Understand the Medicare Part A Deductible

Like most health insurance, Medicare Part A has a deductible. However, the Part A deductible can be a little difficult to understand.

Medicare Part A

Medicare Part A is part of Original Medicare. It covers your hospital insurance. Part A will cover:

• Inpatient care in a hospital
• Nursing home care
• Hospice care
• Home health care
• Skilled nursing facility care

A quick note about skilled nursing facility care and nursing home care- these are not to be confused with long term care. The purpose of these facilities is to provide skilled nursing care largely for recovery purposes.  Long term conditions such as Alzheimers would disqualify you. For that you would need some type of long term care plan.

Costs

So, Part A and Part B which it your outpatient insurance comprise Original Medicare. Together they will cover most of your medical needs. There are costs that you should be aware of:

Premiums

Deductibles

Copays/Coinsurance

Most people don’t actually have a premium for Medicare Part A. There is, however, a deductible. The Part A deductible can be a little confusing because it’s not once annually. It’s applied per benefit period.

Part A Deductible

Your deductible is the amount you pay out of pocket before your insurance contributes to the cost share. In 2022, the deductible for Part A is $1556. Should you need a medical procedure in a hospital you will need to meet this deductible first. However, things can be a little bit more complicated from here.

The Part A deductible, unlike Part B, is not once per year. It is once per benefit period. Should you need to be hospitalized, you basically have 60 days from the day you last need care in the hospital or skilled nursing facility. The time period is your benefit period. The deductible that you’ve paid our of pocket will apply to any Part A covered services during that time. If you need to be admitted after that time, you will need to meet your deductible again.

For example, let’s say you need knee surgery and it’s been deemed medically necessary by your doctor. You’ll have to meet the $1556 deductible first and then the rest will be covered by Medicare. If you need to stay in the hospital or require a stay in a skilled nursing facility to recover, you won’t need to meet that deductible again. Several weeks later, you’re able to resume daily activities and you’re no longer receiving hospital or skilled nursing facility care.

Then, disaster! Several months later, you fall and need wrist surgery. You’ll need to meet that $1556 deductible again. Hopefully, you won’t need major medical care and hospitalization with such frequency. But, should it happen, you should understand upfront what your financial obligations might be.

Medigap Plans

If you wish to avoid the Part A deductible, you may want to consider a Medicare Supplement Plan which can cover or help to cover the deductible. You’ll have to pay an additional premium, but it can help you to avoid out of pocket expenses should you need major medical care.

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