,100 as of 2010. Covered expenses include nursing services and semiprivate rooms.

    Hospitalization Benefits - Days 61-90

    • Medicare pays a reduced amount for services. The patient must pay a daily co-payment of $275 for benefits received in days 61-90, as of September 2010, according to Medicare.gov.

    Renewal Provisions and Benefit Period

    • The 90-day hospitalization coverages renew with each benefit period, as defined by the Medicare program. A benefit period starts when a patient enters the hospital, and ends when a patient has left the hospital and remains out of the hospital for 60 days or more. If the patient reenters the hospital before then, no new deductible applies, but the clock keeps ticking and benefit days count against the 60- and 90-day coverage limits.

    Lifetime Reserve

    • Medicare patients have a 60-day lifetime reserve of hospital coverage. If you are hospitalized beyond your 90-day coverage limit, you can tap the 60-day reserve. This is a one-time benefit; it does not renew with each new benefit period. Co-payments are higher during the lifetime reserve benefit period. You are responsible for all charges after the 90-day benefit period and the 60-day lifetime reserve are exhausted.

    Other Benefits

    • Part A covers skilled nursing facilities, provided the patient was first hospitalized for at least three consecutive days. Skilled nursing treatment facilities are covered for the first 20 days. For days 21 through 100, you must pay a daily co-payment of $137.50. Medicare does not cover skilled nursing beyond 100 days.

      Part A also covers medically necessary hospice care, home health services and limited inpatient psychiatric care -- up to amounts deemed "reasonable" by Medicare officials.

Health Insurance - Related Articles