Medicare Part A

What is Medicare Part A?

Medicare Part A is one of the two parts of Original Medicare and provides hospital coverage. Most people are automatically eligible for Medicare Part A at age 65 if they are already collecting retirement benefits from the Social Security Administration or the Railroad Retirement Board. You may qualify for Medicare Part A before age 65 if you have a disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS).

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What does Part A cover?

  • Inpatient hospital care
  • Skilled Nursing Facility Care
  • Nursing home care (hospital care in a skilled nursing facility that is not custodial or long-term care)
  • Hospice care
  • Home health care

How do I find out if Medicare covers what I need?

  • Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that is generally covered, but your provider thinks Medicare won’t cover it in your situation. If so, you will need to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.
  • Find out if Medicare covers your item, service, or supply.

What Factors Determine Medicare Coverage?

  • Federal and state laws.
  • National coverage decisions made by Medicare about whether something is covered.
  • Local coverage decisions made by companies in every state that process claims for Medicare. These companies decide if something is medically necessary and should be covered in your area.

What does Part A not cover?

  • Long-term care (also called custodial care)
  • Most dental care
  • Eye exams related to the prescription of glasses
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams to fit them
  • Routine foot care

What does Part A cost?

Part A without Premium

Generally, you do not pay a monthly premium for Medicare Part A coverage (hospital insurance) if you or your spouse paid Medicare taxes for a certain amount of time (40 quarters) while you were working. This is sometimes called “no-premium Part A”, and most people get Part A at no premium. You can get premium-free Part A at age 65 if:

  • You already receive retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible for Social Security or Railroad benefits, but have not yet applied for them.
  • You or your spouse had a government job covered by Medicare.

If you are under 65, you can get Part A at no premium if:

  • You had disability benefits from Social Security or the Railroad Retirement Board (RRB) for 24 months.
  • You have end-stage renal disease (ESRD) and meet certain requirements.

Part A Premiums

If you don’t qualify for premium-free Part A, you can buy Part A. If you buy Part A, you’ll pay up to $458 each month. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $458. If you paid Medicare taxes for 30 to 39 quarters, the standard Part A premium is $252.

In most cases, if you choose to buy Part A, you must also:

  • Have Medicare Part B (health insurance)
  • Pay monthly premiums for Part A and Part B

Late Enrollment Penalty

If you don’t buy Part A when you’re first eligible, your monthly premium may go up 10% (you’ll have to pay the higher premium for twice the number of years you could have had Part A, but didn’t sign up).

Hospital stay

  • Deductible of $1,408 for each benefit period.
  • Days 1-60: $0 coinsurance for each benefit period.
  • Days 61-90: $352 coinsurance per day for each benefit period.
  • Days 91 and after: $704 coinsurance for each “lifetime reserve day” after day 90 for each benefit period (up to 60 days during your lifetime).
  • Beyond lifetime reserve days: all costs.

Mental Health Hospitalization

  • Deductible of $1,408 for each benefit period.
  • Days 1-60: $0 coinsurance per day for each benefit period.
  • Days 61-90: $352 coinsurance per day for each benefit period.
  • Days 91 and after: $704 coinsurance for each “lifetime reserve day” after day 90 for each benefit period (up to 60 days during your lifetime).
  • Beyond lifetime reserve days: all costs.
  • 20% of the Medicare-approved amount for mental health services you receive from doctors and other providers while you are in the hospital.

Stay in a Skilled Nursing Facility

  • Days 1 to 20: $0 for each benefit period in a skilled nursing facility
  • Days 21-100: $176 coinsurance per day for each benefit period in a skilled nursing facility
  • Days 101 and later: all costs.

Hospice Care

  • $0 for hospice care.
  • You may have to pay a copayment of no more than $5 for each prescription drug and other similar products to relieve pain and control symptoms while you are at home. In the rare event that your drug is not covered under the hospice benefit, your hospice provider should contact your Medicare drug plan to see if it is covered by Medicare prescription drug coverage (Part D).
  • You may have to pay 5% of the Medicare-approved amount for inpatient respite care.
  • Medicare does not cover room and board when you receive hospice care in your home or another facility where you live (such as a nursing home).

Home Health Care

  • $0 for home health services
  • 20% of the Medicare-approved amount for durable medical equipment (DME)

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