What Is a Medicare Part A Deductible?

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Medicare Part A covers hospital bills, nursing services and some home health services and care. The exact services covered vary according to your physical condition, federal policy and the claims review process. Local companies in each state review claims and set standards for what Medicare will pay. Even if your hospital stay is approved, you will have to pay a deductible and other costs.

Medicare Premiums

  • One expense you probably won't have to worry about is a premium. Most people on Medicare qualify for Part A based on years of having Medicare taxes withheld from their paycheck. As long as you put in enough years working and paying taxes, you qualify to receive Part A at no cost. You can also qualify if your spouse or parent was the wage-earner. The amount of work you need depends on various factors, such as whether you're filing based on age or on disability. If you don't have enough quarters of work to qualify, the premium, at time of publication in March 2015, was $407 a month.

The Benefits Period

  • The benefit period for Part A starts the day you're admitted to a hospital or similar facility. It ends when you haven't received any inpatient care for 60 days. If you leave the hospital, then check back in within a month, you're still in one benefits period. If you check back in three months, you're in a new period. The deductible for each benefits period is $1,260 for a hospital inpatient stay. There's no deductible for home health care, hospice or a skilled nursing facility.

Co-Insurance

  • If you have to stay in the hospital for 61 days, you also have to pay co-insurance. For the first 60 days of your stay, there's no payment. Starting on day 61, you pay $315 per day. At 91 days, you pay $630, and start using up the "reserve days" Medicare gives you for really long stays. You have up to 60 reserve days in your lifetime. If you've been in the hospital more than 90 days for one stay and you have no reserve left, you pay all costs. The rates are lower for a skilled nursing facility.

Other Costs

  • If you want a private duty nurse in your stay, Medicare won't cover that. It won't cover a private room unless that's medically necessary. You foot the bill for having a telephone or television in your room, too. If Medicare covers your home health care, you may have to pay 20 percent of the cost of medical equipment such as a walker or wheelchair. Hospice may charge up to $5 per prescription drug as a co-payment.

References

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