Medicare Part A

What is Medicare Part A?

Medicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care.

[keytakeaways]

• Medicare Part A covers approved costs associated with inpatient care.
• Medicare Part A coverage has a benefit period deductible, copayments, and potentially a monthly premium.
• After 90 days of hospitalization, a beneficiary begins using their 60 lifetime reserve days.
• Beneficiaries can enroll in Medicare Part A during their Initial Enrollment Period or the General Enrollment Period.
• A Part A premium penalty may apply for late enrollment.
• Medicare Part A coverage can be terminated for non-payment of the monthly premium.
• Medicare supplement insurance assists with shared costs, including deductibles and copayments.

[/keytakeaways]

What Does Medicare Part A Cover?

Medicare Part A provides coverage for the costs of inpatient care services. These inpatient care services include:[mfn referencenumber=1]Medicare.gov, “What Part A covers“, Accessed October 22, 2021[/mfn]

• Hospital inpatient stay
• Mental health inpatient stay
• Skilled nursing facility stay
• Home healthcare services after a hospital stay
• Hospice care services

What Is Not Covered By Medicare Part A?

Medicare Part A covers inpatient care. It does not cover doctor visits, lab tests, diagnostics, medical supplies, or durable medical equipment. These costs are covered under Medicare Part B. Medically unnecessary services, such as routine dental, vision exams, hearing care, and cosmetic procedures, are also not covered under Medicare Part A.[mfn referencenumber=2]Medicare.gov, “What’s not covered by Part A & Part B?“, Accessed October 22, 2021[/mfn]

Who Qualifies for Medicare Part A?

People ages 65 and older qualify to enroll in Medicare Part A.  People with Social Security Disability Insurance (SSDI) benefits qualify for Medicare Part A (and Part B) starting on the 25th month of SSDI benefits.

When To Enroll In Medicare Part A

Unless a beneficiary has other creditable coverage through an employer or union, the best time to enroll is during the Initial Enrollment Period (IEP). IEP is a 7-month period starting three calendar months before the new beneficiary’s 65th birthday. If a beneficiary’s IEP has expired, the next time they can enroll is in the General Enrollment Period.

People who have received Social Security Disability Insurance (SSDI) benefits for 25 consecutive months are automatically enrolled in Medicare Part A and Part B.[mfn referencenumber=3]CMS.gov, “Top 5 things you need to know about Medicare Enrollment”, Accessed September 22, 2021[/mfn]

How Much Does Medicare Part A Cost?

Medicare Part A has three costs:

1. Monthly premium (if the beneficiary does not qualify for premium-free Part A)
2. Benefit period deductibles
3. Copayments

Most people qualify for premium-free Part A coverage and do not pay a monthly premium. For more information about Part A premiums, see What is the Medicare Part A Premium?

Each time a beneficiary is admitted for inpatient care it starts a new benefit period and the beneficiary is charged a new benefit period deductible. The deductible covers all inpatient care costs for 60 days. After the 60th day, the beneficiary begins paying a daily copayment.

What Is A Part A Benefit Period?

A benefit period begins when a beneficiary is admitted for inpatient care. The benefit period ends when related inpatient care has not been received for 60 days. A new benefit period starts if the beneficiary is admitted as an inpatient after the previous benefit period ends. For each benefit period, the beneficiary will have to pay the inpatient hospital deductible ($1,484 in 2021).[mfn referencenumber=4]Medicare.gov, “Medicare Glossary“, Accessed October 22, 2021[/mfn]

Each benefit period has three different tiers of costs:[mfn referencenumber=5]Medicare.gov, “Medicare costs at a glance“, Accessed October 22, 2021[/mfn]

• Days 1-60: $0 coinsurance for each benefit period.
• Days 61-90: $371 coinsurance per day (2021 rate) of each benefit period.
• Days 91 and beyond: $742 coinsurance per day (2021 rate)

Note: After 90 days of hospitalization a beneficiary begins using their 60 lifetime reserve days. For a complete definition of how lifetime reserve days work, see What are Medicare Lifetime Reserve Days.

Skilled Nursing Facility Care

When a beneficiary is hospitalized and treated but needs skilled care to convalesce, their doctor may have them transferred to a skilled nursing facility (SNF). Medicare Part A coverage in an SNF is different than in a hospital setting.  The costs are as follows:

• Days 1–20: Beneficiary pays $0 for each benefit period.
• Days 21–100: Beneficiary pays $185.50 coinsurance per day of each benefit period.
• Days 101 and beyond: Beneficiary pays all costs.

For the first 20 days of a beneficiary’s care in a skilled nursing facility, they pay nothing after their deductible has been met. From day 21 until day 100 of their skilled nursing facility benefit period, they pay a $185.50 coinsurance each day. After that, they are responsible for all further costs for their skilled nursing facility care.[mfn referencenumber=6]Medicare.gov, “SNF Care Coverage“, Accessed October 27, 2021[/mfn]

Home Health Care

If a beneficiary’s doctor determines that home healthcare is needed after hospitalization, they will create a plan to provide it. Medicare covers the following for home healthcare services:[mfn referencenumber=7]CMS.gov, “Medicare and Home Health Care”, Accessed September 22, 2021[/mfn]

• Skilled nursing care on a part-time or intermittent basis.
• Home health aide services on a part-time or intermittent basis.
• Physical therapy, speech-language therapy, and occupational therapy
• Counseling for social and emotional concerns related to the beneficiary’s illness.
• Certain medical supplies like wound dressings, but not prescription drugs or biologicals.
• Medical equipment such as a wheelchair or walker.

Medicare covers these home healthcare services as long as the beneficiary’s doctor orders the services. The skilled nursing and home health aide services can only be covered part-time or intermittently. This means that there are limitations on how many hours a beneficiary can receive skilled nursing and home health aide services.[mfn referencenumber=7]CMS.gov, “Medicare and Home Health Care”, Accessed September 22, 2021[/mfn]

What Home Health Care Service Are Not Covered By Medicare Part A?

The following services are not covered by Medicare Part A:[mfn referencenumber=7]CMS.gov, “Medicare and Home Health Care”, Accessed September 22, 2021[/mfn]

• 24-hour care at home
• Prescription drugs
• Meals delivered to the beneficiary’s home
• Homemaker services like shopping, cleaning, and laundry
• Personal care like bathing, toilet usage, or help in getting dressed being given by home health aides, if this is the only care needed

Part A Late Enrollment Penalty

A beneficiary who does not enroll in Part A when they are eligible will have a 10 percent late penalty added to their Part A monthly premium. The penalty for late enrollment lasts twice as many years as they were not been enrolled in Part A without creditable coverage. If the beneficiary qualifies for premium-free Part A, they will not have to pay any premium penalty.[mfn referencenumber=8]Medicare.gov, “Part A late enrollment penalty“, Accessed October 22, 2021[/mfn]

How To Get Help Paying For Medicare Part A Costs

Medicaid and Medicare Savings Program (MSP) offer financial assistance for Medicare beneficiaries who are unable to afford their Medicare Part A coverage. Each program has different benefits.

Medicaid is a state and federal program that provided healthcare to low-income families and individuals. Medicare beneficiaries with incomes at or below the federal poverty level can qualify for both dual-eligible (Medicare and Medicaid) benefits. For more information about dually-eligible benefits, see What is a Dual-Eligible Beneficiary?[mfn referencenumber=9]Medicare.gov, “Medicaid“, Accessed October 25, 2021[/mfn]

Beneficiaries who do not qualify for full Medicaid benefits, but have incomes within 135 percent of the federal poverty level, may qualify for a Medicare Savings Program (MSP).  MSPs provide varying levels of Medicare Part A cost assistance.[mfn referencenumber=10]Medicare.gov, “Medicare Savings Programs“, Accessed October 22, 2021[/mfn]

Medicare Supplement Insurance Part A Coverage

Medicare supplemental insurance policies (Medigap) can also help with the costs of Part A. All current Medigap policies (A, B, C, D, F, G, K, L, M, and N) cover some or all of the out-of-pocket costs associated with Medicare Part A. Plus, all Medigap plans include 365 days of hospital coverage after a beneficiary has used their lifetime reserve days. For more information about how Medicare supplement insurance works, see What are Medicare Supplements?[mfn referencenumber=11]Medicare.gov, “How to compare Medigap policies“, Accessed October 22, 2021[/mfn]

Getting Help With Medicare Part A

Any questions about Medicare Part A coverages and costs can be answered by a Medicare expert at 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048.[mfn referencenumber=12]Medicare.gov, “Pay Part A & Part B premiums“, Accessed October 22, 2021[/mfn]