Medicare is federal health insurance for people aged 65 years or older and for younger people with disabilities. There are four parts of Medicare: A, B, C, and D. Part A covers inpatient care, skilled nursing services, some home health and rehabilitation costs, and hospice care.
Medicare Part A plans are free for people who have worked for 40 quarters and paid Medicare tax.
According to the United States Census Bureau, Medicare plans provided coverage to approximately 17.9% of the population in 2018.
In this article, we define what Medicare Part A covers and its cost.
Medicare Part A covers inpatient hospital stays, including those in a skilled nursing facility.
It also covers some home health services and hospice services. It does not include any doctor fees during a hospital stay, which instead fall under the coverage of Part B.
The chart below summarizes Medicare Part A coverage:
|Inpatient hospital stays||Skilled nursing home services||Home health||Hospice|
|A semi-private room||A semi-private room||Rehabilitation services, such as physical and occupational therapy||Care to manage symptoms and control pain for those with a terminal illness|
|Meals||Meals||Skilled healthcare for people who cannot leave their home||Drugs and medical supplies|
|General nursing care||General nursing care||Drugs and medical supplies||General nursing care|
|Rehabilitation services, such as physical and occupational therapy||Rehabilitation services, such as physical and occupational therapy|
|Drugs and medical supplies||Drugs and medical supplies|
|Care on special units if necessary, such as intensive care|
|Lab and imaging tests and operating room|
When a person reaches 65 years of age, they become eligible for premium-free Part A Medicare if they meet certain conditions.
However, if a person does not qualify for premium-free Medicare Part A, they can buy it. The cost depends on the length of time for which a person paid Medicare taxes during their working years. For example:
Starting at 65 years of age, most people are eligible for Medicare Part A coverage. To be eligible, a person must be a citizen of the U.S. or have been a legal resident for 5 consecutive years.
People below the age of 65 years may meet eligibility requirements based on their medical status.
Medicare Part A eligibility requirements for people under 65 years of age include those collecting Social Security Insurance (SSI) or Railroad Retirement Board (RRB) for 24 months due to a disability.
There are also special rules for people under 65 years of age who have either end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). People with ALS can receive Medicare Part A the first month after qualifying for SSI benefits.
The rules for people with ESRD are more complicated. The waiting period varies according to how long they have been on dialysis, with eligibility beginning after the third month following dialysis. However, if a person has completed self-dialysis training, eligibility starts during the first month.
Coverage will also kick in during the month of a kidney transplant or earlier if a person requires hospitalization 2 months before a kidney transplant to prepare for the procedure.
Medicare Part A enrollment is sometimes automatic, meaning that the individual does not have to take any action to confirm the cover.
If a person is already getting social security, their enrollment in Medicare Part A will take place automatically 3 months before their 65th birthday.
Similarly, people who receive social security disability also receive automatic enrollment at the start of their 25th month of benefits.
People do not receive automatic Medicare enrollment if they are either over 65 years of age or 3 months from reaching 65 years and are not already getting social security. These individuals will need to sign up.
Individuals may apply for Medicare online through the Social Security Administration website or in person at a Social Security office.
The enrollment period for Medicare starts 3 months before a person’s 65th birthday and ends 3 months afterward. There is also an open enrollment period in the fall.
When coverage for Medicare begins will depend on when the person signed up in relation to their 65th birthday.
For example, if a person signs up 3 months before their 65th birthday during the initial enrollment period, coverage will start on the first day of the month during which they reach 65 years of age.
Who qualifies for free Medicare part A?
According to the Centers for Medicare & Medicaid Services, most people do not pay a monthly premium for Medicare Part A coverage. People in the following categories qualify for free Medicare Part A:
- people already getting retirement benefits from the RRB or Social Security
- a person who is eligible for retirement benefits from the above agencies but has not filed yet
- an individual who has Medicare-covered government employment, or their spouse
- a person with ESRD who meets specific requirements
- an individual who receives disability benefits for 24 months
Although a person may qualify for premium-free Medicare Part A, they will still have to pay certain deductibles for some services.
Medicare Part A coverage for 2021 includes inpatient hospital stays, which may take place in:
- acute care hospitals
- long-term care hospitals
- inpatient rehabilitation facilities
- mental health hospitals
2021 Medicare Part A coverage for an inpatient hospital typically includes:
- semi-private rooms
- nursing care
- medical equipment that a doctor uses during the inpatient stay
- rehabilitation services, such as physical therapy
People who use their Medicare Part A coverage for inpatient hospital stays still have to meet their deductible before Medicare funds any treatment. In 2021, this deductible is $1,484.
Once Medicare covers costs, there are often still copayments that depend on the length of stay. For example, Medicare Part A covers the first 60 days of an inpatient stay. However, an individual will have to pay $371 for each additional day between 61 and 90 days.
If an inpatient stay extends beyond 90 days, Medicare provides 60 reserve days that will cost a person $742 a day.
Medicare Part A also covers skilled nursing home stays. However, the rules are different. There is no copayment for the first 20 days of the stay. Between days 21 and 100, the copayment is $185.50 per day.
Medicare Part A does not cover more than 100 days of an inpatient stay in a skilled nursing facility, which means that the individual is responsible for the entire cost after their 100th day in the hospital.
A person can take out supplemental insurance, such as a Medigap plan, to cover costs beyond the limits of Medicare Part A.
Medicare Part A coverage changes yearly. It is essential to stay up to date with each year’s new premiums and deductible.
Federally funded Medicare has four parts: A, B, C, and D.
Part A covers inpatient care, skilled nursing services, some home health and rehabilitation costs, and hospice care. However, it does not cover doctor fees during a hospital stay, as Part B covers those costs.
Part A may be premium-free, depending on certain conditions.
Part C is also known as Medicare Advantage, which is an alternative to original Medicare (Part A and Part B), while Part D provides coverage for prescription drugs.