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Part A
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?
- Hospital care for inpatients
- Skilled nursing facility care
- Nursing home care (hospital 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. It is possible that you need something that is usually covered, but your provider believes that Medicare will not cover it in your situation. If so, you will need to read and sign a notice. The notice says that 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 does Part A not cover?
- Long-term care (also called custodial care)
- Most dental care
- Eye exams related to the prescription of glasses
- Dentures
- cosmetic surgery
- Acupuncture
- Hearing aids and tests to fit them
- Routine foot care
How much does Part A cost?
Part A without Premium
You generally do not pay a monthly premium for Medicare Part A (hospital insurance) coverage if you or your spouse paid Medicare taxes over 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 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 a government job covered by Medicare.
If you're under 65, you can get premium-free Part A if:
- You got disability benefits from Social Security or the Railroad Retirement Board (RRB) for 24 months.
- You have end-stage renal disease (ESRD) and meet certain requirements.
Part A Premiums
If you don't qualify for premium-free Part A, you can buy Part A. If you buy Part A, you'll 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've paid Medicare taxes for 30 to 39 quarters, the standard Part A premium is $252.
In most cases, if you choose to buy Part A, you must also:
- Have Medicare Part B (medical insurance)
- Pay the monthly premiums for Part A and Part B
Late Enrollment Penalty
If you don't buy Part A when you're first eligible, your monthly premium may go up 10% (you'll have to pay the higher premium for twice as many years you could have had Part A but didn't sign up).
Hospital stay
- $1,408 deductible for each benefit period.
- Days 1-60: $0 coinsurance each benefit period.
- Days 61-90: $352 coinsurance per day each benefit period.
- Days 91 and beyond: $704 coinsurance for each "Lifetime Reserve Day" after the 90th day for each benefit period (up to 60 days during your lifetime).
- Beyond lifetime reserve days: all costs.
Mental Health Hospitalization
- $1,408 deductible for each benefit period.
- Days 1-60: $0 coinsurance per day each benefit period.
- Days 61-90: $352 coinsurance per day each benefit period.
- Days 91 and beyond: $704 coinsurance for each "Lifetime Reserve Day" after the 90th day for each benefit period (up to 60 days during your lifetime).
- Beyond lifetime reserve days: all costs.
- 20% of the Medicare-approved amount for 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 1-20: $0 for each benefit period in a Skilled Nursing Facility
- Days 21-100: $176 coinsurance per day each benefit period in a Skilled Nursing Facility
- Days 101 and beyond: all costs.
Hospice Care
- $0 for hospice care.
- You may have to pay a copay of no more than $5 for each prescription drug and other similar products to relieve pain and manage symptoms while you are at home. In the rare case that your drug 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 doesn't cover room and board when you get hospice care at home or in another facility where you live (like a nursing home).
Home Health Care
- $0 for home health care services
- 20% of the Medicare-approved amount for durable medical equipment (DME)
