Medicare Part A Coverage: An Expert Guide (2024)
What is Medicare Part A? Medicare Part A is one of the main parts of Medicare that covers inpatient hospital care and more. Some people will qualify for premium-free Medicare Part A, but others may have to pay a premium of $274 or $499 per month. You may be eligible for Medicare Part A automatically, or you will have to apply through Social Security or the Railroad Retirement Board.
Read moreFree Medicare Insurance Comparison
Compare Quotes From Top Companies and Save
Secured with SHA-256 Encryption
Tim Bain
Licensed Insurance Agent
Tim Bain is a licensed life insurance agent with 23 years of experience helping people protect their families and businesses with term life insurance. His insurance expertise has been featured in several publications, including Investopedia and eFinancial. He also does digital marking and analysis for KPS/3, a communications and marking firm located in Nevada.
Licensed Insurance Agent
UPDATED: Nov 10, 2023
It’s all about you. We want to help you make the right coverage choices.
Advertiser Disclosure: We strive to help you make confident insurance decisions. Comparison shopping should be easy. We are not affiliated with any one insurance provider and cannot guarantee quotes from any single provider.
Our insurance industry partnerships don’t influence our content. Our opinions are our own. To compare quotes from many different insurance companies please enter your ZIP code on this page to use the free quote tool. The more quotes you compare, the more chances to save.
Editorial Guidelines: We are a free online resource for anyone interested in learning more about insurance. Our goal is to be an objective, third-party resource for everything insurance related. We update our site regularly, and all content is reviewed by insurance experts.
UPDATED: Nov 10, 2023
It’s all about you. We want to help you make the right coverage choices.
Advertiser Disclosure: We strive to help you make confident insurance decisions. Comparison shopping should be easy. We are not affiliated with any one insurance provider and cannot guarantee quotes from any single provider.
Our insurance industry partnerships don’t influence our content. Our opinions are our own. To compare quotes from many different insurance companies please enter your ZIP code on this page to use the free quote tool. The more quotes you compare, the more chances to save.
On This Page
- Medicare Part A is one of the four main parts of Medicare that covers hospital care
- Medicare Part A may cover inpatient hospital care, skilled nursing facility (SNF) care, nursing home care, hospice care, and home health care
- Most people qualify for Medicare Part A without having to pay a premium, but they may still have to pay deductibles, coinsurance, and copayments
Medicare consists of four main parts – Medicare Part A, Medicare Part B, Medicare Part C, and Medicare Part D. Some health insurance companies also provide supplemental Medicare plans.
When you sign up for Medicare, you should have a basic understanding of the coverage that each part covers. Read more below to get answers to the question, “What is Medicare Part A?”
Enter your ZIP code into our free quote comparison tool above to find health insurance or a supplemental Medicare plan from a company near you.
Table of Contents
What is Medicare Part A?
Medicare Part A is one of the four parts of Medicare that provides inpatient or hospital care coverage. Medicare Part A and Medicare Part B make up what is known as Original Medicare (also known as Traditional Medicare or Fee-for-Service Medicare).
Medicare is a health insurance program for people over the age of 65. However, some people younger than 65 may qualify for Medicare if they have a disability or permanent kidney failure.
Are you looking for free insurance quotes?
Your one-stop online insurance guide. Get free quotes now!
Secured with SHA-256 Encryption
What does Medicare Part A cover?
Medicare Part A covers the following:
- Inpatient hospital care if a doctor deems it necessary to treat an injury or illness.
- Skilled nursing facility (SNF) care if you have already had a qualifying hospital stay and still have days left in your benefit period.
- Long-term hospital care for people who need more than 25 days of care.
- Nursing home care, if it is not custodial care or long-term care.
- Hospice care if you are terminally ill and you sign away your rights to Medicare coverage for other treatments.
- Eligible home health care after a hospital stay including, but not limited to, part-time skilled nursing care, physical therapy, occupational therapy, speech-language pathology services, medical social services, and more.
If you wonder if Medicare covers a specific product or service, you can begin by discussing your options with your doctor. Your doctor may be able to help you find something that is covered.
You can also use the Medicare coverage search to learn the details of your coverage.
Medicare coverage is based on federal and state laws, national coverage decisions from Medicare, and coverage decisions made by companies that process Medicare claims.
How much does Medicare Part A cost?
Is Medicare Part A free? In some cases, individuals can receive Medicare Part A without paying a premium, sometimes known as premium-free Medicare.
Who qualifies for free Medicare Part A? Most people will be eligible for premium-free Medicare.
If you are 65 and receive retirement benefits, are eligible to receive retirement benefits, or you or your spouse had Medicare-covered government employment, you will receive premium-free Medicare.
If you are under 65 and have received disability benefits for at least 24 months or have End-Stage Renal Disease, you will receive premium-free Medicare.
If you do not qualify for premium-free Medicare Part A, you can pay a premium of $274 or $499 per month in 2022, depending on how long you or your spouse worked and paid Medicare taxes. If you go this route, you will also have to purchase Medicare Part B.
Even if you qualify for premium-free Medicare Part A, you may still have to pay a health care deductible, copayment, or coinsurance.
For inpatient hospital care, the deductible is $1,556 in 2022 for each benefit period. For days 1-60, you do not have to pay coinsurance. For days 61-90, you have to pay $389 per day. For over 90 days, you have to pay $778 per day for up to 60 days, after which you will have to pay all costs.
The costs of long-term hospital care are the same as inpatient hospital care. However, you will not have to pay an additional deductible if you are admitted to the long-term hospital facility within the same benefit period as a regular hospital stay.
There is no deductible for skilled nursing facility (SNF) care. For days 1-20, you do not have to pay coinsurance. For days 21-100, you have to pay $194.50 per day in 2022. For over 100 days, you will have to pay all costs.
There is no deductible or coinsurance for hospice care. However, you may have to pay a $5 copayment for some outpatient drugs and 5% of the Medicare-Approved Amount for inpatient respite care.
There are no costs associated with home health care, but you may have to pay 20% of the Medicare-Approved Amount for durable medical equipment (DME). If you face any costs out-of-pocket, the home health care agency should notify you of this beforehand.
How do I receive Medicare Part A?
If you don’t qualify for premium-free Medicare Part A, you must sign up and pay the premium. However, if you are eligible for premium-free Medicare Part A, you may receive it automatically or need to sign up for it manually.
To receive Medicare Part A automatically, you will need to receive social security or disability benefits from Social Security or the Railroad Retirement Board. Your application for these benefits will also serve as your Medicare application.
Suppose you need to apply for Medicare manually. In that case, you can complete the forms online, call Social Security at (800) 772-1213, contact your local Social Security office, or contact the Railroad Retirement Board at (877) 772-5772 if you or your spouse worked for a railroad.
If you need to purchase health insurance or a Medicare supplement plan, enter your ZIP code into our free quote comparison tool below to find a plan that works for you.
Are you looking for free insurance quotes?
Your one-stop online insurance guide. Get free quotes now!
Secured with SHA-256 Encryption
Case Studies: Medicare Part A Coverage
Case Study 1: Aetna Health Insurance
John, a Medicare beneficiary enrolled in Aetna Health Insurance, experienced an unexpected hospitalization. As he required an extended stay, John relied on his Medicare Part A coverage for inpatient hospital services. This case study delves into John’s journey, outlining the process of navigating Medicare coverage while managing his health and financial obligations.
Case Study 2: Blue Cross Blue Shield
Sarah, a Medicare beneficiary covered under Blue Cross Blue Shield, underwent surgery and required rehabilitative care at a skilled nursing facility. This case study explores the intricacies of Medicare Part A coverage for post-hospitalization care, highlighting Sarah’s experience with coordination of benefits, coverage limitations, and the duration of skilled nursing facility services.
Case Study 3: UnitedHealthcare
Mark, a Medicare beneficiary enrolled with UnitedHealthcare, reached a point in his illness where he needed hospice care. This case study delves into Mark’s journey through the Medicare Part A coverage for hospice services, discussing the eligibility criteria, the role of the interdisciplinary hospice team, and the financial aspects of end-of-life care.
Case Study 4: Humana
Maria, a Medicare beneficiary with Humana coverage, required home health services after a major surgery. This case study explores Maria’s experience with Medicare Part A coverage for home health services, including the eligibility criteria, covered services, and the coordination of care between healthcare professionals and Medicare-certified agencies.
Case Study 5: Cigna
Robert, a Medicare beneficiary with Cigna, required intensive inpatient rehabilitation services following a severe stroke. This case study explores his experience with Medicare Part A coverage for inpatient rehabilitation, emphasizing the significance of meeting criteria, coverage duration, and the role of healthcare professionals in optimizing rehabilitation outcomes.
Frequently Asked Questions
What is Medicare Part A?
Medicare Part A is one of the main parts of Medicare that covers inpatient hospital care and more. Some people will qualify for premium-free Medicare Part A, but others may have to pay a premium of $274 or $499 per month. You may be eligible for Medicare Part A automatically, or you will have to apply through Social Security or the Railroad Retirement Board.
Pros:
- Provides coverage for inpatient hospital care.
- Some individuals may qualify for premium-free Medicare Part A.
- Offers financial protection against high medical costs.
Cons:
- Not all services and treatments are fully covered.
- Premiums and out-of-pocket costs may apply.
- Limited coverage for outpatient services.
What does Medicare Part A cover?
Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and limited home health care services. It includes services such as hospital stays, surgeries, nursing care, and some medications.
Pros:
- Covers hospital stays, surgeries, and other inpatient services.
- Provides skilled nursing facility care.
- Includes hospice care for individuals with terminal illnesses.
Cons:
- Limited coverage for home health care services.
- Does not cover most outpatient services.
- Certain limitations and restrictions may apply.
How much does Medicare Part A cost?
Medicare Part A may be premium-free for most individuals who have worked and paid Medicare taxes for a certain period. However, those who don’t qualify for premium-free Part A may have to pay a monthly premium of $274 or $499, depending on their work history. There are also deductibles, coinsurance, and copayments associated with Part A.
Pros:
- Premium-free for most individuals.
- Affordable premiums for those who don’t qualify for premium-free Part A.
- Provides financial protection against high hospital costs.
Cons:
- Premiums, deductibles, coinsurance, and copayments may still apply.
- Costs can vary depending on individual circumstances.
- Limited coverage for certain services may require additional out-of-pocket expenses.
How do I receive Medicare Part A?
If you qualify for premium-free Medicare Part A, you may receive it automatically when you become eligible for Medicare. If not, you will need to sign up for it manually. To receive Medicare Part A, you can apply online, call Social Security, visit your local Social Security office, or contact the Railroad Retirement Board.
Pros:
- Automatic enrollment for those who qualify for premium-free Part A.
- Various application methods available for manual enrollment.
- Social Security and Railroad Retirement Board can assist with the application process.
Cons:
- Manual enrollment may require additional paperwork and time.
- Eligibility criteria must be met to receive automatic enrollment.
- Limited window for initial enrollment, and late enrollment penalties may apply.
Can I purchase supplemental Medicare plans?
Yes, you can purchase supplemental Medicare plans, also known as Medigap plans, from private insurance companies. These plans help cover the out-of-pocket costs associated with Medicare Part A and Part B, such as deductibles, coinsurance, and copayments.
Pros:
- Provides additional coverage for out-of-pocket costs.
- Offers more comprehensive coverage than Original Medicare alone.
- Allows you to choose from a variety of plans and insurance providers.
Cons:
- Requires payment of monthly premiums in addition to Medicare premiums.
- Plan availability and costs can vary depending on your location.
- Not all services and treatments may be covered by supplemental plans.
Are you looking for free insurance quotes?
Your one-stop online insurance guide. Get free quotes now!
Secured with SHA-256 Encryption
Tim Bain
Licensed Insurance Agent
Tim Bain is a licensed life insurance agent with 23 years of experience helping people protect their families and businesses with term life insurance. His insurance expertise has been featured in several publications, including Investopedia and eFinancial. He also does digital marking and analysis for KPS/3, a communications and marking firm located in Nevada.
Licensed Insurance Agent
Editorial Guidelines: We are a free online resource for anyone interested in learning more about insurance. Our goal is to be an objective, third-party resource for everything insurance related. We update our site regularly, and all content is reviewed by insurance experts.