Medicare Part A covers inpatient hospital benefits for Medicare beneficiaries. When you have Medicare Part A, you are responsible for the Medicare Part A deductible, copayments, and coinsurance when you utilize benefits.
For many, Medicare Part A covers hospital and inpatient benefits. Below, we discuss Medicare Part A, what it covers, and how you can utilize the benefits.
Services Medicare Part A Covers
Medicare Part A covers medically necessary services related to hospital, inpatient, skilled nursing, home health care, and more. Medicare Part A works in connection with Medicare Part B to comprise Original Medicare.
Medicare Part A Covers:
- Overnight hospital stays
- Semi-private rooms
- Hospital meals
- Special care units
- Drugs administered in the hospital
- Hospital supplies and equipment
- Operating room
- Recovery room
- Rehab services for the duration of your hospital stay
- Blood transfusions
- Hospice care
- Skilled nursing facilities
- Home health care
Medicare Part A Coverage for Skilled Nursing Facility
For each benefit period, Medicare Part A will cover up to 100 days in a skilled nursing facility. Before receiving skilled nursing coverage, you must meet specific criteria and a physician must deem the care medically necessary.
In 2023, days 1-20 in a skilled nursing facility receive 100% coverage by Medicare Part A. For days 21-100, you are responsible for a $200 copay each day, with Medicare Part A covering the rest.
Medicare Part A Coverage for Hospital Inpatient
Medicare Part A covers up to 90 days of inpatient hospital services per benefit period and offers an additional 60 days in lifetime reserve. So, in the case you receive inpatient hospital care for 150 consecutive days, Medicare Part A will grant you one-time coverage.
In 2023, Medicare Part A requires a $1,600 deductible for the first day you receive hospital inpatient care. This deductible covers you for an additional 59 days.
For days 61-90 of receiving hospital inpatient care, you are responsible for a $400 copayment per day.
After day 90, you begin using your 60 lifetime reserve days. You must pay a $800 copayment per lifetime reserve day.
All Medicare Part A benefits restart for each new benefit period. Thus, when a new benefit period begins, you are responsible for all copayments and deductibles. However, once you use your 60 lifetime reserve days, they do not renew.
Medicare Part A Coverage for Hospice
When it comes to hospice care, Medicare Part A covers services only when deemed medically necessary for terminally ill patients. When a patient receives hospice care, it is only to provide comfort. Hospice care does not include treatment for the terminal illness.
Medicare Part A Coverage for Home Health Care
Medicare Part A covers up to 100 days of home health coverage per benefit period. To receive home health benefits, the patient must require therapy services, and be certified as homebound by a licensed physician.
To receive coverage, the home health agency providing care must be certified by Medicare.
Who is Eligible for Medicare Part A?
To be eligible for Medicare Part A, you must be an American citizen for at least five years. Generally, you must also be at least 65 years of age. However, if you are under 65, you must receive Social Security Disability Income (SSDI) for at least 24 months, or have amyotrophic lateral sclerosis (ALS) or end stage renal disease (ESRD).
However, most people enroll in Medicare Part A at age 65, upon eligibility for Original Medicare. When you first become eligible for Medicare, you get a 7-month Initial Enrollment Period to enroll in Original Medicare. If you enroll outside of this timeframe, you might be responsible for paying a late enrollment penalty.
Keep in mind, if you are receiving Social Security benefits or Railroad Retirement Board benefits, you will automatically enroll in Medicare Part A once you become eligible.
Medicare Part A Costs
If you or your spouse have worked at least ten years paying Medicare taxes, you are eligible for premium-free Medicare Part A. However, this is not the case for everyone enrolling in Medicare Part A.
If you are enrolling in Medicare Part A and have not worked at least 10 years (40 quarters) paying Medicare tax, you must pay the Medicare Part A premium. The Medicare Part A premium is based on how many quarters you worked paying Medicare tax.
In 2023, beneficiaries who pay Medicare tax for fewer than than 7.5 years (30 quarters) will pay a $506 Medicare Part A premium each month. If you worked between 7.5 and 10 years paying Medicare tax, you must to pay a $278 Medicare Part A premium each month.
Aside from the premium, those with Medicare Part A are also responsible for the Medicare Part A deductible. This deductible is a per occurrence deductible of $1,600 out-of-pocket before Medicare Part A begins to cover your hospital services.