Medicare Part A, often known as hospital insurance, covers services and procedures that generally take place in an inpatient setting.
Medicare Part A is known as hospital insurance. This Medicare coverage helps pay for in-patient hospital stays, hospice care, care in a skilled nursing facility, and some home health care needs. You can get Medicare Part A with no premium if you or your spouse has paid into Medicare for a specific amount of time while working.
Medicare Part A covers in-patient hospital stays and other in-patient care. It’s not the coverage you use for doctor’s visits or prescription drugs.
Includes services like semi-private rooms, meals, general nursing and drugs as part of your inpatient treatment.
Covers care that takes place in a facility or at home. Medicare Part A doesn’t pay for room and board.
Covers medically necessary services such as:
Covers skilled nursing services if you need them while you’re a resident, only if all of these conditions are met:
Note: Medicare Part A won’t cover custodial care, which means you’re living in a nursing home because you need help with activities of daily living (ADLs). In this case, meals, room, and board are not covered by Medicare Part A.
But if you’ve been in the hospital and must transition to a skilled nursing facility, Medicare Part A will cover the cost of your stay, including meals.
Other skilled nursing care costs covered by Medicare Part A include:
Most people do not pay a monthly premium for Medicare Part A, although some do. You will have a deductible to cover before Medicare Part A applies, so it does not cover 100 percent. However, once you pay the deductible for inpatient services, you’re covered for the first 60 days. If your in-patient care lasts longer than 60 days, you’ll start paying a coinsurance amount.
Not all medical services are covered by Medicare Part A. Some are covered by other parts of Medicare, such as Medicare Part B and D, and other treatments are not covered by Medicare at all.
Here are the top items not covered by Medicare Part A:
When you're hospitalized, you’ll have to pay a deductible. In 2021, the Part A deductible is increasing to $1,484. This means you’ll pay $1,484 out of your own pocket before Medicare will start paying benefits. This deductible covers you for up to 90 days of inpatient hospital care.
You pay the inpatient hospital deductible each time you're admitted to the hospital, provided you haven't received hospital or skilled nursing facility services within the previous 60-day benefit period. If your hospital stay is longer than 60 days, you’ll begin paying coinsurance for each additional day.
In 2021, you’ll pay:
While the deductible and coinsurance payments are calculated for each benefit period, your lifetime reserve days are fixed at 60 for your whole life. This means that you only use a lifetime reserve day if you have a stay of more than 90 days in one benefit period.
If you have a series of hospital stays in different benefit periods, but none of them last more than 90 days, you won’t use any lifetime reserve days - even if your total number of days from multiple benefit periods is more than 90.
If you need more than 20 days of skilled nursing care, you’ll pay:
Note: Your Medicare part A costs are not capped under Original Medicare, so there is no out-of-pocket maximum like there is for private health insurance. This is a key reason many people consider Medicare Advantage or Medigap plans.
Most people don’t pay a monthly premium for Medicare Part A. The coverage is paid for by paying into Medicare during your working years. However, if you or your spouse don’t have an adequate work history of paying Medicare taxes, you may have to pay a premium for Part A.
Medicare is health insurance for:
In order to be eligible for Medicare Part A, you must be either:
Upon meeting this requirement, most people enter into Medicare when they meet an enrollment milestone, like turning age 65.
Most people who enter Medicare Part A don’t have to pay a premium. If you’ve worked and paid payroll taxes (FICA) for at least 40 quarters, you’re eligible to receive Part A services without a premium.
If you haven’t worked long enough for premium-free Medicare Part A coverage, you may qualify through your spouse. If your spouse qualifies for premium-free Part A, so will you, as long as any of these are true:
If you have not paid the FICA taxes or don’t qualify for Medicare Part A through your spouse, you can still enroll in Medicare Part A. In this case, you’ll have to pay the Medicare monthly premium, which is $458 for 2020 and $471 in 2021.
You can delay your Medicare Part A enrollment if you work past age 65. However, you may want (or need) to enroll in Medicare Part A. In any case, talk to your employer to find out.
If you’re still covered by your employer or spouse’s employer plan, you won’t enroll during your Initial Enrollment Period. Instead, you’ll have a special window to enroll in Medicare whenever your private health coverage ends. You’ll then have 8 months to enroll in Original Medicare.
You also won’t be subject to any late enrollment penalties, as long as you’ve been covered by an employer or your spouse’s employer.
If you become eligible for Medicare due to disability, you'll have a different Medicare enrollment window. Instead, you will be automatically enrolled in Medicare Part A and B on the first day of the 25th month you receive Social Security Disability Insurance.
Note: The requirement for eligibility is 24 consecutive months, but you don’t actually enter Original Medicare until the 25th month.
The same is true if you receive disability income from the Railroad Retirement Board: 24 consecutive months to become eligible and your enrollment occurs on the 25th month.
You can then enroll in a private Medicare plan as soon as you’re enrolled in Part A and B.
If you’re diagnosed with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, the first step to getting Medicare is to apply for Social Security Disability Insurance. You’ll need to indicate that you’ve been diagnosed with ALS on the application.
Then, you’ll automatically enter Original Medicare Part A and B on the first day of the fifth month that you’ve received SSDI payments. Once you’re active in Medicare with Part A and B start dates, you can enroll in a private Medicare health plan, if needed.
The eligibility and entry details for End Stage Renal Disease (ESRD) are often more complicated than other scenarios. But the general rule for ESRD is that your Medicare coverage will begin on the first day of the fourth month of dialysis treatment.
You can enroll in a Medicare Supplement or a Prescription Drug Plan (Part D plan) as soon as you have a Medicare number as well as Part A and B start dates.
Note: Medicare Advantage plans will cover patients with ESRD beginning in 2021. This is great news for ESRD patients because every Medicare Advantage plan has an annual out-of-pocket maximum cap. So once ESRD patients hit their annual spending caps, they’re not required to pay any more medical expenses for the rest of the year.
Your enrollment will be automatic in these situations:
In all of these cases, your Medicare coverage will begin automatically based on applications for other Federal benefits. You shouldn’t have to do anything else to get Part A coverage.
But you’ll have to actively sign up for Medicare in these situations:
If you'd like to learn more about how to enroll in Medicare Part A, please visit these additional resources:
[Medicare Annual Enrollment period[(https://www.healthinsurance.com/learning-center/article/guide-to-medicare-annual-enrollment-period) When should I apply for Medicare? How to sign up for Medicare at age 65