Medicare Part A Hospital Insurance - learn more

What is Medicare Part A?

Medicare Part A is a health insurance program administered by the federal government which primarily covers inpatient hospital care, but also helps cover skilled nursing facility, hospice care, and home health care costs. Part A and Part B are also known as “Original Medicare”.

 

Who is eligible for Part A?

In general, people 65 or older are eligible for Part A. Younger people with certain disabilities can also be eligible for Part A.

If you are 65 or older, you are eligible for Part A if:

  • You currently receive retirement benefits from Social Security or the Railroad Retirement Board.
  • You are currently eligible for Social Security or the Railroad Retirement Board benefits but you haven’t applied for them yet.

If you are under 65, you are eligible for Part A if:

  • You have received Social Security or the Railroad Retirement Board disability benefits for 24 continuous months
  • You have End-Stage Renal Disease (ESRD) and meet certain criteria.

Most people who meet the eligibility requirement above are automatically enrolled in Medicare Part A and they will receive a government red, white, and blue Medicare card in the mail 3 months before their 65th birthday.

What does Part A cover?

Medicare Part A helps cover the following medical care:
  • Hospital care

    • What is covered - hospital services, including semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. This includes the care you get in these facilities:

      • Acute care hospitals
      • Critical access hospitals
      • Inpatient rehabilitation facilities
      • Long-term care hospitals

      It also includes inpatient care as part of a qualifying clinical research study and inpatient mental health care given in a psychiatric hospital or other hospital.

      What is not covered -

      • Private-duty nursing
      • Private room (unless medically necessary)
      • Television and phone in your room (if there's a separate charge for these items)
      • Personal care items, like razors or slipper socks

    • What is covered - skilled nursing care provided in a skilled nursing facility (SNF) under certain conditions for a limited time.

      Medicare-covered services include, but aren't limited to:

      • Semi-private room (a room you share with other patients)
      • Meals
      • Skilled nursing care
      • Physical and occupational therapy
      • Speech-language pathology services*
      • Medical social services
      • Medications
      • Medical supplies and equipment used in the facility
      • Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that aren’t available at the SNF
      • Dietary counseling

    • What is covered - care in a long-term care hospital (LTCH). LTCHs specialize in treating patients who may have more than one serious condition, but who may improve with time and care, and return home.

  • What is covered - may cover care in a certified skilled nursing facility (SNF) if it's medically necessary for you to have skilled nursing care (like changing sterile dressings). However, most nursing home care is custodial care, like help with bathing or dressing. Medicare doesn't cover custodial care if that's the only care you need.

  • What is covered - hospice care is usually given in your home, but it also may be covered in a hospice inpatient facility. Depending on your terminal illness and related conditions, the plan of care your hospice team creates can include any or all of these services:

    • Doctor services
    • Nursing care
    • Medical equipment (like wheelchairs or walkers)
    • Medical supplies (like bandages and catheters)
    • Prescription drugs for symptom control or pain relief
    • Hospice aide and homemaker services
    • Physical and occupational therapy
    • Speech-language pathology services
    • Social work services
    • Dietary counseling
    • Grief and loss counseling for you and your family
    • Short-term inpatient care (for pain and symptom management)
    • Short term respite care
    • Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness and related conditions, as recommended by your hospice team

  • What is covered - eligible home health services like these:

    • Intermittent skilled nursing care
    • Physical therapy
    • Speech-language pathology services
    • Continued occupational services, and more
    • Usually, a home health care agency coordinates the services your doctor orders for you.

    What is not covered -

    • 24-hour-a-day care at home
    • Meals delivered to your home
    • Homemaker services
    • Personal care

 

Is there a monthly premium cost for Part A?

Yes, but most people will usually not have a monthly premium cost for Part A. If you or your spouse paid taxes while working for at least 10 years then there is no premium cost for Part A, which is sometimes called “premium-free Part A”.

 

What are the out-of-pocket costs (deductible, coinsurance) for Part A?

In 2019 you will be responsible for paying the following deductibles and coinsurance when you need medical care covered by Part A:

  • $1,364 deductible for each benefit period
  • Days 1-60: $0 coinsurance for each benefit period
  • Days 61-90: $341 coinsurance per day of each benefit period
  • Days 91 and beyond: $682 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)
  • Beyond lifetime reserve days: all costs

Medicare Supplement Insurance Plans (Medigap) can help pay for costs which are not covered by Part A, including the deductibles and coinsurance listed above.

 

When can I sign up for Part A?

There is a 7 month initial enrollment period for Part A. You can enroll starting 3 months before the month you turn 65, during the month you turn 65, and 3 months after your birthday month.

 

Is there a penalty for signing up late for Part A?

Yes, a penalty is possible if you sign up late. If you are not eligible for premium-free Part A and you didn’t purchase Part A during your Initial Enrollment Period, then your monthly premium may go up 10%. You'll have to pay the higher premium for twice the number of years you could have had Part A, but didn't sign up. The penalty usually does not apply if you are eligible for a Special Enrollment Period.

 

 

For more information on this topic, please visit www.medicare.gov