Medicare Part A is one of the major types of insurance coverage within the government’s Medicare program. Generally speaking, Part A provides coverage for inpatient hospital services, skilled nursing care, hospice, and certain home health services. Part A, together with Part B (medical insurance), make up the federally administered Original Medicare program. Alternatively, you can also get your Part A and Part B coverage through a Medicare Advantage plan, available through Medicare-approved private insurance companies.
Eligibility for Medicare Part A
Most people are eligible for Medicare Part A when they turn 65 years old unless they qualify for Medicare because of disability or have either end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).
Most citizens or legal permanent U.S. residents of at least five continuous years who are over the age of 65 are eligible for premium-free Part A insurance if they have worked for at least 10 years (40 quarters) in Medicare-covered employment and paid Social Security or Railroad Retirement Board taxes. Citizens or legal permanent U.S. residents with 39 quarters or less of Medicare-covered employment will pay a monthly premium of $226 if they’ve worked between 30 and 39 quarters of Medicare-covered employment. Those who have worked less than that amount pay a $411 monthly premium for Part A coverage.
Many beneficiaries are automatically enrolled in Part A if they’re already receiving SSA or RRB retirement benefits when they turn 65, in which case Medicare sends a package with general Medicare information, a questionnaire, and a red-white-and-blue Medicare card; you should get this welcome packet in the mail about three months before the month you turn 65. Those who are younger than age 65 who have received SSA or certain RRB disability benefits for two years are automatically enrolled in Part A and Part B in the 25th month of their disability payments.
If you don’t get Medicare automatically, you can manually sign up during your Initial Enrollment Period (IEP), or the seven-month period that starts three months before your 65th birthday, includes your birthday month, and ends three months later. After this period, your next chance to sign up is the General Enrollment Period, which occurs from January 1 to March 31 of every year. However, you may need to pay a late-enrollment penalty for Part A if you have to pay a premium for it; this comes in the form of a 10% higher premium for twice the number of years you were eligible but didn’t enroll in Part A. In some situations, you may be eligible to delay Part A (if you don’t get it premium-free) and/or Part B and sign up for it later with a Special Enrollment Period. See this article on Medicare enrollment periods for more information.
What Medicare Part A covers
Part A coverage includes:
- Inpatient care received at a hospital (including critical access, acute care, and long-term care hospitals)
- Inpatient skilled nursing facility care
- Inpatient services you receive as part of a qualifying clinical research study
- Inpatient mental health care
- Hospice care (e.g. symptom management, pain relief, etc.)
- At-home health services when custodial care isn’t the only care needed (e.g. part-time skilled nursing care, physical therapy, etc.)
- Blood transfusions after you pay for the first three pints used within a calendar year
What Medicare Part A does not cover
Part A doesn’t cover everything. You’ll be responsible for certain cost-sharing expenses, including deductibles, copayments, and/or coinsurance (see below for more detail on specific cost amounts).
In addition, there may be other costs that you’re responsible for paying out of pocket. For instance, Part A doesn’t cover:
- First three pints of blood used in a calendar year
- Private-duty nursing
- Private hospital room (unless it’s medically necessary for your condition)
- Television or phone during your inpatient stay (if the hospital or skilled nursing facility charges you separately for these items)
- Personal care items during your inpatient stay, such as shampoo, razors, or toothbrushes
- Nursing care when custodial care (help with daily living tasks like bathing or eating) is the only care you need
If you’re not sure whether a particular service or item is covered, check with your doctor or provider, or call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Medicare representatives are available 24 hours a day, seven days a week.
Medicare Part A costs
Although Medicare Part A covers a wide variety of services, it is important to understand that you’re not covered for all expenses. In 2016, your costs under Part A could include the following, depending on the type of services you need.
Part A inpatient hospital care
- Part A hospital deductible: $1,288 in 2016 for each benefit period
- Part A inpatient hospital coinsurance: In addition to paying the hospital deductible for each benefit period, you have the following coinsurance costs:
- First 60 days: $0 coinsurance per benefit period
- Days 61 to 90: $322 daily coinsurance per benefit period
- Days 91 and beyond: $644 daily coinsurance per benefit period for each “lifetime reserve day” beyond 90 days. You’ll get up to 60 days of coverage that you can use over your lifetime.
- After you use up your lifetime reserve days, you pay all costs.
Part A skilled nursing facility (SNF) care
- Part A SNF coinsurance:
- First 20 days: $0 coinsurance per benefit period
- Days 21 to 100: $161 daily coinsurance per benefit period
- Days 101 and beyond: You pay for all costs.
Part A inpatient mental health care
- Part A deductible: $1,288 per benefit period
- Days 1 to 60: $0 coinsurance per benefit period
- Days 60-90: $322 daily coinsurance for each benefit period
- Days 91 and beyond: $644 daily coinsurance per lifetime reserve day after the 90th day of your mental health stay (per benefit period). You get 60 days of inpatient mental health coverage over your lifetime.
- After lifetime reserve days are used up: You pay for all costs.
- You also pay 20% of the Medicare-approved amount for mental health services you get from a physician during your inpatient stay.
Part A home health services
- You pay 20% of the Medicare-approved cost for durable medical equipment
Hopefully, you now have a better idea of how Medicare Part A works and what your coverage includes. You may not realize that there are other types of coverage available that may help reduce some of your costs in Part A. For example, Medicare Supplement (Medigap) plans work alongside Original Medicare, Part A and Part B, and may help cover certain out-of-pocket expenses, such as copayments, coinsurance, and deductibles. If you have questions about other types of coverage you may be eligible for, feel free to contact a licensed insurance agent by dialing the number on this page. Or, if you like, start browsing plan options in your area now by entering your zip code into the plan finder tool on this page.