Medicare Part A: Hospital Insurance
Once you become eligible for Medicare, one of the key components of your coverage is Medicare Part A, also known as hospital insurance. Part A helps cover the cost of inpatient care in hospitals and skilled nursing facilities. However, it does not cover long-term custodial care.
Most people do not pay a monthly premium for Part A because they paid Medicare taxes during their working years. If you did not pay Medicare taxes for at least 10 years (40 quarters), you may still be able to purchase Part A coverage.
What Does Medicare Part A Cover?
Medicare Part A helps cover medically necessary inpatient care, including:
- Inpatient Hospital Care: If you are admitted to a hospital, Medicare Part A helps cover your stay for up to 90 days per benefit period. There is a deductible for each benefit period, and coinsurance may apply after 60 days.
- Skilled Nursing Facility (SNF) Care: Part A covers room, board, and certain services in a skilled nursing facility for up to 100 days per benefit period, as long as eligibility requirements are met. This includes a qualifying hospital stay of at least three consecutive days and a need for daily skilled care.
- Home Health Care: Medicare Part A may cover up to 100 days of home health care if you are discharged from a hospital (after a three-day inpatient stay) or a Medicare-covered skilled nursing facility. You must begin care within 14 days, be homebound, and need skilled care. After 100 days, or if you don't meet these criteria, Part B may cover ongoing care. In both cases, Medicare typically covers the full cost of approved services.
- Hospice Care: For individuals with a terminal illness and a life expectancy of six months or less, Medicare Part A covers hospice services. A doctor must certify that you are eligible for hospice care.
Eligibility for Medicare Part A
You are eligible for premium-free Medicare Part A if:
- You are 65 or older and you or your spouse paid Medicare taxes for at least 10 years (40 quarters).
- You are under 65 and have a qualifying disability or End-Stage Renal Disease (ESRD).
If you do not qualify for premium-free Part A, you can still purchase coverage and pay a monthly premium. The cost will depend on how long you or your spouse paid Medicare taxes.
Out-of-Pocket Costs with Medicare Part A
While Medicare Part A helps cover many inpatient costs, it does not pay 100% of your medical expenses. You may be responsible for:
- The Part A deductible (which is set annually by Medicare).
- Coinsurance for hospital stays over 60 days.
- Coinsurance for skilled nursing facility stays beyond 20 days.
- Other costs not covered by Part A (e.g., personal items, private rooms, or long-term custodial care).
Need Help Navigating Medicare?
Understanding Medicare and choosing the right coverage can feel overwhelming, but you don't have to do it alone. As a licensed local agent, we can guide you through the process and help you make informed decisions about your healthcare and retirement needs.
We can help you:
- Understand your Medicare options and eligibility.
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*Disclaimer: This page has not been reviewed or endorsed by Medicare.gov or any member of the Centers for Medicare & Medicaid Services (CMS).
