What is Medicare Part A?
Medicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient careInpatient care refers to care provided in a hospital or other inpatient facility. Inpatients are admitted and stay at least one night depending on their condition. in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospiceHospice is a special way of caring for people who are terminally ill. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional, and spiritual needs of the patient. care.
Key Takeaways
- Medicare Part A covers approved costs associated with inpatient care.
- Medicare Part A coverage has a benefit periodA benefit period is a method used in Original Medicare to measure a beneficiaries use of hospital and skilled nursing facility (SNF) services. With each new benefit period, the beneficiary is charged a new benefit... deductible, copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service., and potentially a monthly premium.
- After 90 days of hospitalization, a beneficiaryA person who has health care insurance through the Medicare or Medicaid programs. begins using their 60 lifetime reserve daysMedicare Part A covers up to 90 days of inpatient care per benefit period. Beneficiaries get an additional 60 days of coverage known as lifetime reserve days. Lifetime reserve days can be used once. Beneficiaries....
- Beneficiaries can enroll in Medicare Part A during their Initial Enrollment PeriodThe Initial Enrollment Period is a seven-month period when new beneficiaries can enroll in Medicare without a penalty. Most people enroll in Medicare at age 65. or the General Enrollment PeriodThe General Enrollment Period (GEP) allows beneficiaries to enroll in Medicare Part A and Part B from January 1 to March 31 if they missed their Initial Enrollment Period. Beneficiaries can also enroll in a....
- A Part A premium penalty may apply for late enrollment.
- Medicare Part A coverage can be terminated for non-payment of the monthly premium.
- Medicare supplement insuranceMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. assists with shared costsAn amount patients pay for their share of the cost of medical service or supply, like a doctor’s visit, hospital inpatient visit, or prescription drug., including deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share. and copayments.
What Does Medicare Part A Cover?
Medicare Part A provides coverage for the costs of inpatient care services. These inpatient care services include:1Medicare.gov, “What Part A covers“, Accessed October 22, 2021
- Hospital inpatient stay
- Mental health inpatient stay
- Skilled nursing facility stay
- Home healthcare services after a hospital stay
- Hospice care services
What Is Not Covered By Medicare Part A?
Medicare Part A covers inpatient care. It does not cover doctor visits, lab tests, diagnostics, medical supplies, or durable medical equipmentDurable medical equipment (DME) is equipment that is designed to last and can be used repeatedly. It is suitable for home use and includes wheelchairs, oxygen equipment, and hospital beds.. These costs are covered under Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services.. Medically unnecessary services, such as routine dental, vision exams, hearing care, and cosmetic procedures, are also not covered under Medicare Part A.2Medicare.gov, “What’s not covered by Part A & Part B?“, Accessed October 22, 2021
Who Qualifies for Medicare Part A?
People ages 65 and older qualify to enroll in Medicare Part A. People with Social Security Disability Insurance (SSDI) benefits qualify for Medicare Part A (and Part B) starting on the 25th month of SSDI benefits.
When To Enroll In Medicare Part A
Unless a beneficiary has other creditable coverageCreditable coverage refers to health insurance or prescription drug benefits that meet Medicare's minimum qualifications necessary to avoid a penalty. through an employer or union, the best time to enroll is during the Initial Enrollment Period (IEP). IEP is a 7-month period starting three calendar months before the new beneficiary’s 65th birthday. If a beneficiary’s IEP has expired, the next time they can enroll is in the General Enrollment Period.
People who have received Social Security Disability Insurance (SSDI) benefits for 25 consecutive months are automatically enrolled in Medicare Part A and Part B.3CMS.gov, “Top 5 things you need to know about Medicare Enrollment”, Accessed September 22, 2021
How Much Does Medicare Part A Cost?
Medicare Part A has three costs:
- Monthly premium (if the beneficiary does not qualify for premium-free Part A)
- Benefit period deductibles
- Copayments
Most people qualify for premium-free Part A coverage and do not pay a monthly premium. For more information about Part A premiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. , see What is the Medicare Part A Premium?
Each time a beneficiary is admitted for inpatient care it starts a new benefit period and the beneficiary is charged a new benefit period deductible. The deductible covers all inpatient care costs for 60 days. After the 60th day, the beneficiary begins paying a daily copayment.
What Is A Part A Benefit Period?
A benefit period begins when a beneficiary is admitted for inpatient care. The benefit period ends when related inpatient care has not been received for 60 days. A new benefit period starts if the beneficiary is admitted as an inpatient after the previous benefit period ends. For each benefit period, the beneficiary will have to pay the inpatient hospital deductible ($1,484 in 2021).4Medicare.gov, “Medicare Glossary“, Accessed October 22, 2021
Each benefit period has three different tiers of costs:5Medicare.gov, “Medicare costs at a glance“, Accessed October 22, 2021
- Days 1-60: $0 coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. for each benefit period.
- Days 61-90: $371 coinsurance per day (2021 rate) of each benefit period.
- Days 91 and beyond: $742 coinsurance per day (2021 rate)
Note: After 90 days of hospitalization a beneficiary begins using their 60 lifetime reserve days. For a complete definition of how lifetime reserve days work, see What are Medicare Lifetime Reserve Days.
Skilled Nursing Facility Care
When a beneficiary is hospitalized and treated but needs skilled care to convalesce, their doctor may have them transferred to a skilled nursing facility (SNF). Medicare Part A coverage in an SNF is different than in a hospital setting. The costs are as follows:
- Days 1–20: Beneficiary pays $0 for each benefit period.
- Days 21–100: Beneficiary pays $185.50 coinsurance per day of each benefit period.
- Days 101 and beyond: Beneficiary pays all costs.
For the first 20 days of a beneficiary’s care in a skilled nursing facility, they pay nothing after their deductible has been met. From day 21 until day 100 of their skilled nursing facility benefit period, they pay a $185.50 coinsurance each day. After that, they are responsible for all further costs for their skilled nursing facility care.6Medicare.gov, “SNF Care Coverage“, Accessed October 27, 2021
Home Health Care
If a beneficiary’s doctor determines that home healthcare is needed after hospitalization, they will create a plan to provide it. Medicare covers the following for home healthcare services:7CMS.gov, “Medicare and Home Health Care”, Accessed September 22, 2021
- Skilled nursing care on a part-time or intermittent basis.
- Home health aide services on a part-time or intermittent basis.
- Physical therapy, speech-language therapy, and occupational therapy
- Counseling for social and emotional concerns related to the beneficiary’s illness.
- Certain medical supplies like wound dressings, but not prescription drugs or biologicals.
- Medical equipment such as a wheelchair or walker.
Medicare covers these home healthcare services as long as the beneficiary’s doctor orders the services. The skilled nursing and home health aide services can only be covered part-time or intermittently. This means that there are limitations on how many hours a beneficiary can receive skilled nursing and home health aide services.7CMS.gov, “Medicare and Home Health Care”, Accessed September 22, 2021
What Home Health Care Service Are Not Covered By Medicare Part A?
The following services are not covered by Medicare Part A:7CMS.gov, “Medicare and Home Health Care”, Accessed September 22, 2021
- 24-hour care at home
- Prescription drugs
- Meals delivered to the beneficiary’s home
- Homemaker services like shopping, cleaning, and laundry
- Personal care like bathing, toilet usage, or help in getting dressed being given by home health aides, if this is the only care needed
Part A Late Enrollment Penalty
A beneficiary who does not enroll in Part A when they are eligible will have a 10 percent late penalty added to their Part A monthly premium. The penalty for late enrollment lasts twice as many years as they were not been enrolled in Part A without creditable coverage. If the beneficiary qualifies for premium-free Part A, they will not have to pay any premium penalty.8Medicare.gov, “Part A late enrollment penalty“, Accessed October 22, 2021
How To Get Help Paying For Medicare Part A Costs
MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. and Medicare Savings Program (MSP) offer financial assistance for Medicare beneficiaries who are unable to afford their Medicare Part A coverage. Each program has different benefits.
Medicaid is a state and federal program that provided healthcare to low-income families and individuals. Medicare beneficiaries with incomes at or below the federal poverty level can qualify for both dual-eligibleDual-eligible beneficiaries are those who receive both Medicare and Medicaid benefits. It includes beneficiaries enrolled in Medicare Part A and/or Part B while receiving full Medicaid and/or financial assistance through a Medicare Savings Program.... (Medicare and Medicaid) benefits. For more information about dually-eligible benefits, see What is a Dual-Eligible Beneficiary?9Medicare.gov, “Medicaid“, Accessed October 25, 2021
Beneficiaries who do not qualify for full Medicaid benefits, but have incomes within 135 percent of the federal poverty level, may qualify for a Medicare Savings Program (MSP). MSPs provide varying levels of Medicare Part A cost assistance.10Medicare.gov, “Medicare Savings Programs“, Accessed October 22, 2021
Medicare Supplement Insurance Part A Coverage
Medicare supplemental insurance policies (Medigap) can also help with the costs of Part A. All current Medigap policies (A, B, C, D, F, G, K, L, M, and N) cover some or all of the out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. associated with Medicare Part A. Plus, all Medigap plans include 365 days of hospital coverage after a beneficiary has used their lifetime reserve days. For more information about how Medicare supplement insurance works, see What are Medicare Supplements?11Medicare.gov, “How to compare Medigap policies“, Accessed October 22, 2021
Getting Help With Medicare Part A
Any questions about Medicare Part A coverages and costs can be answered by a Medicare expert at 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048.12Medicare.gov, “Pay Part A & Part B premiums“, Accessed October 22, 2021
Citations
- 1Medicare.gov, “What Part A covers“, Accessed October 22, 2021
- 2Medicare.gov, “What’s not covered by Part A & Part B?“, Accessed October 22, 2021
- 3CMS.gov, “Top 5 things you need to know about Medicare Enrollment”, Accessed September 22, 2021
- 4Medicare.gov, “Medicare Glossary“, Accessed October 22, 2021
- 5Medicare.gov, “Medicare costs at a glance“, Accessed October 22, 2021
- 6Medicare.gov, “SNF Care Coverage“, Accessed October 27, 2021
- 7CMS.gov, “Medicare and Home Health Care”, Accessed September 22, 2021
- 8Medicare.gov, “Part A late enrollment penalty“, Accessed October 22, 2021
- 9Medicare.gov, “Medicaid“, Accessed October 25, 2021
- 10Medicare.gov, “Medicare Savings Programs“, Accessed October 22, 2021
- 11Medicare.gov, “How to compare Medigap policies“, Accessed October 22, 2021
- 12Medicare.gov, “Pay Part A & Part B premiums“, Accessed October 22, 2021