Medicare Part A is the part of Original Medicare that covers inpatient services. If you enroll in Medicare Part A, you will receive coverage for hospital stays, home healthcare, hospice, etc.
The Medicare Part A premium can be zero-dollar if you meet specific criteria. However, if you do not meet the requirements, you could pay up to $499 the monthly premium for Medicare Part A coverage.
What is Medicare Part A?
Medicare Part A is one of the two parts of Original Medicare. Medicare Part A offers essential inpatient benefits to Medicare enrollees and is available to U.S. citizens over 65 or those with a qualifying disability.
Medicare Part A is not mandatory; however, it is wise to enroll in coverage if you qualify. Medicare Part A often comes at no cost if the beneficiary has paid Medicare taxes throughout their working life. Because of this, if you receive employer coverage after you become eligible for Medicare, you can still enroll in Medicare Part A coverage.
Medicare Part A Coverage
Medicare Part A covers several significant inpatient benefits. Services from hospital meals to rehabilitation therapy are covered by Medicare Part A.
Medicare Part A covered services:
- Hospice Care
- Part-time skilled nursing care
- Rehab services during your hospital stay
- Some blood transfusions
- Hospital meals
- Semi-private rooms
- Special care units
- Operating room and recovery room
Drugs, supplies, and equipment used while inpatient
Medicare Part A does not cover any outpatient services, personal care items, or private nursing in private rooms. Only essential inpatient services are covered when you enroll in Medicare Part A.
Medicare Part A Eligibility
To be eligible for Part A, you must:
- Be an American citizen or documented resident for at least 5 years
And do one of the following:
- Attain 65 years of age
- Receiving Social Security Benefits (SSDI) for at least 24 months
- Diagnosed with Amyotrophic Lateral Sclerosis (ALS)
- Diagnosed with End-Stage Renal Disorder (ESRD)
If you receive Medicare Part A based on disability status, you will automatically be eligible for Part A with zero-premium. If you become eligible for Medicare Part A at age 65, you will only be eligible for zero-premium if you have worked at least ten years paying Medicare tax.
Medicare Part A Premium Costs
If you qualify for Medicare Part A with a zero-dollar premium, you will still be responsible for Medicare Part A cost-sharing. However, if you do not qualify for a zero-dollar premium, you will be required to pay a monthly premium for Medicare Part A coverage.
The Medicare Part A premium is based on how many years you or your spouse worked and paid Medicare tax. The chart below depicts your Medicare Part A premium based on years worked in the United States.
|2022 Medicare Part A Monthly Premium Costs|
|Time worked Paying Medicare Tax:||Medicare Part A Premium Cost:|
|More than ten years||$0/ month|
|Between 7.5 and 10 years||$274/ month|
|Fewer than 7.5 years||$499/ month|
If you delay Medicare Part A benefits without creditable coverage, you may be responsible for the Medicare Part A late enrollment penalty. Creditable coverage is coverage that covers at least as much as Original Medicare. If you are still employed, employer group coverage is the most common form of Creditable coverage.
If you do not have creditable coverage, the late enrollment penalty adds 10% to your monthly premium for twice the years (12-month periods) you go without Medicare Part A coverage.
For example, if Tom becomes eligible for Medicare Part A in December 2018 but did not enroll in coverage until January 2022, during the General Enrollment Period, he will receive a 30% premium increase for six years when his coverage goes active in July for the three 12-month periods he went without coverage.
Medicare Part A Deductible and Cost-sharing
Each time you use Medicare Part A benefits, you are responsible for the Part A deductible, coinsurance, and copayments. In 2022, the Medicare Part A deductible is $1,556.
The Medicare Part A deductible is a per-occurrence deductible charged each time you visit the hospital for a new benefit period. A new benefit period begins once the beneficiary is out of care for 60 consecutive days. Once a new benefit period begins, you are responsible for the deductible as coinsurance amounts again.
When you are admitted to the hospital, Medicare Part A will cover a specific amount per day you are admitted. The chart below outlines Medicare Part A copayments for each day you are admitted to the hospital during a benefit period.
|2022 Medicare Part A Copayments|
|Length of stay||Your copayment|
|Days 1-60||$0 (fully covered)|
|60 Lifetime reserve days||$778|
|Additional days per benefit period||100% of the cost (not covered)|
After day 90, Medicare Part A will cover up to 60 lifetime reserve days with a $778 copay. Lifetime reserve days are only eligible to be used once in your lifetime. So, once you use these days, they cannot be reused.
For example, if your hospital stays lasts 130 days, the first 90 days are covered by Medicare Part A. Then you can use 40 lifetime reserve days during this benefit period. Additionally, if another benefit period lasts 115 days, Medicare Part A will cover the first 90 days and you can use your left over 20 lifetime reserve days. However, you will be responsible for the total cost of the additional five days during this benefit period.
After using all of your lifetime reserve days, you are responsible for 100% of the costs after day 90 for a single benefit period.
To help cover the costs that Medicare Part A does not cover, many beneficiaries enroll in a Medicare Supplement plan. Several top Medicare Supplement plans cover the full Medicare Part A deductible and copayment for each benefit period.
How to Enroll in Medicare Part A
The first chance you receive to enroll in Medicare Part A is during your Initial Enrollment Period. If you enroll during this time, coverage will go active on the first day of your 65th birth month or the first day of the 24th month you receive SSDI benefits, depending on how you become eligible.
Suppose you do not enroll during your Initial Enrollment Period. In that case, you will need to wait until the Medicare General Enrollment Period or until you lose creditable coverage and are eligible for a Special Enrollment Period.