Medicare Part A covers inpatient stays at a hospital or skilled nursing facility (SNF). Other areas of coverage include hospice and home healthcare.

A person may enroll in original Medicare (Part A and Part B) if they are aged 65 years or older. Younger people with end stage renal disease or amyotrophic lateral sclerosis (ALS) may also enroll.

Most people are eligible for premium-free Part A because they have 40 work credits. However, people with insufficient work credits can enroll in Part A but may have to pay a monthly premium.

This article provides an overview of Medicare. It also discusses the details of Part A coverage and the differences between Part A and Part B. It also examines Part A eligibility and costs.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

  • Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
  • Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
  • Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

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Medicare is the federal health insurance program for people aged 65 years and older, as well as for younger individuals with certain disabilities or conditions.

The program has the following parts:

  • Original Medicare is Part A, or hospitalization insurance, and Part B, or medical insurance. It does not include prescription drug coverage.
  • Part C, or Medicare Advantage, is an alternative to original Medicare and provides the same basic coverage. Medicare Advantage plans may also offer prescription drug coverage and extra benefits, such as vision, hearing, and dental care.
  • Part D is prescription drug coverage. It is available to people enrolled in original Medicare. Part D plans generally include commonly prescribed medications.
  • Medigap is Medicare supplement insurance, and it is available to people with original Medicare. It pays 50–100% of the parts A and B out-of-pocket costs.

Medicare Part A covers several services, including inpatient care, hospice care, and home healthcare. The following sections will look at each of these aspects in more detail.

Inpatient care

Inpatient care generally involves services that a person receives in a hospital, SNF, psychiatric facility, or rehabilitation facility.

Coverage includes:

  • meals
  • semi-private rooms
  • general nursing
  • medications that a person takes during a stay
  • dietary counseling
  • physical therapy
  • occupational therapy
  • speech therapy
  • medical social services

Coverage does not include:

  • private rooms
  • private-duty nursing
  • room televisions and phones
  • personal care items, such as slipper socks

Hospice

If someone has a life expectancy of 6 months or under, Medicare covers hospice care, including:

  • medical and nursing services
  • pain medication
  • symptom management
  • durable medical equipment
  • nurse aide services
  • social services
  • grief counseling for a person and their family

Coverage also includes short-term inpatient care in a hospice facility or hospital and short-term respite care, which is 5 days of inpatient care to give a person’s regular caregiver a break from their duties.

Home healthcare

Home healthcare may fall under original Medicare Part A, Part B, or both. Most of the time, a home health agency will coordinate the services for an individual. Coverage includes:

  • physical therapy
  • occupational therapy
  • speech therapy
  • part-time nursing care
  • medical social services
  • part-time home health aide services
  • injectable osteoporosis medications

Home healthcare coverage does not include:

  • 24-hour-per-day care
  • custodial services, such as dressing or bathing, when this is the only care that a person needs
  • homemaker services, such as cleaning or shopping, when this is the only care that a person needs
  • meal delivery to the person’s home

The main difference between parts A and B is that Part A involves coverage of inpatient care, while Part B involves coverage of outpatient care.

Part B also covers preventive services, such as screenings and flu shots, as well as the following services and treatments:

  • doctor visits
  • laboratory tests
  • durable medical equipment
  • partial hospitalizations, which provide mental health treatment
  • limited outpatient medications
  • ambulance services
  • clinical research studies

People aged 65 years and older are eligible to enroll in Medicare Part A. Younger individuals with end stage renal disease or ALS are also eligible.

A person may get premium-free Part A if they or their spouse has 40 work credits. People earn these credits when they pay Social Security taxes on their income. People may earn four credits per year, so it takes 10 years of employment to earn 40.

If a person does not have the required work credits for premium-free Part A, they can still enroll if they pay the monthly premium.

If someone has fewer than 30 work credits, their Part A premium will be $471 per month in 2021. If they have between 30 and 39 credits, their Part A premium will be $259 per month in 2021.

Learn more about 40 quarters here.

Part A hospital inpatient costs include:

  • a $1,484 deductible for each benefit period
  • a $0-per-day coinsurance for days 1–60 for each benefit period
  • a $371-per-day coinsurance for days 61–90 for each benefit period
  • a $742-per-day coinsurance for each lifetime reserve day after day 90
  • all costs beyond 60 lifetime reserve days

Part A SNF costs include:

  • a $0-per-day coinsurance for days 1–20 of each benefit period
  • a $185.50-per-day coinsurance for days 21–100 of each benefit period
  • all costs for days 101 and beyond

Parts A and B home health services costs include $0 for home health services and 20% of the Medicare-approved fee for durable medical equipment, such as a hospital bed.

Part A is the hospitalization insurance of original Medicare. A simple way to differentiate it from Part B is that it covers inpatient services, whereas Part B covers outpatient services.

Costs associated with Part A include deductibles and coinsurance. If a person is not eligible for premium-free Part A, the costs will also include the monthly premium.