Everything You Need to Know about Medicare Part A

Original Medicare consists of two parts, Medicare Part A and Medicare Part B. Part A (Hospital insurance) covers inpatient care, care at a skilled nursing facility, and at-home care (in limited circumstances).

To be eligible for premium-free Part A, you must be entitled to receive Medicare based on your earnings or those of a spouse, parent, or child. You must also have 40 of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. Most people will be automatically enrolled in Part A once they turn 65. You may also be automatically enrolled in Part B if you are already enrolled in Part A and receiving Social Security benefits.  

In general, Medicare Part A covers inpatient hospital care, limited home health services, hospice care, and skilled nursing facility care. These benefits are covered based on your specific situation and only if certain conditions are met.

What Part A covers

  • Hospital Care
    • Acute care 
    • Critical access
    • Inpatient rehabilitation facilities
    • Long-term care
    • Mental health care
    • Qualifying clinical research study
  • Home Health Care
    • Part-time or intermittent skilled nursing care
    • Part-time or intermittent home health aide care
    • Physical therapy
    • Occupational therapy
    • Speech-language pathology services
    • Medical social services
  • Nursing Home Coverage
    • Semi-private room
    • Meals
    • Skilled nursing services
    • Rehabilitation services
    • Medical social services
    • Medications received while in SNF care
    • Medical supplies and equipment used in SNF
    • Ambulance transportation
    • Dietary counseling
  • Hospice
    • Doctor services
    • Nursing care
    • Pain relief medications
    • Social services
    • Durable medical equipment
    • Medical supplies
    • Hospice aide
    • Homemaker services
    • Physical and occupational therapy
    • Dietary counseling
    • Short-term inpatient care
    • Short-term respite care

What is not covered?

Medicare doesn’t cover everything, so you may have to pay out of pocket for certain services. Even if Medicare covers the costs of a service or piece of equipment, you will most likely still have to pay your copayment, coinsurance, and the Part A deductible, which is $1,408. Talk to your doctor to find out specifics about what Medicare won’t cover.

Some examples of services that Part A does not cover are:

  • A private room (unless medically necessary)
  • Private-duty nursing
  • Personal care items, like razors or slipper socks
  • Extra charges, like a telephone or TV in your room
  • Non-donated blood
  • Meals delivered to your home
  • 24-hour-a-day care at home
  • Homemaker services
  • Personal care
  • Custodial (long-term) care

2020 Part A premium, deductible, and coinsurance

Premium. Most enrollees will not have a Part A premium, but those who don’t have 40 quarters of work history or a spouse with 40 quarters of work history will need to pay a premium. For 2020, the premium for people who have between 30 and 39 quarters of work history is $252 per month. For people with fewer than 30 quarters, it’s $458 per month. 

Deductible. The Part A deductible for 2020 is $1,408 (up from $1,364 in 2019) and applies to each benefit period rather than calendar year, but many beneficiaries have supplemental coverage, such as Medigap, that pays for this deductible. 

Coinsurance. If you need inpatient care, the deductible will cover your first 60 days. After that, you will be charged a daily coinsurance charge of $352 per day for days 61-90. After 90 days, the coinsurance rate is $704 per day.

Understanding Medicare Part A

Medicare Part A covers inpatient care like a skilled nursing facility, care received in a hospital, and some limited in-home care. You will probably be automatically enrolled in Part A whenever you turn 65. If you are not already enrolled in Part B and need to enroll manually, you can do so during your initial enrollment period, which is a six-month window that begins three months before you turn 65. 

If you still have questions about your coverage or health care pertaining specifically to you, call 1-800-MEDICARE.

Medicare and Mental Health: What are Your Options?

Did you know that more than 40 million American adults suffer from mental illnesses such as depression, bipolar disorder, anxiety disorder, and schizophrenia? Mental Health Awareness Month has been observed in May since 1949 in the United States. It was initially started by Mental Health America, which releases a toolkit of materials every year in March. The toolkit is useful as a guide for outreach activities.

According to Mental Health America, 56% of American adults with a mental illness do not receive the treatment they need. A large part of the problem remains the lack of access to the treatment that people need.

“In my work as a Clinical Psychologist, I have seen numerous improvements related to mental health and behavioral health over the years in a geriatric population,” said Dr. Kelly F. Trusheim, Clinical Director at Highland Rivers Health. “Namely, I have seen them benefit from regular screenings at annual ‘wellness’ visits, at which time early identification and treatment psychiatric symptoms and disorders was initiated.”

Mental Health Coverage Under Medicare

Here is what Medicare does and does not cover when it comes to mental health care.

What Part A Covers

Medicare Part A covers mental health services that you receive in a hospital that require you to be admitted as an inpatient. While this includes both general hospitals and psychiatric hospitals, Part A only covers 190 days of inpatient psychiatric hospital services during your lifetime. It does not cover a private nurse, a private room (unless medically necessary), a phone/television in your room, or personal items during your stay.

The deductible for each benefit period in Original Medicare is $1,408. There’s no limit on the number of benefit periods you can use when you get mental health care in a general hospital. You can have multiple benefit periods when you receive care from a psychiatric hospital as well, but there is still a lifetime limit of 190 days.

What Part B Covers

Medicare Part B covers mental health services and visits for outpatients with professionals such as psychiatrists, clinical social workers, clinical psychologists, clinical nurse specialists, nurse practitioners, and physician assistants. It also covers outpatient mental health services in settings like a healthcare provider’s office, hospital outpatient center, or community mental health center.

Along with these services, Part B covers:

  • one depression screening per year when done in a primary care doctor’s office or clinic
  • individual and group psychotherapy with doctors or licensed professionals allowed by the state
  • family counseling
  • medication management
  • testing to see if you’re getting the services you need
  • certain prescription drugs
  • diagnostic tests
  • psychiatric evaluation
  • partial hospitalization
  • yearly “wellness” visit and a one-time preventive visit.

The costs for Original Medicare are 20% of the Medicare-approved amount for visits to a doctor or health care provider.

While the stigma attached to mental health issues has improved, there are still steps to take when improving the quality of life and access to help for those who struggle with mental health issues.

Benefits of getting help

Dr. Trusheim notes she has seen people benefit from access to help. “While conducting individual psychotherapy, I have watched patients successfully cope with severe medical diagnoses and major transitions in life,” she said. “I have witnessed the benefits of psychiatric evaluation and medication management, including lessening depressive symptoms, reducing anxiety, promoting restful sleep, managing psychotic symptoms, and slowing the progression of dementia symptoms. I have conducted assessments/testing that have clarified if a patient’s presentation is considered part of the normal aging process or is indicative of a psychiatric or neurological condition. In my work with families, I have assisted them in better understanding their loved one’s illness, as well as what they can expect and how to help the patient. The benefits of behavioral health treatment are too many to list.”

Suicide

With respect to suicide, this is a rather important topic for patients of all ages. There are 25 attempts per every death by suicide per year, and the ratios are 4:1 for the elderly, according to the American Association of Suicidology. In addition, white males who are 65 years old or older are at a higher risk than the general population.

There are various misnomers about suicide. For example, talking about it does not increase the risk. In fact, asking about it earlier can assist in early intervention, treatment, and recovery. For more information on how you can learn how to ask your loved ones about suicide, visit the QPR Institute and the Suicide Prevention Resource Center.

If you or someone you know is in danger, call the National Suicide Prevention Lifeline at 1-800-273-8255. You can speak to a counselor 24 hours a day. You can also text 741741 to talk to a trained crisis counselor for free 24/7.