What is Medicare Part A?
Two parts make up Original Medicare: Medicare Part A and Medicare Part B. Medicare Part A, also known as hospital insurance, provides coverage for Medicare inpatient care; this may include care received during hospital admittance, some skilled nursing facility care after an inpatient hospital stay, and in specific situations, care received at home.
When most people turn 65, Medicare Part A eligibility is automatic if they receive retirement benefits from the Railroad Retirement Board or the Social Security Administration. If you have amyotrophic lateral sclerosis (ALS), a disability, or end-stage renal disease (ESRD), you may qualify for Medicare Part A before age 65.
Other eligibility requirements include being a citizen of the United States or maintaining five consecutive years of legal permanent residency.
Compare Medicare Part A Plans
Medicare Part A, also known as hospital insurance, provides coverage for care received in the hospital, some skilled nursing facility care, and some home care situations. Keep in mind, however, even if Medicare covers an item or service, you will generally have to pay a copayment, deductibles, and coinsurance.
What Does Medicare Part A Cover?
When visiting your doctor, be sure to speak to them or other healthcare providers about why you need specific services or supplies. Ask them if Medicare will cover your needs. It may be a situation where something is usually covered, but your healthcare professional thinks that Medicare may not cover it in your case.
If this situation applies to you, then you’ll have to read and sign a notice. The notice will say that you understand that you may have to pay for the item, service, or supply.
In General, Services Covered under Medicare Part A include:
- Hospital care (inpatient)
- Limited home health services
- Hospice care
Medicare Part A Hospital Care Coverage:
- Acute care hospitals
- Critical access hospitals
- Inpatient rehabilitation facilities
- Long-term care hospitals
- Mental health care
- Participate in a qualifying clinical research study
Medicare Part A Home Health Care Benefits:
- Intermittent or part-time skilled nursing care
- Physical therapy
- Speech-language pathology assistance
- Occupational therapy
- Medical social assistance
- Part-time or intermittent home health aide assistance
Medicare Part A Nursing Home Coverage:
- Skilled nursing services
- Semi-private rooms
- Medical social services
- Rehabilitation services, if medically necessary to treat your illness
- Medical supplies and equipment used in an SNF
- Medications received while in SNF care
- Dietary counseling
- Ambulance transportation to the closest provider if needed services are not provided at the SNF
Medicare Part A will not cover:
- Routine foot care
- Hearing aids and exams for fitting them
- Most dental care
- Cosmetic surgery
- Long-term care
- Eye examinations related to prescribing glasses
- Your first 3 pints of blood (depending on your specific case)
- Private rooms
Medicare Part A has restrictions. For example, if you are hospitalized for a stay of 90 days or more at one time, there are limits to the number of days Part A will cover. This is true regarding the amount of time spent at an SNF that Part A covers as well. Private Medicare Part A provides coverage for hospice care visits regardless of the number of visits and home health care visits. However, you must meet several conditions to receive either kind of help.
Does Medicare Part A Cover Emergency Room Visits?
Emergency room (ER) visits can hit even the heftiest of budgets hard. In 2014-2017, there were 43 ER visits per 100 persons aged 60 and over. The ER visit rate increased with age, from 34 visits per 100 persons aged 60-69 to 86 visits per 100 persons aged 90 and over.
That means that if you’re in the age 65 and up group, your chances of an emergency room visit are something to consider. Plus, emergency room visit costs are generally higher than a visit to your doctor, per reports to the US Agency for Healthcare Research and Quality (AHRQ).
You might think that an emergency department visit is free, but chances are if you’re treated and released without being admitted as a patient then Medicare won’t cover your trip. Even though visitors can stay overnight in the ER without needing to be officially admitted or transferred elsewhere for your condition—you still need written orders from doctors ordering said treatment for it to be covered. For the most part, you need to be admitted as an inpatient for two consecutive days and nights for Medicare Part A cover your visit.
Medicare Part B could cover some of your emergency room expenses if you suffer a heart attack, stroke, or other sudden illness. If you’re admitted to the same hospital as an inpatient for a related condition within three days of your visit to the ER. In that case, Medicare Part A may cover the ER visit as part of your inpatient care, and you typically will have no copayment.
For Medicare Part A, beneficiaries may pick any qualified US provider that is accepting new patients or is approved by Medicare. Because Medicare Part A will offer the same benefits throughout the United States, the beneficiary is not limited to a particular region or state for your healthcare needs.
Medicare Part A Costs
While working, beneficiaries or their spouses who contributed to Medicare taxes ordinarily do not have to pay monthly premiums for their Medicare Part A coverage or premium-free Part A.
|Part A Deductible and Coinsurance Amounts for Calendar Years 2022 and 2023
by Type of Cost Sharing
|Inpatient hospital deductible||$1,556||$1,600|
|Daily coinsurance for 61st-90th Day||$389||$400|
|Daily coinsurance for lifetime reserve days||$778||$800|
|Skilled Nursing Facility coinsurance||$194.50||$200.00|
How Much is Medicare Part A?
If you buy Part A, you may pay up to $506 (as recorded in 2023 by the CMS), but most people qualify for premium-free Part A. Voluntary enrollees who are eligible for a 45% reduction in the monthly premium will pay $278 in 2023. This includes individuals who had at least 30 quarters of coverage or were married to someone with at least 30 quarters of coverage. (Source) To be eligible for premium-free Part A at age 65, you must meet the following criteria:
- You or your spouse maintained a Medicare-covered government job
- Currently, you receive retirement benefits from the Railroad Retirement Board or Social Security
- You qualify for Railroad benefits or Social Security but haven’t yet applied
If you are not 65, you could qualify for premium-free Part A if:
- You have a diagnosis for End-Stage Renal Disease (ESRD) and meet specific requirements
- For 24 months, you have received Railroad Retirement Board or Social Security benefits
- In most situations, if someone decides to buy Part A, they also have to have Medicare Part B (Medical Insurance) and pay the monthly premiums for each
When will Coverage for Medicare Part A Begin?
Medicare Part A coverage will begin during the first three months of the Initial Enrollment Period and go into effect on your birthday month’s first day unless your birthday is on the first day of the month. Let’s say your 65th birthday is on July 20th, 2023, and you sign up for coverage in April, May, or June, your coverage will begin on July 1st, 2023.
However, if your birthday is the first day of the month, then your coverage will start the first day of the previous month. For example, if your 65th birthday is July 1st, 2023, and you sign up for Medicare in March, April, or May, your coverage will begin June 1st, 2023.
How to Enroll in Medicare Part A
To enroll in Medicare Part A:
- Visit SocialSecurity.gov and click on “Medicare Enrollment”
- Call the Social Security office at 800-722-1213. If you need TTY, call 800-325-0778.
- Apply in person at your nearest Social Security Office.
For most people, Medicare Part A enrollment is automatic. However, some scenarios require you to manually sign up for Medicare Part A during the Initial Enrollment Period (IEP), which is the seven months beginning three months before turning 65, including your 65th birthday month and ending three months later.
Situations where you may not be enrolled automatically in Original Medicare:
If you are near your 65th birthday and not yet receiving benefits, you can sign up for Medicare Part A during your IEP. Suppose you chose to postpone your Social Security retirement benefits or Railroad Retirement Benefits (RRB) past age 65 – in that case, you have the choice to enroll in just Medicare and apply for retirement benefits at a later time.
If you do not qualify for retirement benefits:
If you are not eligible for retirement benefits from Social Security or the RRB, you will not be automatically enrolled in Original Medicare. However, during your IEP, you can still sign up for Medicare Part A. You may not be eligible for premium-free Medicare Part A if this is the case. Your monthly Part A premium will be based on the length of time you worked and paid Medicare taxes.