Medicare Part A
Medicare Part A is one of the two parts that make up Original Medicare. Original Medicare is a health insurance program provided by the government of the United States to senior citizens (aged 65 and above) and under-65 people with disabilities and other specified health conditions.
Part A is also known as "hospital insurance", and with it, enrollees can use any doctor, healthcare provider, hospital, or healthcare facility that accepts Medicare payment.
Inpatient Care In A Hospital Setting
Medicare Part A provides coverage for the following inpatient healthcare services:
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Inpatient care in a hospital setting
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Skilled nursing facility (SNF) care
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Hospice care
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Home health care
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Nursing home care
Inpatient Care In A Hospital Setting
Inpatient care refers to the care received when you are admitted to a hospital or healthcare facility by a physician.
As an inpatient admitted to a hospital or healthcare facility, Part A covers:
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General nursing care
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Intensive care
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Semi-private room within the hospital
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Meals
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Some drugs and medical supplies
These services are covered for up to 90 days in a general hospital for each benefit period in a general hospital (A Benefit Period is 60 days). You also get covered for 60 lifetime reserve days. If you are admitted into a psychiatric hospital that accepts Medicare, Medicare covers up to 190 lifetime days.
Skilled Nursing Facility (SNF) Care
Medicare Part A covers SNF care if you have been a hospital inpatient for at least three days in a row and within 30 days of admission to the skilled nursing facility (SNF). You must also need skilled nursing care or therapy services.
If you meet the requirements, Medicare covers the following under SNF care:
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Room and board
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Wound care
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Tube feeding
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Administration of medications
Home Health Care
If you need skilled healthcare in your home, Medicare Part A covers the following services:
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Physical therapy and other rehabilitation services
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Certain medical supplies, such as wound dressings that are necessary for the patient's care
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Skilled healthcare
To qualify for Medicare-covered home health care, you must have been an inpatient in a hospital for at least three days in a row within 14 days of receiving home health care. If you are eligible, you are covered for up to 100 days of daily care or an unlimited amount of intermittent care.
Hospice Care
Hospice care is for people who are certified terminally ill by their physicians.
When enrolled in Medicare Part A, the following services get covered under hospice care:
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General nursing care
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Some medications that help manage symptoms and relieve pain in people with a terminal sickness.
What are the gaps in Medicare Part A?
Medicare Part A does not cover the following healthcare services:
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Cosmetic procedures
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Private nursing care
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Private rooms except they are required for medical reasons
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Personal care supplies (Like socks or slippers)
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Televisions or telephones in the room
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Long-term care in nursing homes or assisted living facilities
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Most dental care, including dentures
What Are Medicare Part A Costs?
Most eligible beneficiaries of Medicare do not pay a monthly premium for Medicare Part A. This is also referred to as “premium-free part A."
You qualify for a premium-free Part A if you are 65 and:
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You or your spouse have paid Medicare taxes while working for at least ten years (40 quarters).
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Receive (or are eligible to receive) retirement benefits from Social Security or the Railroad Retirement Board
If you're under 65, you can get premium-free Part A if you:
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Have end-stage renal disease (ESRD)
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Are eligible for (and have received) disability benefits from Social Security or Railroad Retirement Board for at least 24 months (2 years)
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Have family relationship coverage, when a person's parent or a spouse paid Medicare taxes for a certain period
If you do not qualify for premium-free Part A, you can buy Part A. If you buy Part A, your premium depends on how long you or your spouse has worked and paid Medicare taxes.
Deductible and Coinsurance
Even though a service may be considered “covered” under part A, it does not mean you don’t have to pay anything out of pocket. In Medicare, the benefit period is how Medicare measures and pays for inpatient hospital and skilled nursing facility (SNF) services. A benefit period begins the day you are admitted into a hospital or SNF and ends when you have been out for 60 days in a row.
So in Medicare Part A, you pay a deductible for each benefit period. You also pay a copay if you have stayed in a hospital or skilled nursing facility for more than 60 days. However, you do not pay deductibles or co-payments for home health or hospice care.
In 2023 the Medicare Part A deductible is $1600 per benefit period. For days 61-90 the daily hospital copay is $400 per day. Medicare does allow for up to 60 lifetime reserve days at a cost of $800 per day in 2023.
These costs can add up quickly which is why most people consider enrolling in a Medicare Advantage plan or adding a Medigap plan to help mitigate the financial risks associated with Original Medicare.
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