Medicare Part A, sometimes called hospital Medicare, is responsible for covering fees related to many services you would receive in a hospital or hospital-like setting, such as a skilled nursing care facility. Medicare Part A is part of Original Medicare.
Read on to learn who’s eligible for Medicare Part A, how much it costs, and what kind of coverage you can expect.
Who is Eligible for Medicare Part A?
Anyone who is over the age of 65, has a disability that qualifies for Social Security disability insurance, or has End Stage Renal Disease is eligible for Medicare Part A. Most people who are eligible for Part A can enroll in it without paying a monthly premium–you’re eligible for premium-free Part A if you’re 65 or older and you or your spouse worked a job and paid Medicare taxes for at least 10 years.
However, you can still get premium-free Part A if you:
- Are eligible for or already receive retirement benefits from Social Security or the Railroad Retirement Board
- You or your spouse worked for the government and had Medicare-approved employment
- You are a kidney transplant patient or receiving kidney dialysis
If you do not meet the qualifications for premium-free Part A, you can still purchase Medicare Part A if you are age 65 or older and a permanent resident or citizen of the U.S.
How Much Does Medicare Part A Cost?
The exact costs of Medicare can vary based on your individual circumstances, but in general, there are some basic costs to Medicare Part A that include:
Part A premium
If you or your spouse paid Medicare taxes for at least 10 years, you won’t have to pay a monthly premium for Part A. Most people qualify for premium-free Part A. If you do have to pay for Part A, you’ll pay a set amount every month based on how much long you paid Medicare taxes. The 2021 costs are set at the following rates based on how long you paid Medicare taxes:
- Less than 30 quarters: $471 monthly premium
- 30 to 39 quarters: $259
If you are unable to qualify for premium-free Part A and decide to purchase it, you are required to purchase Part B also.
You will pay a $1,484 deductible for each benefit period in 2021.
The inpatient coinsurance payments differ by days in your coverage:
- One to 60 days: $0 coinsurance
- 61 to 90 days: $371
- Each lifetime reserve day over 90 days: $742
You are only allotted up to 60 lifetime reserve days. After your lifetime reserve days, you are responsible for all costs.
Mental health care
The costs for inpatient mental health care are the same as the costs for inpatient hospital stays. However, you’ll also be responsible for 20% of the Medicare-covered provider services you receive while in the hospital.
Home health care
You won’t pay anything for hospice care at home, aside from up to $5 for some medications. However, if your hospice care is inpatient, you may be responsible for 5% of Medicare-covered respite care.
Skilled nursing facility care
You won’t owe anything for the first 20 days of care at a skilled nursing facility. After that, it’s $185.50 every day for days 21 to 100. Beyond that, you will be responsible for all costs.
Part A late enrollment penalty
You may have to pay a late enrollment penalty, depending on when you enroll. This can make the cost of your monthly premium higher for those who were not eligible for premium-free Part A and did not enroll in Part A as soon as they were eligible to purchase it. The penalty cost is equal to 10% of your Part A premium and is paid for two years for every one year you were eligible but failed to sign up.
What Does Medicare Part A Cover?
Medicare Part A is often referred to as hospital Medicare because it covers specific costs related to inpatient care at certain facilities that include:
- Acute care hospitals
- Critical access hospitals
- Inpatient rehabilitation facilities
- Inpatient psychiatric facilities (limited to 190 days)
- Long-term care hospitals
- Inpatient care you receive if you’re part of a qualifying clinical research study
Here are the specific aspects of care that Part A covers:
Hospital inpatient care
Part A will cover any inpatient hospital stays providing that you are admitted on a doctor’s order, the hospital accepts Medicare or if needed, your stay is approved by the hospitals’ Utilization Review Committee. Medicare Part A will cover the costs of your:
- Room, providing it’s semi-private (private rooms are not covered unless medically necessary)
- Nursing care (except private duty nursing care)
- Medications you need for treatment
- Services and supplies for your treatment (excluding personal care items like razors and slippers)
Skilled nursing facility care
A skilled nursing facility (SNF) is one that offers short-term nursing care for qualifying therapy or treatment. SNFs are not hospitals or nursing homes, but some SNFs are attached as a separate unit of the hospital or a long-term care facility. They offer specialized care and short-term stays for qualifying patients. You qualify for Part A coverage for SNF care if you:
- Have days left in your benefit period
- Have had a qualifying hospital stay or SNF stay
- Your doctor orders daily skilled care that must be given or supervised by a nurse
- Your doctor has decided that you need daily skilled care given by, or under the supervision of, skilled nursing or therapy staff
- Get the services from a SNF that is approved by Medicare
Some of the Medicare-covered services you can receive under Part A coverage with a SNF are:
- Semi-private rooms
- Meals and medications
- Skilled nursing care
- Physical, occupational, and speech-pathology therapy and services
- Medical social services
- Medical supplies and equipment
- Ambulance transportation if medically necessary
- Dietary counseling
- Swing bed services
Nursing home care
The only way Part A covers nursing home care is if it’s for medically necessary skilled nursing care. Part A does not cover custodial care or long-term care.
Part A covers at home or inpatient hospice care for anyone who is certified terminally ill with a life expectancy of six months or less. Coverage for hospice care includes:
- Pain management, including medications for pain
- All medical, nursing and social services
- Any medical equipment needed for pain relief and symptom management
- A home aide or homemaker service
- Qualifying support services, such as pain management and grief and spiritual counseling for both you and your family
Home health care
Medicare Part A will cover home health care for patients who are certified homebound and require certain doctor-ordered services, such as skilled nursing care or physical therapy. Home health care usually also relies on Part B for full coverage, which will include:
- Nursing care that’s not 24/7
- Physical and occupational therapy
- Speech-language pathology
- Social services
- Home health aide care
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