If you are enrolled in Medicare, you are likely enrolled in Part A coverage. Some people choose to do without Part B coverage since there is a monthly premium associated with it. Still, nearly everyone enrolls in Part A.
Medicare Part A, also known as hospital insurance, covers many things related to hospital stays. However, it covers several other items as well. So, just what does Medicare Part A cover?
Keep reading as we provide all the details. We will tell you what is covered by Part A and what is not, and we’ll also give you an overview of the other parts of Medicare. So, let’s get started.
What Does Medicare Part A Cover?
Original Medicare consists of two parts: Medicare Part A and Medicare Part B. So, what is Part A Medicare? Part A is traditionally known as hospital insurance. It covers hospital stays and other inpatient care.
Part B, known as traditional medical insurance coverage, covers doctor visits, lab tests, and preventive care. Since we are focused on Part A coverage in this article, let’s dive deeper into the details of Part A coverage.
Hospital and Inpatient Care
As mentioned, your Medicare Part A will cover hospital stays and other inpatient care. Typically, this requires at least one night’s stay in the facility. Once you have been admitted to the hospital, Part A also covers any necessary tests or treatments for your care. In addition to hospital stays, Part A will also cover care in a skilled nursing facility. Many people might require a short stay in a skilled nursing facility upon their release from the hospital. Part A will pay for this stay if the facility qualifies as a skilled nursing facility.
Hospice and Mental Health Care
Part A also provides coverage for hospice care and some home health care, but this coverage is limited to medically necessary home health care. Finally, Part A will pay for inpatient mental health care. Most Part A coverage is subject to deductibles and coinsurance or copayment amounts. We will discuss the costs of Part A coverage in more detail later in this article.
KEY TAKEAWAYS
- Medicare Part A is also known as hospital insurance. It covers hospital and inpatient care, hospice care, home health, and inpatient mental health care.
- Even though Medicare Part A covers hospital stays, it does not pay for a private room. It does not cover nursing homes, assisted living facilities, prescription drugs, doctor visits, or preventive care.
- Many people think Medicare is free, but that is not the case. Most people receive Medicare Part A premium-free but will still have deductible and copay costs.
What Does Medicare Part A Not Cover?
Now that you know what is covered by Medicare Part A, it is helpful to understand the items that are not covered by Part A. Some of these things might seem like services that would be included in Medicare coverage, but they are not. Here are some of the things that are not covered by Medicare Part A.
Private Rooms
First, Medicare Part A does not cover private rooms in the hospital. Although it will pay for your hospital stay, the coverage is limited to a semi-private room only. You would be responsible for paying any additional charges related to a private room in the hospital.
Nursing Home or Assisted Living Facility
Next, Part A does not pay for long-term care in a nursing home or assisted living facility. If you need long-term care in a nursing home or other facility, you must pay for that on your own. Part A only covers short-term care in a skilled nursing facility.
Other Items
Medicare Part A also does not cover your first three pints of blood during a medical procedure. Medicare will cover the additional amount if you need more than three pints. Many people choose to purchase a Medigap policy or Medicare supplement insurance to get assistance with this type of coverage.
Finally, Part A does not cover items that are covered by other parts of Medicare, like prescription drug coverage, doctor visits, preventive care, and others.
Must read articles related to Medicare
- Steps to sign up for Medicare
- What documents do I need to apply for Medicare?
- How much do Medicare Part B premiums cost?
- Is there a benefit to enrolling in Medicare Part D prescription drug coverage?
- Leveraging the Medicare Part B give-back benefit to reduce premiums.
Overview Of The Parts Of Medicare
Medicare consists of several different parts, and it is helpful to understand the differences. While Original Medicare consists of Part A & B, you might also hear people discuss Medicare Part C or D coverage. If you are wondering, “What does Medicare pay for,” the answer often depends on which part of Medicare you are referring to. Here is what you need to know about each part of Medicare.
TIP
Original Medicare consists of Parts A and B, each covering different medical conditions. If you need prescription coverage, you will need to add Part D coverage or a Medicare Advantage plan (Part C).
Costs Associated With Medicare Part A
Many believe they will have no health care costs once they enroll in Medicare coverage. However, that is not a valid statement! While many people qualify for premium-free Part A coverage, there are other costs with Medicare Part A. Depending on income, some people must pay a premium for Part A coverage, which is either $285 or $518 per month.
Deductible Costs
The deductible is one of the most significant costs associated with Part A coverage. A deductible of $1,676 will apply for each benefit period. You must pay this amount out of your pocket before Medicare starts to pay anything. Also, this deductible applies to each benefit period and is not limited to each calendar year. It is possible to have more than one benefit period per year, so you might need to pay this deductible multiple times within a single calendar year.
Copay Costs
You will have no copay for the first 60 days of hospital stays. However, you will have a copay of $419 per day for days 61 through 90. For days 91-150, you will be responsible for a copayment of $838 per day. If you have an extended stay in the hospital, these amounts could add up very quickly! Thankfully, there is no copay associated with covered home health care services.
Medicare Part A Eligibility & Enrollment
The eligibility requirements for Medicare are not that difficult to meet. You must be 65 or older, be a U.S. resident, or be a U.S. citizen or a permanent resident who has resided in the country for at least five continuous years.
If you have enough work credits and have paid Medicare taxes while working, you can qualify for premium-free Part A coverage. Part B coverage is optional, but you must pay a premium.
If you already receive Social Security benefits upon turning 65, you will be automatically enrolled in Medicare coverage. Those not already receiving Social Security must sign up for Medicare benefits. The application can be completed online or in person.
The Bottom Line
Medicare Part A is considered hospital insurance, covering hospital stays, short-term care in a skilled nursing facility, inpatient mental health care, hospice care, some home health care, and other inpatient services.
Part A does not cover nursing home or assisted living facility care. You might be surprised that neither Medicare nor Medicaid covers assisted living stays. Most people receive Part A at no cost, although you will have to pay a monthly premium if you don’t have enough work credits.
If you have questions about coverage, you can always contact Medicare or ask your healthcare provider.
Frequently Asked Questions
Medicare Part A does cover some services at 100%. After you have met your deductible, Part A will cover the first 60 days of your hospital stay at 100%. Similarly, Part A covers hospice care and home health care services at 100%.
Lastly, Part A covers the first 20 days of your stay in a skilled nursing facility at 100%. Services beyond those mentioned here generally require a copayment. For example, days 61 through 90 of a hospital stay require a copay of $389 per day.
The most significant difference between Medicare Part A and Part B is the services that are covered by each.
- Medicare Part A covers inpatient care and hospital stays, while Medicare Part B covers outpatient care, doctor visits, and preventive services.
- Another big difference is the monthly premium. Most people qualify for premium-free Part A coverage, while everyone must pay a premium for Part B coverage.
Signing up for a Medicare Advantage plan will include both Part A and Part B coverage.
No, Medicare Part A does not cover prescription drugs. However, there is an exception to this rule. If you are receiving covered hospice care, then Part A will cover prescription drugs that are necessary for pain relief and symptom control.
These drugs will be subject to a $5 copay. Similarly, Medicare Part B will pay for some prescription drugs required during a hospital stay. If you need full prescription drug coverage, you must sign up for a Medicare Part D plan.
Medicare Part B is similar to traditional medical insurance. It covers doctor visits, preventive services, outpatient services, and durable medical equipment. Part B includes a monthly premium, and covered services are subject to a deductible and coinsurance amount.
In many cases, Part B will cover these services at 80%, although some are covered at 100%. For example, preventive services, like covered vaccines, are usually covered at 100%.
You can find a Social Security Administration office near you by using our SSA office locator and searching for your closest location.
