Close  

Medicare Part A Coverage and Benefits


Original Medicare is made up of two parts: Medicare Part A and Part B. Your Medicare Part A coverage provides protection for hospital inpatient care, skilled nursing facilities, hospice, and home health care.

Find Medicare Plans in 3 Easy Steps

We can help find the right Medicare plans for you today

For most seniors receiving Medicare Part A benefits, the coverage has a $0 monthly premium. However, you must meet certain criteria. If not, you may need to pay a premium each month.

Below, we discuss everything you need to know about Medicare Part A, including eligibility, coverage, enrollment, and more.

What is Medicare Part A?

Medicare Part A is basic inpatient coverage that you can use during hospital stays. To enroll in Medicare Part A coverage, you must be a United States citizen or legal resident of at least five years. Additionally, you must be 65 years old, receive Social Security Disability Income (SSDI) for at least 24 months, or have a diagnosis of amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD).

Medicare Part A Coverage

Most people will be eligible for zero-premium Medicare Part A. However, not everyone qualifies for this perk. To be eligible for premium-free Medicare Part A coverage, you or your spouse must work at least ten years (40 quarters) paying Medicare tax.

If you do not meet this requirement, Medicare Part A benefits could cost up to $506 a month in 2023. Additionally, the premium is subject to increase each year.

What Does Medicare Part A Cover?

Medicare Part A (hospital insurance) covers various healthcare services that take place in a hospital and inpatient care. Part A of Medicare also covers services such as an overnight stay in the hospital or drugs the hospital administers during your stay.

Hospital care costs can quickly add up. There are many charges that can add to your bill, including things such as meals and medical supplies necessary for your care, that may be taken for granted.

Your Medicare Part A coverage focuses on helping you protect against these medical expenses but will also deliver healthcare that doesn’t require a hospital stay.

Medicare Part A also covers other inpatient care, including end-of-life hospice care or skilled nursing services.

Together with Medicare Part B, your Part A coverage makes up Original Medicare and serves as the foundation of your coverage. Below, we review the healthcare services Medicare Part A covers.

What is covered under Medicare Part A?

  • Hospital meals
  • Semi-private room
  • Special care units
  • Drugs, supplies, and equipment
  • Operating room and recovery room
  • Rehabilitation services during your stay
  • Some blood transfusions
  • Hospice care
  • Skilled nursing care on a part-time basis

Medicare Part A will not cover a private room, private nursing, or any personal care items.

Find Medicare Plans in 3 Easy Steps

We can help find the right Medicare plans for you today

Do You Pay for Medicare Part A?

The Medicare Part A premium is based on how many quarters you worked in the United States and paid Medicare tax. If you worked and paid Medicare tax for ten or more years (40 or more quarters), you will qualify for premium-free Part A.

Your Monthly Part A Premium Costs

On the other hand, if you or your spouse did not work for at least ten years in the United States paying Medicare tax, you will not be eligible for premium-free Medicare Part A. In this case, you could be responsible for up to $506 each month in Medicare Part A premiums.

If you did not work for at least ten years paying Medicare tax, the premium you pay is based on the number of years you did work. If you worked more than 7.5 years but fewer than ten, your Medicare premium is $278 each month. Those with fewer than 7.5 years of contributing to Medicare taxes are responsible for the full Medicare Part A premium of $506 monthly.

What is the Medicare Part A Deductible?

The Medicare Part A deductible in 2023 is $1,600, according to CMS.gov. This is not a calendar year deductible. You are responsible for paying the deductible each time you are admitted to the hospital under a new benefit period.

To receive help covering this deductible, many seniors enroll in a Medicare Supplement plan. The Medicare Part A deductible benefit period begins when you become an inpatient in the hospital.

Then, the benefit period continues until you’re out of the hospital for a minimum of 60 days. Any care in a skilled nursing facility after your hospital stay counts toward the benefit period.

Every time a new benefit period starts, you must meet your Medicare Part A deductible. Meaning, if you are out of the hospital for at least 60 days and then need to be re-admitted, you must meet the deductible again.

Medicare Part A Out-of-Pocket Costs

After you meet the Medicare Part A deductible, Medicare hospital coverage pays the first 60 days of your benefit period in full.

For days 61-90, you must pay a hospital coinsurance of $400 per day. Then, Medicare will cover up to 60 extra lifetime reserve days.

Find Medicare Plans in 3 Easy Steps

We can help find the right Medicare plans for you today

For days 91 and beyond, the coinsurance is $800 per day. After you stay 60 days beyond your lifetime benefit, ALL costs are your responsibility.

What You Will Pay for a Hospital Stay with Medicare Part A

To start a new benefit period, you must stay out of the hospital for at least 60 consecutive days. Additionally, beginning another benefit period means paying the Medicare Part A deductible again.

How Do You Qualify for Medicare Part A?

U.S. citizens and documented immigrants who legally reside in the U.S. for at least five years qualify for Medicare Part A coverage. Most U.S citizens are eligible for Medicare Part A upon turning 65. However, many seniors qualify for Medicare Part A due to disability.

If you receive Social Security Disability Income (SSDI) benefits, you become eligible for premium-free Medicare Part A after two years of receiving those benefits. Also, if you or your spouse has Medicare-covered government employment, you get premium-free Medicare Part A.

Seniors with amyotrophic lateral sclerosis do not need to wait two years before becoming eligible for Medicare. Medicare Part A and Medicare Part B benefits begin immediately and automatically. Those with ESRD can apply upon diagnosis, but Medicare enrollment isn’t automatic.

When Should I Enroll in Medicare Part A?

You should sign up for Medicare Part A benefits three months before you turn 65. Even if you’re working past retirement, Medicare Part A is still premium-free if you or your spouse previously worked at least 40 quarters.

In addition, when you should enroll in Medicare Part A depends on whether your employer is large or small. When you work for a small employer, you may need Medicare Part A and Part B as soon as you’re Medicare-eligible. It is best to talk to the benefits administrator at your place of employment to figure out your options.

Find Medicare Plans in 3 Easy Steps

We can help find the right Medicare plans for you today

FAQs About Medicare Part A

How many times can I pay the Medicare Part A deductible in one year?
The Medicare Part A deductible is per benefit period. So, each new benefit period means you are responsible for the deductible again. Because a benefit period can last up to 60 days, the worst-case scenario is six benefit periods per year.
Are you automatically enrolled in Medicare Part A when you turn 65?
If you are collecting Social Security benefits, you will automatically enroll around the month prior to your birthday. If you are not collecting your Social Security benefits yet, you will need to call the Social Security office to enroll.
How can I receive help paying the Medicare Part A deductible?
To receive help with the Medicare Part A deductible, most seniors enroll in a Medicare Supplement plan. This will help cover all costs Original Medicare leaves behind.

How to Get Help With Medicare Part A

Are you confused about inpatient vs. outpatient? Do you find choosing a policy difficult? We understand! Working with clients like you each day, we know how confusing Medicare seems. Our agents can help simplify the information and show you the best options for your Medicare Part A benefits.

We can even walk you through the application process over the phone. Your agent will ask you a few questions about doctors, prescriptions, and insurance preferences. Then, they will discuss the best plan options for you available in your service area. There are many plans and carriers for supplemental Medicare coverage – don't waste time calling each company individually.

Don't navigate the Medicare Part A maze alone. Give us a call at the number above and see why so many people trust an agent with their health care. Can't call now? Fill out our online rate comparison form and get one step closer to the best coverage for you!

Enter ZIP Code

Enter ZIP Code

Enter your ZIP code to pull plan options available in your area.

Compare Plans

Compare Plans

Select which Medicare plans you would like to compare in your area.

Get Quote

Get Quote

Compare rates side by side with plans & carriers available in your area.

Sources:

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. What Part A Covers, Medicare.gov. Accessed February 2022.
    https://www.medicare.gov/what-medicare-covers/what-part-a-covers
  2. Original Medicare Eligibility and Enrollment, CMS. Accessed February 2022.
    https://www.cms.gov/Medicare/Eligibility-and-Enrollment/OrigMedicarePartABEligEnrol
  3. An Overview of Medicare, KFF. Accessed February 2022.
    https://www.kff.org/medicare/issue-brief/an-overview-of-medicare/

Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

8 thoughts on “Medicare Part A Coverage and Benefits

  1. So where do I find the most current INPT only list for surgery? And so starting Jan 1 it doesn’t matter if the Surgery is on the list or not? If pt needs INPT care and it is not on the list you can still do INPT?

    Comment

    Your email address will not be published.