Medicare Part A

Medicare Part A is essentially hospital insurance. It covers expenses related to inpatient hospital stays, including services from hospitals, skilled nursing facilities, hospice care, and certain home health services.

What services does Medicare Part A cover? While it includes many types of care, it doesn’t always cover the full cost. Here’s a breakdown:

Benefits under Part A are managed in 60-day periods. Initially, you must meet a deductible, which was $1,408 in 2020. After this, your first 60 days in the hospital are fully covered. If you stay beyond 60 days, you’ll face coinsurance charges: $352 per day for days 61-90, and $704 per day for days 91-150. Coverage stops after 150 days. Once you have been out of the hospital for 60 days, your coverage resets for future admissions.

Part A also covers up to 190 days of inpatient psychiatric care during your lifetime. Services provided during a hospital stay include a semi-private room, meals, nursing care, medications, medical supplies, lab tests, and rehabilitation services. However, amenities such as private rooms or personal care items are not covered.

Medicare Part A provides coverage for up to 100 days of skilled nursing care following a hospital stay. The first 20 days are fully covered, while days 21-100 require a coinsurance payment of $176 per day (as of 2020). You must enter the nursing facility within 30 days of hospitalization for the same condition, and care must be medically necessary and prescribed by a doctor.

Custodial care, which includes assistance with daily activities, is not covered under Part A

Part A offers hospice care for those diagnosed as terminally ill. This care focuses on comfort and includes counseling, medical equipment, and necessary prescriptions. You must agree to palliative care instead of curative treatments. Coverage is provided in 90-day increments, requiring re-certification by a doctor after each period. While there is no deductible for hospice care, you may have a small copayment for medications.

If you require home health care, Medicare may cover these services under Part A or Part B, depending on your situation. Coverage includes skilled nursing care and therapy, but personal care services like bathing or dressing are not included. Medicare typically covers 100% of nursing and therapy services.

Certain services and items are not covered by Part A, such as:

To qualify for Part A, you must be 65 or older and a U.S. citizen or permanent resident. Younger individuals may also qualify due to disabilities or specific health conditions. Most people who meet these criteria can access Part A without a monthly premium, as long as they or their spouse have paid Medicare taxes for at least 10 years.

Enrollment in Part A occurs automatically for those already receiving Social Security or Railroad Retirement Board benefits. Others should apply during their Initial Enrollment Period, which lasts seven months—three months before, the month of, and three months after their 65th birthday.

It’s crucial to apply during your Initial Enrollment Period to avoid penalties. If you miss this window, you can enroll during the General Enrollment Period from January 1 to March 31 each year, with coverage starting July 1.

If you qualify for premium-free Part A, enrolling is generally beneficial, as you have already contributed through taxes during your working years. Even if you have other health coverage, Medicare can serve as secondary insurance, covering services not included in your primary plan.