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How Part A Works: Benefits Vs Premium

Medicare Part A is one of the most popular Medicare segments. Inpatient care in a hospital or skilled nursing facility fall under coverage in this section, but that’s not the only benefits you’ll receive from it.

Deductibles (typically an expense incurring once a year) are included within cost sharing for Part A. On the first day of January, you cover all costs for your medical expenses. After you’ve spent the money necessary to satisfy the quota of the deductible, Medicare kicks in and provides coverage for additional expenses throughout the entire year. When the next January rolls around, this starts over.

When it comes to Medicare A, deductibles are not laid out in this typical fashion. As opposed to having the requirement of filling the quota once a year, you have to fill it once every benefit period. A benefit period is marked on the calendar the moment you set foot into a hospital/skilled nursing facility. The benefit period dissipates once you’ve been home for sixty consecutive days.

Throughout the benefit period, you may find yourself in the hospital/skilled nursing facility multiple times. Staying in treatment, going home, and then returning the next week because of the same ailment – this means two hospital visits within the same benefit period. You would only have to provide funds for one deductible, not two.

However, if sixty days have passed before you return to the hospital for the same ailment, a new benefit period takes place. You would then have to pay dual deductibles this article at Able Medicare does over it.

Part A has no limit cap on how many benefit periods one can experience throughout the year. It also helps provide coverage for up to ninety days of hospital/skilled nursing care per benefit period. Lifetime reserve days are also a factor which comes into play, which are like a bank account of additional hospital days falling under Medicare coverage. These can be used if you find yourself in a hospital/skilled nursing facility post-ninety days within Medicare Part A’s benefit period. Sixty bonus days exist in this account
which can be pulled out throughout your entire life span.

Understanding how the gears turn on Medicare Part A’s coverage policies when it comes to benefit periods, the time allotments and lifetime reserve days can help you preserve the hard earned cash in your wallet.


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