If you are enrolled in Medicare, you are more than likely enrolled in Part A coverage. Some people choose to do without Part B coverage since there is a monthly premium associated with it, but nearly everyone enrolls in Part A. Medicare Part A is also known as hospital insurance, and it 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 give you all the details. We will tell you what is covered by Part A and what is not covered. 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 is made up 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 is commonly known as traditional medical insurance coverage, and it covers things like 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.
As we have already mentioned, your Medicare Part A will cover hospital stays and other inpatient care in the hospital. 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 tests or treatments that are necessary 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 as long as the facility qualifies as a skilled nursing facility.
Part A also provides coverage for hospice care and some home health care. This care is limited to home health care that is medically necessary. 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.
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.
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. 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 will need to pay for that on your own. Part A only covers short-term care in a skilled nursing facility.
Medicare Part A also does not cover your first three pints of blood during a medical procedure. If you need more than three pints, then Medicare will cover the additional amount. 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.
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.
— Medicare Part A
As we have already discussed, Medicare Part A coverage is considered Medicare hospital coverage. This coverage will pay for inpatient hospital care and other inpatient services. It covers skilled nursing facility care, some home health care, inpatient mental health care, and hospice care. Although most people receive Part A coverage without paying a monthly premium, this coverage is subject to an annual deductible and coinsurance amounts.
— Medicare Part B
Part B is considered more traditional medical insurance. Part B covers doctor visits, some wellness screenings, and preventive services like vaccines. In addition, Part B also covers durable medical equipment. While Part B helps cover the cost of this equipment, some equipment that you might expect to be covered is not. For example, hearing aids are not covered by Medicare because they are considered elective devices. Medicare Part B also provides coverage for outpatient care where an overnight stay is not required. Part B coverage does include some out-of-pocket costs, like monthly Part B premiums, deductibles, and copays.
— Medicare Part C
Medicare Part C is also called a Medicare Advantage plan. These plans are managed by private insurance companies that contract with Medicare to provide this coverage. All Part C plans must provide at least the same minimum level of coverage as Original Medicare, but many of these plans provide additional benefits as well. Many people wonder, “Does Medicare cover dental?” The answer is no, but some Advantage plans include vision and dental coverage, prescription drug coverage, and other benefits, like gym memberships. These health insurance programs generally include a monthly premium, and the options available to you will depend on where you live.
— Medicare Part D
Medicare Part D is a form of prescription drug coverage administered by private insurance companies. These drug plans are purchased separately from Original Medicare. Most Part D plans include a monthly premium, and they also include a list of drugs that are included in the coverage. If a medication that you take is not listed in the plan’s formulary, then it will not be included in the coverage. If you have purchased a Medicare Advantage health plan, your plan likely already includes prescription drug coverage.
Costs Associated With Medicare Part A
Many people believe that they will have no health care costs once they enroll in Medicare coverage. However, that is not a true statement! While many people qualify for premium-free Part A coverage, there are other costs associated with Medicare Part A. Some people must pay a premium for Part A coverage. This premium is either $274 or $499 per month, depending on your income.
One of the largest costs associated with Part A coverage is the deductible. A deductible of $1,556 will apply for each benefit period. You must pay this amount out of your pocket before Medicare starts to pay anything. Also, be aware that 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.
For hospital stays, you will have no copay amount for the first 60 days in the hospital. However, you will have a copay amount of $389 per day for days 61 through 90. For days 91-150, you will be responsible for a copayment of $778 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 years of age or older, be a U.S. resident, and be either 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 will need to pay a premium for it.
If you are already receiving Social Security benefits upon turning 65, you will be automatically enrolled in Medicare coverage. Those who are not already receiving Social Security will need to sign up for Medicare benefits. The application can be completed online, and you can visit Medicare.gov to sign up.
The Bottom Line
Medicare Part A is considered hospital insurance, and it covers 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 care in a nursing home or assisted living facility. In fact, you might be surprised to learn that neither Medicare nor Medicaid cover 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
Does Medicare Part A cover services at 100%?
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.
What is the difference between Medicare Part A and Part B?
The biggest 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 in the monthly premium. Most people qualify for premium-free Part A coverage, while everyone needs to pay a premium for Part B coverage. If you sign up for a Medicare Advantage plan, it will include both Part A and Part B coverage.
Does Medicare Part A cover prescription drugs?
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, then you will need to sign up for a Medicare Part D plan.
What does Medicare Part B cover?
Medicare Part B is much like traditional medical insurance, and 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 amounts. In many cases, Part B will cover these services at 80%, although some services are covered at 100%. For example, preventive services, like covered vaccines, are usually covered at 100%.
