Planning for Your Health Care in Retirement

What Medicare Part A covers and what it doesn't: Thinking about health care is very important when planning for retirement. Three months before you turn 65, you can sign up for Medicare. If you decide to retire early, you'll need to save extra money for health insurance until you turn 65.

Medicare is split into two parts. Part A covers care you receive while in the hospital, and Part B covers preventive care like check-ups at the doctor.

Let's dig deeper into Medicare Part A to understand what it includes and what it doesn't cover. This information can help you focus on planning for your retirement wisely.

Part A Coverage Details and Inclusions Explained

1. Medicare Part A - Hospital Care (Covered) Medicare provides coverage for various types of hospital care, including emergency treatment, planned procedures, and tests. This includes nursing care, hospital services, and necessary supplies.
2. Medications in the Hospital (Covered) Medicare covers the cost of medications received in the hospital, whether administered through an IV or in pill form. This also includes prescribed medications like methadone for addiction treatment.
3. Hospital Room and Meals (Covered) Medicare Part A includes coverage for hospital room and meals. Even if you end up in a private room without extra charge from the hospital, Medicare will still cover the cost.
4. Mental Health Care in the Hospital (Covered) Medicare provides coverage for mental health care in the hospital, including up to 190 days in a psychiatric hospital, if recommended by a doctor.
5. Long-term care hospital services (Covered) Medicare assists with the costs of long-term care in a hospital setting, including expenses for pain management, heat trauma treatment, and respiratory care after meeting the deductible requirement.
6. Skilled nursing facility (Covered) Medicare Part A covers short-term stays in a skilled nursing facility, provided it's recommended by a doctor and deemed necessary after a hospital stay.
7. Most skilled nursing facility services (Covered) Medicare Part A covers various services in a skilled nursing facility, such as meals, nursing care, room accommodations, medications, social services, therapy, and medical supplies.
8. Ambulance transportation to a skilled nursing facility (Covered) Medicare covers the cost of ambulance transportation to the nearest Medicare-approved skilled nursing facility in case of an emergency, ensuring prompt access to necessary care.
9. Clinical research study care (Covered) Medicare Part A provides coverage for inpatient care related to participation in a qualifying clinical research study.

Medicare Part A: Coverage Limitations and Exclusions

1. Private-duty care in a hospital setting (Not covered) Medicare Part A does not cover hiring a private nurse or receiving specialized nursing care beyond general nursing needs without medical necessity.
2. A private room (Usually not covered) Medicare does not cover the cost of a private room unless medically necessary or when offered by the hospital without request.
3. Entertainment in your room (Not covered) Medicare does not cover charges for in-room amenities like phone or TV use; however, utilizing free hospital WiFi is often allowed.
4. Personal care items (Not covered) While certain hospital-provided items may be covered, personal care items like hygiene supplies are not typically covered by Medicare.
5. Long-term care in a skilled nursing facility (Not covered) Coverage for long-term care in a skilled nursing facility under Medicare Part A is limited, with out-of-pocket costs increasing after the initial 20-day period.
6. Dental and eye exams (Not covered) Medicare does not cover expenses for dental care, eye exams, dentures, or hearing aids. These services may require a supplemental plan or out-of-pocket payment.
7. Alternative care services (Not covered) Services like cosmetic surgeries, massage therapy, and acupuncture are not covered by Medicare and need to be paid for independently.
8. Concierge medical services (Not covered) Higher-end medical services, such as concierge or boutique medicine, are not covered by Medicare; care must be provided by a Medicare-approved provider.
9. Routine physical exams (Not covered) While routine physical exams are not covered under Medicare Part A, Part B may provide coverage for certain outpatient services, emphasizing the importance of understanding the differences in coverage plans.

Not sure if your required care is covered? Utilize the Medicare Coverage tool, an easy online resource that allows you to enter the test, item, or service you need and find out if it's usually covered. https://www.medicare.gov/coverage

You have options to save on out-of-pocket costs, such as Medicare Advantage Plans and Medigap coverage. Additionally, eligibility for Medicaid may provide further financial protection.