What is Medicare Part A? Benefits and Costs Explained

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 are already collecting retirement benefits from the Social Security Administration or the Railroad Retirement Board. You may qualify for Medicare Part A before age 65 if you have a disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS).

What does Part A cover?

Inpatient hospital care
Skilled nursing facility care
Nursing home care (inpatient care in a skilled nursing facility that is not custodial or long-term care)
Hospice care
Home health care

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 is usually covered, but your provider thinks Medicare won't cover it in your situation. If so, you will need to read and sign a notice. The notice says 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 if something is medically necessary and should be covered in your area.

What is not covered by Part A?

Long-term care (also called custodial care)
Most dental care
Eye examinations related to the prescription of eyeglasses
Dentures
Cosmetic surgery
Acupuncture
Hearing aids and fitting tests
Routine foot care

How much does Part A cost?

Part A without Premium

Generally, you do not pay a monthly premium for Medicare Part A coverage (hospital insurance) 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 no cost to you. You can get premium-free Part A at age 65 if:

You already receive retirement benefits from Social Security or the Railroad Retirement Board.
You are eligible for Social Security or Railroad benefits, but have not yet applied for them.
You or your spouse had government employment covered by Medicare.

If you are under age 65, you can get Part A with no premium if:

Earned 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 do not qualify for premium-free Part A, you can buy Part A. If you buy Part A, you will 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 to 39 quarters, the standard Part A premium is $252.

In most cases, if you choose to purchase Part A, you must also:

Have Medicare Part B (medical insurance)
Pay the monthly premiums for Part A and Part B

Late Registration Penalty

If you do not purchase Part A when you are first eligible, your monthly premium may increase by 10% (you will have to pay the higher premium for twice as many years as you could have had Part A, but did not enroll).

Hospital Stay

$1,408 deductible for each benefit period.
Days 1 - 60: $0 coinsurance for each benefit period.
Days 61 through 90: coinsurance of $352 per day of each benefit period.
Days 91 and later: coinsurance of $704 for each "lifetime reserve day" after day 90 for each benefit period (up to 60 days in your lifetime).
Beyond the lifetime reserve days: all costs.

Mental Health Hospitalization

$1,408 deductible for each benefit period.
Days 1 through 60: coinsurance of $0 per day of each benefit period.
Days 61 through 90: coinsurance of $352 per day of each benefit period.
Days 91 and later: coinsurance of $704 for each "lifetime reserve day" after day 90 for each benefit period (up to 60 days in your lifetime).
Beyond the lifetime reserve days: all costs.
20% of the Medicare-approved amount for the mental health services you receive from doctors and other providers while you are an inpatient in a hospital.

Stay in a Skilled Nursing Facility

Days 1 to 20: $0 for each benefit period in a skilled nursing facility
Days 21 through 100: coinsurance of $176 per day of each benefit period in a skilled nursing facility
Days 101 and later: all costs.

Hospice Care

$0 for palliative care.
You may be required to pay a copayment of no more than $5 for each prescription drug and other similar products to relieve pain and control symptoms while you are at home. In the rare event that your medication is not covered under the hospice benefit, your hospice provider should contact your Medicare drug plan to see if it is covered under Medicare prescription drug coverage (Part D).
You may have to pay 5% of the Medicare-approved amount for inpatient respite care.
Medicare does not cover room and board when you receive hospice care in your home or another facility where you live (such as a nursing home).

Home Health Care

$0 for home health care services
20% of the Medicare-approved amount for durable medical equipment (DME)

Part A