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’re already collecting retirement benefits from the Social Security Administration or the Railroad Retirement Board. You may qualify for Medicare Part A before 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?

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’s usually covered but your provider thinks that Medicare won’t cover it in your situation. If so, you’ll have 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 each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

What's not covered by Part A?

  • Long-term care (also called custodial care)
  • Most dental care
  • Eye exams related to prescribing glasses
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Routine foot care

What does Part A cost?

Premium-free Part A

You usually don’t pay a monthly premium for Medicare Part A (Hospital Insurance) coverage if you or your spouse paid Medicare taxes for a certain amount of time (40 quarters) while working. This is sometimes called “premium-free Part A”, and most people get premium-free Part A. You can get premium-free Part A at 65 if:

  • You already get retirement benefits from Social Security or the Railroad Retirement Board.
  • You’re eligible to get Social Security or Railroad benefits but haven’t filed for them yet.
  • You or your spouse had Medicare-covered government employment.

If you’re under 65, you can get premium-free Part A if:

  • You got Social Security or Railroad Retirement Board (RRB) disability benefits 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 30-39 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 (Medical Insurance)
  • Pay monthly premiums for both 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 Inpatient Stay

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

Mental Health Inpatient Stay

  • $1,408 deductible for each benefit period.
  • Days 1–60: $0 coinsurance per day of each benefit period.
  • Days 61–90: $352 coinsurance per day of each benefit period.
  • Days 91 and beyond: $704 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime).
  • Beyond lifetime reserve days: all costs.
  • 20% of the Medicare-approved amount for mental health services you get from doctors and other providers while you’re a hospital inpatient.

Skilled Nursing Facility Stay

  • Days 1–20: $0 for each benefit period in a Skilled Nursing Facility
  • Days 21–100: $176 coinsurance per day of each benefit period in a Skilled Nursing Facility
  • Days 101 and beyond: all costs.

Hospice Care

  • $0 for hospice care.
  • You may need to pay a copayment of no more than $5 for each prescription drug and other similar products for pain relief and symptom control while you’re at home. In the rare case your drug isn’t covered by the hospice benefit, your hospice provider should contact your Medicare drug plan to see if it’s covered under Medicare prescription drug coverage (Part D)
  • You may need to pay 5% of the Medicare-approved amount for inpatient respite care.
  • Medicare doesn’t cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).

Home Health Care

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