What is Medicare Part A?

Medicare Part A is the category of Medicare Hospital insurance coverage that includes inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities.  It also helps cover hospice care and some home health care.  Certain conditions must be met to get these benefits. 


To be eligible for Medicare Part A, one must be a US citizen over the age of 65 or younger with a qualifying disability, end-stage renal disease (SSRD), or amyotrophic lateral sclerosis (ALS).

What does Part A Cost?

Most beneficiaries do not pay a premium for Medicare Part A if they have worked at least 10 years (or 40 quarters) and paid Medicare taxes during that time.  Individuals who aren't eligible for premium-free Medicare Part A can still enroll in Part A and pay a premium.  Beneficiaries who delay enrollment after they first become eligible for Medicare Part A may be subject to a late enrollment penalty once they sign up.

 

Part A annual deductible and copayments:

 

Hospital Inpatient:

  • $1,408 deductible for each benefit period

  • $0 coinsurance days 1-60 for each benefit period

  • $352 coinsurance days 61-90 for each benefit period

  • $704 coinsurance days 91 and beyond per each

"lifetime reserve day" for each benefit period

(up to 60 days over our lifetime)

  • All costs beyond lifetime reserve days

 

Home health care

  • $0 for home health care services

  • 20% of the Medicare-approved amount for durable medical equipment

 

Hospice care

  • $0 for hospice care

  • Co-payment for each prescription drug for pain relief and symptom control while you are home.

  • 5% of the Medicare-approved amount for inpatient respite care

 

Skilled nursing facility stay

  • $0 days 1-20 for each benefit period

  • $176 days 21-100 for each benefit period

  • All costs days 101 and beyond

What Does Part A Cover?

 

Medicare Part A - Hospital Insurance coverage includes:

  • Inpatient hospital care

  • Home health services

  • Nursing home care (as long as custodial care isn't the only care required)

  • Skilled nursing care

  • Hospice care

 

Part A hospital care coverage

Hospital care coverage helps cover hospital expenses that are critical to your inpatient care, such as a semi-private room, meals, nursing services, medications that are part of your impatient treatment, and any other services and supplies from the hospital. 

 

Part A nursing home coverage

Skilled nursing facility (SNF) stays are covered after a qualifying inpatient hospital stay for a related illness of injury.  The hospital stay must be a minimum of three days, beginning on the day you were admitted as an inpatient, to qualify for a SNF care.  Time spent under observation as an outpatient does not count toward your qualifying stay.

Your doctor must certify that your need daily skilled care that you cannot receive at home. Part A does NOT cover long-term care.

 

Part A home health care coverage

Home health services are covered when deemed medically necessary and ordered by your doctor.  Service may include:

  • Part-time or intermittent skilled nursing care

  • Physical therapy

  • Speech-language pathology services

  • Occupational therapy

  • Durable medical equipment

  • Part A does NOT cover 24-hour home care.

 

 

Part A hospice coverage

If your doctor has certified that you have a terminal illness with an estimated six months or less to live, you may be eligible for hospice care.  The focus of hospice is on palliative care, not curing your disease.  The goal is to relieve pain and make you as comfortable as possible.  You must give up curative treatments for your illness, but you have the right to stop hospice care at any time.  Hospice care is usually received in your home.

 

Part A does NOT cover:
  • Private-duty nursing

  • Private room (unless medically necessary)

  • Long-term care (custodial care)

  • Cosmetic surgery

Part A Late Enrollment Penalty

If you aren't eligible for premium-free Part A, and you don't buy it when you're first eligible, your monthly premium may go up 10%.  You will pay the 10% penalty twice the number of years you could have had Part A but didn't sign up.

 

If you have limited income and resources, your state may help you pay for Part A and/or Part B.

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