What does Medicare Part A cover?
Medicare Part A covers inpatient care, skilled nursing services, some home health and rehabilitation costs, and hospice care.
Medicare is federal health insurance for people ages 65 years or over and for younger people with disabilities. It has four parts: A, B, C, and D.
Medicare Part A plans are free for people who have worked for 40 quarters and paid Medicare tax. Individuals who do not qualify will need to pay a monthly premium.
This article defines what Medicare Part A covers and its cost.
Medicare Part A coverage chart
This article originally appeared on Medical News Today
According to the United States Census Bureau, Medicare plans provided coverage to approximately 18.7% of the population in 2022.
Medicare Part A covers inpatient hospital stays, including those in a skilled nursing facility. It also covers some home health services and hospice services.
It does not include any doctor fees during a hospital stay. Instead, these fall under Part B coverage.
The table below summarizes Medicare Part A coverage:
Inpatient hospital stays | Skilled nursing home services | Home healthcare | Hospice |
|---|---|---|---|
a semiprivate room | a semiprivate room | rehabilitation services, such as physical and occupational therapy | care to manage symptoms and pain for those with a terminal illness |
meals | meals | skilled healthcare for people who cannot leave their home | drugs and medical supplies |
general nursing care | general nursing care | drugs and medical supplies | general nursing care |
rehabilitation services, such as physical and occupational therapy | rehabilitation services, such as physical and occupational therapy | — | — |
drugs and medical supplies | drugs and medical supplies | — | — |
care on special units if necessary, such as intensive care | — | — | — |
lab and imaging tests and operating room | — | — | — |
Medicare Part A coverage in 2024
Medicare Part A coverage for 2024 includes inpatient hospital stays, which may take place in:
acute care hospitals
long-term care hospitals
inpatient rehabilitation facilities
critical access hospitals
Coverage for an inpatient hospital stay in 2024 typically includes:
a semiprivate room
meals
nursing care
medications
medical equipment that a doctor uses during the inpatient stay
rehabilitation services, such as physical therapy
People who use their Medicare Part A coverage for inpatient hospital stays still have to meet their deductible before Medicare will pay for any treatment. In 2024, this deductible is $1,632.
Even once Medicare covers costs, an individual often still has to pay copayments, depending on the length of their stay. For example, Medicare Part A covers the first 60 days of an inpatient stay. However, a person will have to pay $408 for each additional day between days 61 and 90, according to the Centers for Medicare & Medicaid Services (CMS).
If an inpatient stay extends beyond 90 days, Medicare provides 60 reserve days that will cost a person $816 a day, per the CMS.
Medicare Part A also covers skilled nursing home stays. However, the rules are different. There is no copayment for the first 20 days of the stay. Between days 21 and 100, the copayment is $204 per day, according to the CMS.
Medicare Part A does not cover more than 100 days of an inpatient stay in a skilled nursing facility, which means that the individual is responsible for the entire cost after their 100th day in the hospital.
Medicare Part A also covers hospice care. Individuals may be responsible for around 5% of the Medicare-approved amount for respite care. They may also have to pay a copayment of $5 for each prescription drug.
A person can take out supplemental insurance, such as a Medigap plan, to cover costs beyond the limits of Medicare Part A.
Medicare Part A coverage changes yearly. It is important to stay up to date with each year’s new premiums and deductibles.
Medicare Part A cost
When a person reaches 65 years of age, they become eligible for premium-free Part A Medicare if they meet certain criteria.
If a person does not qualify for premium-free Medicare Part A, they can buy it. The cost depends on the length of time for which a person paid Medicare taxes during their working years. For example:
Individuals who paid Medicare taxes for at least 30 quarters pay $278 per month for Medicare Part A.
People who paid Medicare taxes for fewer than 30 quarters and those with certain disabilities who have reached their current benefit limits pay $505 per month for Part A.
Learn more about Medicare Part A costs.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare Part A eligibility
Starting at 65 years of age, most people are eligible for Medicare Part A coverage. To be eligible, a person must be a citizen or permanent resident of the United States.
People below age 65 years may meet eligibility requirements based on their medical status.
Medicare Part A eligibility requirements for people under age 65 years include those collecting Social Security Disability Insurance (SSDI) or Railroad Retirement Board (RRB) benefits for at least 25 months due to a disability.
There are also special rules for people under age 65 years who have either end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). People with ALS can receive Medicare Part A the first month after qualifying for SSDI benefits.
The rules for people with ESRD are more complicated. The waiting period varies according to how long they have been on dialysis, with eligibility beginning after the third month following the start of dialysis. However, if a person has completed self-dialysis training, eligibility starts during the first month.
Coverage will also begin during the month of a kidney transplant or earlier if a person requires hospitalization 2 months before a kidney transplant to prepare for the procedure.
Medicare Part A enrollment
Medicare Part A enrollment is sometimes automatic. This means that an individual does not have to take any action to confirm their coverage.
If a person is already getting Social Security, their enrollment in Medicare Part A will take place automatically on the first day of the month of their 65th birthday. If a person’s birthday falls on the first day of the month, then their enrollment will begin on the first day of the previous month.
Similarly, people who receive SSDI also receive automatic enrollment at the start of their 25th month of benefits.
People do not receive automatic Medicare enrollment if they are either over age 65 years or 3 months from reaching age 65 years and not receiving Social Security. These individuals will need to apply.
Individuals may apply for Medicare online through the Social Security Administration (SSA) website or in person at a Social Security office.
The enrollment period for Medicare starts 3 months before a person’s 65th birthday and ends 3 months afterward. There is also an open enrollment period in the fall.
When coverage for Medicare begins will depend on when the person signed up in relation to their 65th birthday.
For example, if a person signs up 3 months before their 65th birthday during the initial enrollment period, coverage will start on the first day of the month during which they reach 65 years of age.
Learn more about Medicare enrollment.
Who qualifies for free Medicare Part A?
According to the CMS, most people do not pay a monthly premium for Medicare Part A coverage. People in the following categories qualify for free Medicare Part A:
people already getting retirement benefits from the RRB or SSA
a person who is eligible for retirement benefits from the RRB or SSA but has not filed yet
an individual who has Medicare-covered government employment or if their spouse has it
a person with ESRD who meets specific requirements
an individual who receives disability benefits for 24 months
Although a person may qualify for premium-free Medicare Part A, they will still have to pay certain deductibles for some services.
Summary
Federally funded Medicare has four parts: A, B, C, and D.
Part A covers inpatient care, skilled nursing services, some home health and rehabilitation costs, and hospice care. However, it does not cover doctor fees during a hospital stay, as Part B covers those costs. Together, parts A and B are known as Original Medicare.
Part A may be premium-free, depending on certain criteria.
View the original article on Medical News Today
