Key Takeaways
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Medicare Part A offers vital hospital coverage but doesn’t cover all expenses, leaving beneficiaries with out-of-pocket costs that can add up quickly.
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PSHB plans can significantly reduce your out-of-pocket expenses for hospital stays by filling in the gaps left by Medicare Part A.
What Medicare Part A Covers for Hospital Stays
Medicare Part A is your hospital insurance, covering inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. While this coverage is essential, it’s not all-inclusive. Here’s a closer look at what Medicare Part A includes:
Hospital Coverage Basics
Medicare Part A generally covers:
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A semi-private room
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Meals during your stay
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General nursing care
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Medications administered in the hospital
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Medical supplies and equipment used in the hospital
Inpatient Hospital Costs in 2025
While Medicare Part A covers many hospital services, you are still responsible for several costs:
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Deductible: $1,676 per benefit period.
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Coinsurance: After 60 days of hospitalization, you pay $419 per day for days 61-90 and $838 per day for each lifetime reserve day (up to 60 days).
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Out-of-pocket expenses: These can escalate quickly if your hospital stay extends beyond what is covered.
The Financial Gaps in Medicare Part A
Medicare Part A leaves several financial gaps, making additional coverage essential for many beneficiaries.
Limited Coverage Periods
Your hospital stay coverage under Medicare Part A is time-limited. After 90 days, you enter the lifetime reserve period, which offers only 60 extra days of coverage for your entire life. Beyond that, you’re responsible for all costs.
Skilled Nursing Facility Costs
While Medicare Part A covers skilled nursing care for up to 100 days after a qualifying hospital stay, only the first 20 days are fully covered. From day 21 to day 100, you pay $209.50 per day. After 100 days, you’re on your own.
No Coverage for Outpatient Services
Any outpatient services required during or after your hospital stay are not covered under Part A, leaving you to rely on Part B or pay out of pocket.
How PSHB Plans Help Cover Hospital Stay Costs
The Postal Service Health Benefits (PSHB) Program is designed to complement Medicare coverage for postal workers and retirees. Here’s how it can reduce your hospital-related expenses.
Covering Deductibles and Coinsurance
Many PSHB plans cover deductibles, coinsurance, and other hospital-related out-of-pocket costs left by Medicare Part A. This can dramatically lower your financial burden during a hospital stay.
Extended Coverage Beyond Medicare Limits
PSHB plans often provide additional coverage for extended hospital stays or skilled nursing care that exceed Medicare’s time limits. This means you’re not left scrambling to cover unexpected expenses.
Lower Prescription Drug Costs
Most PSHB plans include prescription drug coverage, reducing the cost of medications you may need during or after your hospital stay. This benefit can save you a significant amount over time.
Coordinating Medicare and PSHB Coverage
To maximize your benefits, understanding how Medicare and PSHB plans work together is key.
Primary vs. Secondary Coverage
If you’re enrolled in both Medicare and a PSHB plan, Medicare typically acts as your primary payer, and the PSHB plan serves as secondary coverage. This arrangement ensures that most of your hospital-related expenses are covered.
Medicare Part B Integration
Many PSHB plans encourage enrollment in Medicare Part B, as this can further reduce your out-of-pocket costs. With both Medicare Parts A and B, plus a PSHB plan, you’ll have comprehensive coverage for hospital stays and related expenses.
Coordination for Prescription Drugs
PSHB plans often integrate seamlessly with Medicare Part D, ensuring your prescription drug costs are minimized. For 2025, a $2,000 out-of-pocket cap for prescription drugs under Part D adds another layer of financial protection.
Key Benefits of PSHB Plans for Hospital Stays
PSHB plans are tailored to meet the needs of postal workers and retirees. Here are some of the key advantages:
Predictable Costs
With PSHB plans, you’ll enjoy more predictable healthcare expenses. Copayments, coinsurance, and deductibles are often lower than with Medicare alone, helping you plan your finances more effectively.
Access to Nationwide Networks
PSHB plans offer access to extensive networks of hospitals and healthcare providers. This ensures you can receive care from top facilities, no matter where you live or travel.
Supplemental Benefits
Many PSHB plans include additional benefits such as:
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Telehealth services
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Wellness programs
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Vision, dental, and hearing coverage
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Discounts on health-related products and services
What to Consider When Choosing a PSHB Plan
Selecting the right PSHB plan to complement your Medicare coverage is crucial. Here are some factors to weigh:
Hospital Coverage
Look for plans that provide robust hospital coverage, including low deductibles and coinsurance rates. Ensure the plan covers extended hospital stays and skilled nursing care beyond Medicare’s limits.
Prescription Drug Integration
Choose a plan that includes prescription drug coverage and coordinates well with Medicare Part D. This will minimize your out-of-pocket costs for medications.
Cost vs. Benefits
Compare the monthly premium, copayments, and other costs against the benefits offered. While a lower premium may seem appealing, a plan with higher coverage levels might save you more in the long run.
Provider Networks
Ensure the plan’s network includes hospitals and healthcare providers you trust. A larger network gives you more options for care.
Steps to Enroll in a PSHB Plan
Enrollment in a PSHB plan is straightforward, but timing is critical.
During Open Season
The PSHB Open Season typically runs from mid-November to mid-December each year. This is the best time to enroll in or change your plan. For 2025, the Open Season ended on December 13, 2024.
Qualifying Life Events (QLEs)
Outside of Open Season, you can only make changes to your PSHB plan following a QLE, such as:
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Marriage or divorce
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Birth or adoption of a child
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Loss of other health coverage
Coordinating with Medicare Enrollment
If you’re approaching age 65, plan your PSHB enrollment alongside your Medicare enrollment to maximize benefits. Enroll in Medicare during your Initial Enrollment Period to avoid penalties and gaps in coverage.
Maximizing Your Hospital Coverage with Medicare and PSHB
Combining Medicare Part A with a PSHB plan can give you peace of mind and comprehensive hospital coverage. By understanding how these plans work together, you can:
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Minimize your out-of-pocket costs
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Access high-quality care nationwide
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Protect yourself financially from unexpected hospital expenses
Peace of Mind for Your Healthcare Needs
Medicare Part A provides essential hospital coverage, but it’s not enough to protect you fully from high medical costs. A PSHB plan can fill in the gaps, ensuring you’re covered for hospital stays, skilled nursing care, and related expenses. With the right combination of Medicare and PSHB, you can enjoy comprehensive coverage and financial peace of mind in 2025 and beyond.
