As part of Original Medicare, Medicare Part A helps Medicare beneficiaries afford inpatient hospital care, nursing care, hospice and healthcare. The other part is Part B, which assists with doctor and healthcare services, outpatient care, some medical equipment, and preventive services. But although Original Medicare refers to Parts A and B, you can choose to enroll in Part A only.
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What Does Medicare Part A Cover?
Medicare Part A primarily covers hospital services, such as inpatient care in a hospital, skilled nursing facility care, nursing home care (so long as it’s not custodial or long-term care), hospice care, and home health care. It is important to note that vision and dental care are not covered by Medicare Part A.
If you are enrolled in a Medicare Advantage plan, also known as Medicare Part C, there could be different things covered, but it will always cover what Original Medicare does, including Part A services. Here’s a closer look at the types of care covered by Part A:
- Inpatient hospital care: This is covered as long as a doctor states that inpatient care is needed for for the patient’s illness or injury, and the hospital accepts Medicare. For example, you may need a long-term stay at a hospital after a prolonged illness. This would be considered inpatient care.
- Skilled nursing care: Not to be confused with a nursing home, skilled nursing facilities, or SNFs, are often used for post-hospitalization care following an accident, severe illness, or surgery. SNFs help patients regain their ability to do everyday activities under the guidance of a skilled nurse, such as if a patient needs to learn how to walk again following a surgery.
- Nursing home care: Nursing homes are residential centers for seniors who are medically stable, but have chronic conditions or mobility issues that make living alone difficult or dangerous. Unlike SNFs, nursing homes do not necessarily have physical therapy-focused goals.
- Hospice care: Hospice care is for terminally ill people who have been determined by a doctor to have 6 months or less to live. However, note that Medicare only covers hospice care if the provider is Medicare-approved. Once approved for hospice care, beneficiaries and their families work with a dedicated hospice team to set up a plan of care that suits their needs.
- Home health care: Physical therapy, occupational therapy, and speech-language pathology services are examples of home health care covered by Part A. However, Part A does not cover 24-hour care at your home, meal delivery, or custodial care.
How Much Does Medicare Part A Cost?
Most people are eligible for premium-free Medicare Part A, where Part A coverage comes with no additional costs. However, those who are not eligible for premium-free Part A can purchase Part A coverage. In 2023, those who purchase Part A pay a premium of either $278 or $506 each month, depending on how long the beneficiary worked and paid Medicare taxes.
Medicare Part A Premiums
A premium is the amount of money you pay for your health coverage each month. Although the majority of people eligible for Medicare Part A receive their benefits premium-free, those who have not worked and paid Medicare taxes long enough must purchase their Part A Medicare coverage. Generally, to be eligible for premium-free Part A, you must:
- Be 65 years old or older
- Be eligible for monthly Social Security or Railroad Retirement Board cash benefits
Medicare Part A Copays and Coinsurance
Coinsurance is usually based on a percentage of the fee charged, such as 20%, meaning the insurer would pay 80% of the total fee while you would pay the remaining 20%. However, Medicare Part A has coinsurance that functions similarly to a copay, which is generally a set amount rather than a percentage. Below are the coinsurance amounts beneficiaries pay for 2022:
Days 1 to 60
Days 61 to 90
Beyond 90 days
Inpatient hospital care
$400 per day
$800 per lifetime reserve day, otherwise beneficiary pays all costs
Inpatient mental health care
$400 per day
$800 per lifetime reserve day, otherwise beneficiary pays all costs
In addition to these coinsurance amounts, beneficiaries also pay:
- Skilled nursing care: Beneficiaries do not have to pay anything for the first 20 days of their skilled nursing care stay, but will pay up to $200 per day for days 21 to 100 and cover all costs beyond 100 days.
- Home health care: 20% of Medicare-approved amount for durable medical equipment
- Hospice care: No more than $5 per prescription drug for pain relief or symptom control; 5% of Medicare-approved amount for respite care
Medicare Part A Deductibles
A deductible is the amount of out-of-pocket fees the policyholder pays before an insurance provider will pay any expenses. The standard deductible for Medicare Part A in 2023 is $1,600.
Medicare Part A Penalty Cost for Late Enrollment
Not everyone qualifies for premium-free Medicare Part A. For those that don’t, Part A must be purchased, and if it isn’t bought when you’re first eligible for Medicare, your monthly premium can increase by 10%. Additionally, late enrollment will mean that you have to pay the higher premium for twice the number of years you didn’t sign up. For example, if you were eligible for Part A for four years and didn’t sign up, you’ll have to pay higher premiums for eight years.
Are You Eligible for Medicare Part A?
For the most part, Medicare is available for people 65 and over, younger people with disabilities, and those with End Stage Renal Disease (ESRD). It’s worth noting that many people — when eligible — will receive Part A at no cost.
Eligibility criteria for Medicare Part A:
- You are receiving Social Security Benefits or the Railroad Retirement Board
- You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them
- You or your spouse had Medicare-covered government employment
When Can You Enroll in Medicare Part A?
You may enroll in Medicare Part A in the 3 months preceding and following your 65th birthday, during the annual enrollment period, or during a special enrollment period if you have a qualifying life event.
- Initial enrollment period: Your Initial Enrollment Period is the first time you can enroll in Medicare Part A. Generally, this begins three months before you turn 65 and lasts for three months after you turn 65 for a total of seven months. For example, if your birthday is in April, your initial enrollment period would begin in January and last until the end of July.
- Annual enrollment period: The annual enrollment period is when anyone can make changes to their coverage and enroll in Medicare. It runs from October 15 through December 7.
- Special enrollment period: A Special Enrollment Period (SEP) is triggered when certain events require you to change your Medicare coverage plan. Common scenarios when an SEP may be required include:
- You have moved out of your plan’s service area
- You have just moved back to the U.S. after living abroad
- You have moved into or out of a skilled nursing facility, psychiatric facility, rehab hospital or long-term care facility.
- Your employer-provided plan ends
Once enrolled in Medicare Part A, coverage always starts on the first of the month after you enrolled. For example, if you enrolled in May, your coverage would begin June 1st.
Are There Reasons to Not Enroll in Medicare Part A?
There are a few reasons why enrolling in Medicare Part A might not be ideal. Here are a couple of examples.
- You’re not retired and have access to a group health plan. If you have a group health plan through your employer and you’re pleased with the coverage it provides, then signing up for Medicare Part A might not be in your best interest, especially if you are not eligible to receive premium-free Part A. In addition, late enrollment penalties for Medicare Part A typically do not apply to those who have access to an eligible group health plan, so you may not have to pay late enrollment penalties when you do retire and lose access to your group health plan.
- You’re retired, but are still covered under your spouse’s group health plan. Just like if you were to have a group health plan through your own employer, having access to a spouse’s plan has advantages over Medicare. In addition, if your spouse’s group health plan covers 20 or more people, you may not have to pay late enrollment penalties if you do decide to enroll in Medicare Part A later once your spouse retires or otherwise loses access to their group health plan.
How to Delay Part A Enrollment
To defer Medicare coverage, do not sign up when you become eligible. No other paperwork or process is needed. In some situations, it may be ideal to delay Part A enrollment, such as if you have access to a group health plan. To delay enrollment without accruing costly penalties, you must adhere to Medicare’s strict guidelines and you must have qualifying health insurance, such as group health insurance through your employer that covers 20 or more employees.
How to Apply for Medicare Part A
If you are receiving benefits from the Social Security Administration (SSA), you will be automatically enrolled at age 65 for Part A and Part B of Medicare. It’s worth noting that Medicare is operated by the Federal Centers for Medicare and Medicaid Services, whereas enrollment is handled by the SSA.
If you were not automatically enrolled and you need to enroll manually, you may do so during the allotted enrollment periods, as mentioned earlier. Enrollment can be done online, over the phone, or in person through your local Social Security office.