Key takeaways
- Medicare Part A helps cover the costs of inpatient hospital stays, skilled nursing facility care, hospice care, and some at-home healthcare services.
- While some individuals are automatically eligible for premium-free Part A, others may be required to pay a monthly premium based on their work history and Medicare tax contributions.
- In addition to premiums, Part A enrollees may also be responsible for deductibles and copayments, which can vary depending on the length of stay and type of care needed.
Medicare Part A plans are free for individuals who have worked for 40 quarters and paid Medicare taxes. Individuals who do not qualify need to pay a monthly premium.
Medicare is federal health insurance for individuals ages 65 years or older and for younger people with certain disabilities. It has four parts: A, B, C, and D.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Part A covers inpatient care, including care that is given in:
It also covers hospice care and some home health services.
Medicare Part A coverage chart
| Category | What it covers |
|---|---|
| Inpatient hospital stays | • a semiprivate room • meals • general nursing care • drugs and medical supplies • other hospital services and supplies that doctors deem necessary for inpatient treatment |
| Skilled nursing home services | • a semiprivate room • meals • skilled nursing care • rehabilitation services, such as physical, occupational, and speech therapy • drugs and medical supplies • ambulance transportation to the hospital, if necessary • dietary counseling |
| Home healthcare | • rehabilitation services, such as physical, occupational, and speech therapy • skilled healthcare for those who cannot leave their home • drugs and medical supplies |
| Hospice | • care to manage symptoms and pain for those with an end stage illness • drugs and medical supplies • general nursing care |
Medicare Part A does not cover:
- a private room unless medically necessary
- private-duty nursing
- the cost of a television or phone in the room
- personal care items, such as razors or slippers
When a person reaches 65 years of age, they become eligible for premium-free Part A Medicare if they meet certain criteria.
This criterion includes a person or their spouse working for at least 10 years and paying Medicare taxes.
If someone does not qualify for premium-free Medicare Part A, they can buy it. The cost depends on how long they or their spouse worked and paid Medicare taxes.
Medicare Part A deductibles and copayments
People who use their Medicare Part A coverage for inpatient hospital stays must still meet their deductible before Medicare will pay for any treatment. This deductible changes annually.
However, even when Medicare covers costs, an individual may still have to pay copayments, depending on the length of their stay.
For example, Medicare Part A covers the first 60 days of an inpatient stay. However, between days 61 and 90, a person must pay a set coinsurance amount per day.
If an inpatient stay extends beyond 90 days, Medicare provides 60 lifetime reserve days. If a person uses these days, they will be responsible for a higher coinsurance amount per day.
Medicare Part A covers skilled nursing home stays with different costs. There is no copayment for the first 20 days of the stay. Between days 21 and 100, the individual is responsible for a daily copayment.
Medicare Part A does not cover more than 100 days of an inpatient stay in a skilled nursing facility. This means after the 100th day in the hospital, the individual is responsible for the entire cost.
For hospice care, individuals may be responsible for around 5% of the Medicare-approved amount for respite care. They may also have to pay a copayment for each prescription drug.
Help with Part A costs
A person can purchase a supplemental insurance (Medigap) plan from a Medicare-approved private insurance company to help cover costs associated with Original Medicare (parts A and B).
Most people become eligible for Medicare Part A coverage once they reach 65 years of age. They must also be a citizen or permanent resident of the United States.
Medicare Part A eligibility requirements for individuals under the age of 65 include those receiving Social Security Disability Insurance (SSDI) or Railroad Retirement Board (RRB) benefits for at least 24 months due to a disability.
There are also special rules for people under age 65 years with either end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). Those with ALS can receive Medicare Part A the first month after qualifying for SSDI benefits.
The rules for people with ESRD are more complicated. The waiting period varies according to how long the individual has been on dialysis, with eligibility beginning after the third month following the start of dialysis.
However, if a person has completed self-dialysis training, eligibility starts during the first month.
Coverage will also begin 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 resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
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.
Part A may be premium-free, depending on certain criteria. However, individuals are still responsible for deductibles and copayments for inpatient stays.