Medicare Part A
Medicare Part A Premium
Most people don’t pay a Part A premium because they paid Medicare taxes while working. If you don’t get premium-free Part A, you may pay up to $426 each month.
For more information on what Part A cost including adjustment for high income individuals see our Page on "What Medicare Costs".
For deductibles and other co-pay information on Medicare Part A see below.
Gaps in Medicare Part A
Hospital Stay
In 2015, you pay:
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$1,260 deductible per benefit period (Was $1,216)
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$0 for the first 60 days of each benefit period
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$315 per day for days 61–90 of each benefit period (was $304)
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$630 per “lifetime reserve day” after day 90 of each benefit period(up to a maximum of 60 days over your lifetime) - Was $608.
Skilled Nursing Facility Stay
In 2015, you pay:
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$0 for the first 20 days of each benefit period
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$157.50 per day for days 21–100 of each benefit period (Was $152)
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All costs for each day after day 100 of the benefit period
Medicare Part A: Hospital Insurance
Part A covers hospital stays (including stays in a skilled nursing facility) if certain criteria are met:
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The hospital stay must be at least three days, three midnights, not counting the discharge date.
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The nursing home stay must be for something diagnosed during the hospital stay or for the main cause of hospital stay. For example, hospital stay for broken hip and then nursing home stay for physical therapy would be covered.
If the patient is not receiving rehabilitation but has some other ailment that requires skilled nursing supervision, then the nursing home stay would be covered.
The care being rendered by the nursing home must be skilled. Medicare Part A does not pay for custodial, non-skilled, or long-term care activities, including activities of daily living (ADLs) such as personal hygiene, cooking, cleaning, etc.
The maximum length of stay that Medicare Part A will cover in a skilled nursing facility per ailment is 100 days. The first 20 days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment (as of 2015, $157.50 per day).
Many insurance companies have a provision for skilled nursing care in the policies they sell. If a beneficiary uses some portion of their Part A benefit and then goes at least 60 days without receiving skilled services, the 100-day clock is reset and the person qualifies for a new 100-day benefit period.
Medicare will start on the first day of your birth month unless you were born on the first day. In your case it will start on May 1. If you were born on May 1 it would start on April 1. It never starts on any other day of the month.
You have a certain time period to sign up. If you are collecting social security benefits your Medicare card will automatically be sent to you around 3 months prior to your birth month. If you are not collecting Social Security benefits you will have to sign up by contacting the social security office by phone, in person, or online.
You can sign up during a 7 month window which is 3 months prior to your birth month, your birth month, and 3 months after your birth month. (See Medicare Part B enrollment periods) If you sign up during or after your birth month Medicare will be effective the first day of the following month. For example, if you turn 65 on May 22 this year and you haven’t contacted social security or received your card you need to do this now and Medicare will be effective June first. If you wait until sometime in June to sign up it will be effective July 1. If you do not sign up by August 31 your next window will be January 1 through March 1 for a July 1 effective date, plus you will have a Part B penalty to pay monthly forever.