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.

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).

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.

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.

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.

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.

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.

You’ll want to be sure you enroll in Medicare Part A as soon as you are eligible. If not, you may be responsible for the Medicare Part A late enrollment penalty. 

FAQs About Medicare Part A