Medicare is a little like alphabet soup. It’s comprised of Part A, Part B, Part C and Part D and each of those parts offers particular types of coverage and benefits. Part A is the hospital insurance part.
Medicare Part A helps cover more than just the cost of being in a hospital when you’re 65 or older. Part A also sometimes covers skilled facility care, home health care and hospice care.
Signing up for Medicare Part A
You don’t have to sign up for Part A when you turn 65, but there’s usually no reason not to do so. You can sign up starting three months before you turn 65 until three months after. You’ll automatically get Part A once you start claiming Social Security.
Philip Moeller, author of Get What’s Yours for Medicare, says if you’re 65 or older and work for an employer with fewer than 20 employees, you generally should get Part A (and B) since the U.S. government will consider Medicare your primary health insurance.
If you’re 65 or older and work for a larger employer, he adds, “there’s nothing to lose by signing up for Part A unless you have a Health Savings Account (an HSA).” Medicare won’t let you continue making tax-free HSA contributions, though you can keep the balances you have and use them as you want, Moeller notes.
How much Medicare Part A costs
One of the best features of Part A is that you pay no premiums for it, as long as you or your spouse have worked and paid Medicare taxes for at least 10 years.
If you don’t meet that test, you can buy Part A coverage. It will cost you:
- $278 a month in 2023 if you or your spouse worked and paid Medicare taxes for at least 7 ½ years
- $506 a month for fewer qualifying years.
That translates to $3,336 to $6,072; the premiums are reset annually. You can sign up between January 1 and March 31 each year.
Should you need to buy Part A, you’ll want to do so when you’re first eligible for Medicare. Otherwise, you’ll owe a 10% late enrollment penalty of up to 10% of the monthly premium. You’ll pay that penalty for twice the number of years you didn’t sign up.
Costs for services
Medicare Part A has a hospital deductible—the amount you must pay out-of-pocket before coverage kicks in—and coinsurance (your portion of Part A bills) for hospital and skilled nursing facility stays.
The amounts in 2023 are:
Inpatient hospital care:
- Every time you’re admitted into a hospital, there’s a $1,600 deductible. So, if you’re admitted in January and then again in July, the $1,600 deductible applies each time.
- There’s $400-per-day coinsurance for days 61 to 90 of each hospital stay. Then, $800-per-day for days 91 and beyond, with a “total lifetime reserve” of 60 days. After that, you’re responsible for all costs.
Skilled nursing facility:
- You’ll owe up to $200-per-day in coinsurance for days 21 to 100 in a skilled nursing facility. After that, you’re responsible for all costs.
Getting help to pay Part A costs
A Medigap or Medicare Supplement Insurance policy can help pay for some expenses Medicare Part A doesn’t. Moeller says it’s best to get a Medigap policy within six months of your initial eligibility for Medicare because they you can’t be charged more or declined based on a pre-existing condition.
You may be able to get help paying Medicare Part A’s deductibles, coinsurance and—if you owe them—premiums through one of the federal Medicare Savings Programs administered by states.
The Qualified Medicare Beneficiary Program (QMB) is available to people 65 and older whose monthly income this year doesn’t exceed $1,235 ($1,663 for a married couple) and whose resources generally are under $9,090 ($13,630 for married couples).
What Medicare Part A does and doesn’t cover
Inpatient hospital care
If you’re admitted to a hospital (including a psychiatric hospital), Medicare Part A will pay for a semi-private room, meals, general nursing, drugs and other hospital services and supplies. The key word here is “admitted.”
Often, hospitals keep patients “under observation” without officially admitting them. Observation stays are not covered by Medicare Part A; you must be formally admitted with a doctor’s order for coverage.
“If you’re flat on your back on a gurney, you’re not going to be asking questions about what’s covered and what’s not,” says Moeller. So, when you enter a hospital, your caregiver should ask if you’re being admitted.
If you’ll be brought in under observation, you caregiver should try to get your doctor to admit you, so you’ll qualify for Medicare coverage.
You may prefer a private room when staying in a hospital, but Medicare won’t cover that unless it’s deemed medically necessary or the only room available. Nor will Medicare pay for private duty nursing.
Veterans Affairs hospitals generally take VA insurance and not Medicare.
Skilled nursing facility care
If you’ve had a medically necessary hospital stay of at least three days, Medicare will cover care in a skilled nursing facility if your doctor prescribes that. You might go to a skilled nursing facility after joint replacement surgery, a stroke or another brain injury, for example.
Here again, Medicare will pay for a semi-private room, not a private room. It will also cover meals, skilled nursing and therapy services and other medically necessary services and supplies.
If you have Traditional Medicare, you won’t need to pay for the first 20 days in a skilled nursing facility. But if you instead have an alternative Medicare Advantage plan from a health insurer, you may be charged copayments during the first 20 days.
Home health care
Medicare covers home health care under both Part A and Part B. Either way, though, this coverage is fairly skimpy.
What qualifies: medically necessary part-time or intermittent (generally less than eight hours a day or 28 hours per week) skilled nursing care, physical therapy, speech-language pathology services or continued occupational therapy services.
What doesn’t qualify: personal care like bathing or help getting dressed or meal deliveries.
You must be homebound to receive Medicare coverage and the care has to be certified and ordered by a doctor or another health care provider and provided by a Medicare-certified home health agency.
Hospice care
Medicare Part A covers hospice care (the kind focused on the quality of life when you have an advanced, life-limiting illness). But a hospice doctor and your doctor, if you have one, need to certify that you have a life expectancy of six months or less. After six months, you can keep getting hospice care if the hospice medical director or doctor recertifies that you’re still terminally ill.
This coverage includes drugs, medical equipment and other items and services for pain relief and symptom management; medical, nursing, aide and homemaker services and spiritual and grief counseling for you and your family.
This type of care is usually given in your home or in a nursing home and the copayment is up to $5 per prescription for outpatient drugs for pain and symptom management.
Get help with Medicare Part A
If you have questions about Medicare Part A, Moeller says, speak with someone at your state’s free State Health Insurance Assistance Program (SHIP). The staffers and volunteers in these programs can help you figure out how to make Medicare decisions wisely.
