What is Medicare Part A?
Medicare Part A, along with Medicare Part B, is part of Original Medicare. Part A is the insurance coverage that helps pay for the costs of hospital admission or a stay in a skilled nursing facility.
What Does Medicare Part A Cover?
Medicare Part A health insurance covers a range of services.
Those services include:
- Inpatient hospital care
- Skilled nursing facility care (after three consecutive days)
- Hospice care
- Home health services (within limits)
- Short-term nursing home care
- Inpatient mental health care in a psychiatric facility (limited to 190 lifetime days)
Inpatient Hospital Care
Medicare Part A hospital insurance covers healthcare costs you acquire during a hospital admission. However, you must have been formally admitted on doctor's order for Part A to apply. If you are not formally admitted, payment will come under Medicare Part B, which covers outpatient services.
Medicare Part A covers inpatient hospital care you receive in the following facilities:
- Critical access hospitals
- Acute care hospitals
- Long-term care hospitals
- Inpatient rehab centers
- Mental health facility
- Inpatient care delivered as part of a clinical research study
Once you are admitted, Medicare Part A covers various services.
Examples of inpatient hospital care services that Medicare Part A covers include:
- Semi-private room
- Lab tests
- Operating and recovery room
- Nursing services
- Special-unit care such as ICU or CCU
- Blood for transfusion after the first three pints (you pay for the first three pints if a free blood bank is not available)
Medicare Part A hospital insurance does not cover any physician fees (Surgeon, anesthesiologist, and radiologist services) even if you are an inpatient in the hospital. Medicare Part B covers these fees. If you receive care that is not covered by Part A, such as private duty-nursing, personal items, or private rooms that are not medically necessary, you will have to pay the costs of these services yourself.
Skilled Nursing Home Care
Part A pays for care in a skilled nursing facility (SNF) after you have a stayed there at least three days in a row. If this does not apply to you, Medicare Part A will not pay for SNF care.
In addition to staying three days, you must also meet the following conditions:
- You have days left in your benefit period.
- Your doctor states that you need skilled care.
- Skilled therapy or nursing staff provide or supervise the care.
- The SNF where you receive services is Medicare-certified.
- You need skilled services because of a hospital-related medical condition or a condition that began while receiving SNF care.
Medicare Part A hospital insurance will pay for hospice care if you meet these criteria:
- Your family doctor or hospice doctor certifies that your life expectancy is six months or less.
- You opt for palliative care (comfort care) rather than medical treatment.
- You sign a statement choosing hospice care rather than other Medicare services to treat your terminal illness.
Your cost-sharing amounts include:
- $5 per prescription for pain and symptom management
- 20% of the cost of durable medical equipment used at home
- 5% of the cost of inpatient respite care
Medicare Part A will cover all your hospice care, medications, and services, and will also cover grief counseling for you and your family if needed.
Home Health Care
Your Part A benefits include coverage for some home health services.
You qualify for Medicare Part A health insurance home health care benefits if:
- You are under a doctor’s care.
- A doctor certifies that services are medically necessary.
- A doctor certifies that you are homebound.
- A Medicare-approved home health agency provides the care.
Home health services that Part A covers include the following:
- Skilled nursing (part-time or intermittent)
- Physical or occupational therapy
- Speech-language pathology services
- Social services
- Home health aide (personal hands-on care, occasional or part-time)
Your cost-share includes:
- 20% of Medicare’s approved amount for durable medical equipment
What is the Deductible for Medicare Part A?
For 2023, the deductible for Medicare Part A is $1,600 for each benefit period. A benefit period starts on the day you are admitted to the hospital and ends when you have been out of the hospital or skilled nursing facility for 60 consecutive days.
You can have more than one benefit period in a calendar year. For example, if you have an admission in February, you pay a $1,600 deductible for that benefit period. If you are admitted again in September, you will pay another $1,600 deductible.
Who is Eligible for Part A?
Most individuals are automatically eligible for Medicare Part A if they meet at least one of the following:
- Are 65 or older.
- You have been receiving benefits from Social Security or the Railroad Retirement Board for 24 months.
- You receive disability benefits because you have Amyotrophic Lateral Sclerosis (ALS).
- You have end-stage renal disease.
If you are receiving SS or RR benefits, you are automatically enrolled the day you turn 65. If you qualify through disability, you are automatically enrolled the 25th month after you begin receiving SS benefits. If you qualify by ALS, you are automatically enrolled the month you start receiving SS benefits.
Suppose you qualify for Part A based on Social Security (SS), Railroad Retirement (RR) benefits, disability, ESRD, or ALS. In that case, you will not pay a monthly premium for Part A benefits (premium-free Part A).
If you do not qualify for Medicare Part A under one of these situations, you will pay a monthly premium for Part A (premium Part A). Your premium amount is based on how many years you or your spouse worked.
When Can I Enroll?
The first time you can enroll is your Initial Enrollment Period (IEP). This period starts three months before your 65th birthday, includes your birthday month, and ends three months after your 65th birthday.
If you did not enroll in Medicare Part A when you were first eligible, you can sign up during the General Enrollment Period. The GEP runs from Jan. 1 to Mar. 31 of each year. Your Medicare Part A coverage will begin July 1. Your Medicare card will typically arrive three months before coverage begins.
If you do not qualify for premium-free Medicare Part A and did not enroll in premium Medicare Part A when you first qualified, you will pay a 10% higher monthly premium. You will have to pay this higher premium for twice the amount of time you could have been enrolled but were not. For example, if you sign up two years after you were eligible for premium Part A, you will pay the higher premium for four years. This higher premium is waived if you meet the conditions of a special enrollment period.
Some beneficiaries qualify for a Special Enrollment Period (SEP).
If you delayed enrolling in premium Medicare Part A because you had group coverage through an employer, you could join during a special enrollment period without penalty. Your SEP is an eight-month period that begins the month that either your employment ends or your group coverage ends, whichever comes first. You can also enroll in Part A while still having group health coverage.
*If you receive premium-free Medicare Part A benefits, you cannot voluntarily stop your coverage. Your coverage ends upon death or if you no longer qualify for SS or RR benefits.
Premium Medicare Part A benefits can be terminated for several reasons:
- Failure to pay your premiums
- Part A entitlement ends for those under age 65 with ESRD or disability
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