What is Medicare Part A and What Does it Cover?

When you first start exploring Medicare, the different parts can feel a bit like alphabet soup. Medicare Part A is often described as hospital insurance, but that’s just the beginning. It covers a range of services related to inpatient care, including hospital stays, skilled nursing facility care, and more. In this article, we’ll break down what Medicare Part A includes, who’s eligible, and what costs to expect.

What is Medicare Part A?

How It Fits Into Original Medicare

Medicare Part A is the first portion of the Federal program known as Original Medicare. Medicare Part A provides coverage for medical care such as inpatient hospital stays, skilled nursing facility care, and hospice services.

Who’s Eligible for Part A?

You’re typically eligible for Medicare Part A at age 65 if you or your spouse paid Medicare taxes during your working years. People under 65 may also be eligible if they have a qualifying disability or condition such as end-stage renal disease (ESRD).

What You’ll Pay for Medicare Part A

Most people don’t pay a premium for Medicare Part A if they’ve worked and paid Medicare taxes for at least 10 years (or 40 quarters). However, there are standard costs that can change yearly, including a deductible and potential daily coinsurance for hospital stays beyond certain limits.

How to Enroll in Medicare Part A

The process for enrolling in Medicare Part A will depend on several factors, including your age, reasons for eligibility, and if you are enrolling in Medicare Part B at the same time or if you will be delaying enrollment in Part B due to having other coverage.

Learn more about How to Enroll in Medicare

What Does Part A Cover? 

Inpatient Care 

Medicare Part A covers inpatient care in a hospital when you are admitted to the hospital as an inpatient after an official doctor's order. For coverage to occur, the hospital must accept Medicare, and in certain cases, the Utilization Review Committee of the hospital must approve your stay while you are in the hospital. Medicare inpatient hospital care will cover your doctor care, tests, procedures, semi-private room, medication, and anything deemed as medically necessary. 

For inpatient hospital care you'll be responsible for paying a deductible per benefit period and a copay per day beyond 60 days. If you have other coverage, such as a Medicare Advantage Plan or Medigap policy, this may help cover these costs. 

Related: Medicare Advantage vs Medicare Supplements: Which One Is Right For Me?

Skilled Nursing Facility Care 

Medicare Part A covers skilled nursing facility (SNF) care on a short-term basis following a qualifying hospital stay, in addition to other potential requirements. Beginning on your first day at a skilled nursing facility, you will start a health assessment that is covered by Medicare Part A. Once your health condition is assessed, SNF staff work on preparing or updating your care plan.  

Hospice Care

If you meet all of the conditions to qualify for hospice care, you will work with the hospice team to set up a care plan that's specific for you.  

Home Health Care 

Medicare Part A and/or Medicare Part B covers home health services like physical therapy, occupational therapy, part-time or intermittent skilled nursing care, medical social services, speech-language pathology services, and part-time or intermittent home health aide services. Home health care is only covered if it is deemed medically necessary.

Keep in mind that if you're in a Medicare Advantage Plan or other Medicare plan, you may have different rules. However, your plan must give you at least the same coverage as Original Medicare and some of these services may only be covered in certain settings or for patients with certain conditions. 

Do you have additional questions about Medicare Part A and what it covers? Want to learn more about the different parts of Medicare and the types of Medicare insurance options? We have the answers and guidance you are looking for. Come to one of our free Medicare workshops or meet one-on-one with one of our Medicare agents to get your questions answered! Contact us today to get started.   

This is an updated blog that was originally published in 2019. 

References: https://www.medicare.gov/what-medicare-covers/what-part-a-cover

Do you need help with Medicare, insurance and health plans? Explore your options with Allina Health Aetna, BlueCross BlueShield of Minnesota, Medica, UCare, United HealthCare and more. We work with you to find the best plan for your needs and budget. Contact us today to get started.