Medicare Part A

Many seniors face rising health care costs as they age, both because of health problems that arise later in life and because insurance companies are allowed to charge older adults higher monthly premiums. This can make it difficult for you to afford comprehensive health coverage in your Golden Years. In 1965, Congress attempted to address this problem by passing the Social Security Act Amendments, establishing an insurance program designed to help senior citizens get hospital care and pay for other medical services. The program, Medicare, originally consisted of Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).

Since the law passed, Medicare has evolved to meet the needs of a changing population. Originally developed for seniors, Medicare coverage is now available to younger people with end-stage renal disease and certain disabilities. You can also buy Medicare Supplement Insurance (Medigap), add a prescription drug plan to supplement your Original Medicare coverage or sign up for Medicare Part C, an all-in-one Medicare plan managed by a private insurance company.

All of this can be overwhelming, especially if you’re new to the Medicare program. That’s why we created this guide. Below, we provide an in-depth overview of Medicare Part A, including what it is, what it covers, how much it costs and how to enroll. This guide also explains the difference between Medicare Part A and Medicare Part B. Use the information to better understand your Medicare Part A coverage or help an older loved one make Medicare-related decisions.

Medicare Part A, also known as Medicare Hospital Insurance, is part of the Original Medicare program. This type of Medicare pays for expenses incurred while you’re admitted to a medical facility. Even though Medicare Part A is called Hospital Insurance, it also covers expenses arising from a stay in an inpatient psychiatric facility, a skilled nursing facility, hospice care and home health care. You can even use your Medicare Part A coverage to pay for home health services. Although it’s possible to sign up for Medicare Part A without enrolling in Medicare Part B, most seniors sign up for both to ensure they have comprehensive coverage.

If you decide to enroll in Medicare Part C, you’ll continue to have your Medicare Part A coverage. The main difference is that your plan will be managed by an insurance company instead of the federal government. Medicare Part A is different from Medicare Part D because it only covers medications administered while you’re in the hospital or other type of inpatient facility. Medicare Part D is a supplemental drug plan that covers the prescriptions you pick up at a pharmacy or have delivered to your home from a mail-order pharmacy company. Although Medicare Part A is fairly comprehensive, it doesn’t cover long-term care or cosmetic surgery.

Although Medicare Part A and Medicare Part B are both parts of Original Medicare, they cover different things. Medicare Part A covers a variety of inpatient services, such as room and board, nursing care and medications administered while you’re an inpatient. In contrast, Medicare Part B mostly covers the services you receive on an outpatient basis, such as doctor visits and tests performed by an outpatient laboratory. It also covers emergency room care and services provided by any doctors who treat you while you’re in the hospital. Part A and Part B have separate deductibles and different coinsurance requirements.

Now that you understand the difference between Medicare Part A and other forms of Medicare, you need to know exactly what Medicare Part A covers. Your Medicare Hospital Insurance covers four broad categories of services: inpatient hospital care, skilled nursing care, home health care and hospice care. If you’re admitted to a hospital, it pays for the services and supplies used for your care. For example, if you have an infected wound, Medicare Part A covers things like dressings and antibiotics to treat the infection.

Medicare Part A doesn’t cover nursing home care, but it does cover temporary stays in skilled nursing facilities. You may need to stay in a nursing facility while you recover from a broken hip or if you need help regaining your mobility after a joint replacement. Medicare Part A may pay for home health services you need to manage your health condition. However, it won’t pay for these services if you need more than a part-time or intermittent level of care. If you have a terminal illness, you can also use your Medicare Part A benefits to pay for hospice care. Learn more about each type of care below.

Medicare Part A covers a wide variety of services associated with a stay in a hospital or other inpatient facility. If you have surgery, it pays for the surgical procedure, the nursing care you need after the surgery, antibiotics or other medications administered during your stay, meals and the cost of staying in a semiprivate room. Medicare Part A also covers lab tests and X-rays performed while you’re in the hospital. If you have kidney disease, for example, you may need daily lab tests to check your kidney function. Medicare Part A will pay for these tests.

For Medicare to cover your inpatient care, you must receive services at a facility that accepts Medicare. You must also have a doctor’s order to be admitted to the hospital. The order must indicate that you need inpatient care to manage your injury or illness. Medicare Part A doesn’t cover emergency room care or care provided by doctors who treat you while you’re admitted; these services are covered by Medicare Part B.

Although Medicare doesn’t pay for nursing home care, it does cover services received in a skilled nursing facility (SNF), provided you meet certain conditions. One of the main requirements is that you must have a qualifying hospital stay before you enter the SNF. You must also enter the SNF within 30 days of leaving the hospital, and the care you receive at the SNF must be related to the care you received in the hospital. Finally, the facility you enter must be Medicare-certified. Medicare Part A pays for a wide variety of the services provided in an SNF, including the following:

• Physical and occupational therapy
• Skilled nursing care
• Medications
• Social services related to your medical care
• Speech-language pathology services
• Dietitian services
• Ambulance transportation to other facilities if you need care that isn’t available at the SNF
• Medical supplies used in your care

If you’re homebound due to a health condition, Medicare Part A may pay for the home health services you need to manage chronic illnesses or get treatment for acute conditions without having to stay in the hospital or making frequent trips to a doctor’s office. For Medicare to pay for these services, a doctor must certify that you need skilled nursing or some type of therapy that’s complex or can only be performed by a qualified professional. The recommended therapies must be considered “specific, safe and effective” for your condition. Your doctor must also certify that you’re homebound and regularly review your care plan to determine if it needs to be updated. Home health coverage is a great benefit if you need part-time medical care and can’t leave your home due to your health.

Medicare Part A may pay for the following home health services:

• Skilled nursing care for fewer than eight hours per day or 28 hours per week
• Speech-language pathology services
• Physical and occupational therapy
• Medical social services
• Medical supplies used as part of your care
• Medicare Part A and Part B help pay for some injectable drugs that treat osteoporosis, under certain conditions.

Medicare doesn’t pay for meal delivery, 24/7 home-based care, personal care services or homemaker services.

If you have a terminal illness, you may decide to enter hospice care instead of pursuing aggressive treatments. This type of care relieves pain and other symptoms, making you more comfortable. In many cases, Medicare Part A covers inpatient hospice or home hospice, ensuring you get the care you need without straining your finances. For Medicare Part A to pay for your hospice services, your doctor must certify that you’re terminally ill, which means a life expectancy of 6 months or less. You must also sign a document stating that you want to enter hospice care instead of pursuing treatments for your condition. If you qualify, Medicare will cover the cost of your nursing care, durable medical equipment, medications for symptom management, spiritual and grief counseling for you and your family and other services to keep you as comfortable as possible.

Most people have premium-free Medicare Part A, but you may have to pay a monthly premium if you paid Medicare taxes for fewer than 40 quarters. In 2021, the premium is $259 per month if you paid Medicare taxes for 30 to 39 quarters and $471 if you paid Medicare taxes for fewer than 30 quarters. Even if you don’t pay a premium, Medicare Part A does have some out-of-pocket costs, including deductibles, copays and coinsurance.

Deductibles

A Medicare Part A deductible is applied to each benefit period rather than each calendar year. In 2021, the deductible is $1,484 per benefit period for care in a hospital or skilled nursing facility. A benefit period begins the first day you’re admitted, and it ends when you haven’t received any inpatient care for 60 days in a row. If you have serious health problems, you may have to pay the Part A deductible more than once in a calendar year depending on how often you need to be admitted. For example, if you’re in the hospital for one week in January and don’t receive any inpatient care for 60 days after your discharge, then you’ll start a new benefit period if you’re admitted again in September.

Copays

A copay is a set amount that you pay for each Medicare-approved service you receive. Medicare Part A doesn’t have many copays when compared to Part B. If you receive hospice care, you’ll have to pay a copay of $5 or less on the medications used to treat pain and other symptoms at home.

Coinsurance

Coinsurance is usually a percentage of each Medicare-approved service that you must pay as your share of the cost. The exception is the coinsurance for inpatient hospital care, which is a flat fee paid for each day of your stay at a hospital or skilled nursing facility. For hospital care, the coinsurance amount is $0 per day for the first 60 days of each benefit period, $371 per day for days 61 through 90 and $742 per day for days 91 and beyond for each benefit period, up to your total number of lifetime reserve days. You have 60 lifetime reserve days to use if the length of a hospital stay exceeds 90 days. If you use them all, you’ll be responsible for all of your costs.

For hospice care, you may have to pay 5% of the Medicare-approved amount for some inpatient services. There’s no coinsurance requirement for covered home health services, but you’ll have to pay 20% coinsurance for any durable medical equipment you need. If you need care in a skilled nursing facility, you’ll pay $0 per day for the first 20 days of a benefit period. The coinsurance for days 21 to 100 is $185.50 per day. If you use all your lifetime reserve days, you’ll be responsible for all costs after day 100.

 

 

Medicare Part A eligibility is based on age, disability status, and citizenship. If you don’t have a qualifying disability, you must be at least 65 years old to qualify. Since Medicare was first established in 1965, the program has expanded to include younger people with Lou Gehrig’s disease, end-stage renal disease (kidney failure) and other conditions that affect a person’s ability to perform activities of daily living. If you’re in your early 60s and don’t qualify for Medicare Part A based on your age, you may be able to qualify based on a disability. In most cases, you must receive disability benefits from the Social Security Administration or U.S. Railroad Retirement Board for 24 months before you qualify for premium-free Part A. Medicare coverage is available to U.S. citizens and lawful permanent residents who’ve lived in the United States for at least five years in a row.

If you start receiving your Social Security or railroad retirement benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare Part A. Don’t worry if you don’t meet this requirement; it’s easy to apply for Medicare coverage on your own. Simply fill out the online application, call Social Security at 800-772-1213 or visit your local Social Security Administration office. If you worked for a railroad, you’ll call the Railroad Retirement Board instead of the SSA. The number is 877-772-5772. You can apply for premium-free Medicare Part A at any time once you become eligible.

If you have to pay a premium because you didn’t pay Medicare taxes for enough quarters, you need to be aware of certain enrollment periods. Your first opportunity to enroll is during your initial enrollment period, which starts three months before you turn 65 and ends three months after your birthday month. You can also enroll during the general enrollment period, which begins on January 1 and ends on March 31 each year. If you don’t enroll during your initial enrollment period, you may have to pay a higher premium for your Part A coverage, so it’s best to enroll early.

You may qualify for a special enrollment period under certain circumstances. A special enrollment period allows you to sign up for Medicare Part A outside the initial enrollment and general enrollment periods. You may qualify for a special enrollment period if you’re volunteering in a foreign country or if you’re covered by a group health plan based on employment. To qualify based on your group health coverage, you or your spouse must be working, and you must have health coverage through an employer or labor union. Once the employment or the group health coverage ends, you’ll have eight months to sign up for Medicare Part A.

Learn more about Medicare in our Beginner’s Guide to Medicare.

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