Original Medicare is made up of two parts: Medicare Part A and Medicare Part B. Medicare Part A provides coverage for hospital inpatient care, skilled nursing facilities, hospice, and home health care.
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For most Medicare beneficiaries, Medicare Part A is premium-free. However, you must meet certain criteria. If not, you may need to pay a premium.
Below, we discuss everything you need to know about Medicare Part A including eligibility, coverage, enrollment, and more.
What is Medicare Part A?
Medicare Part A is basic inpatient coverage that Medicare beneficiaries can use during hospital stays. To enroll in Medicare Part A, you must be 65 years old, receive Social Security Disability Income (SSDI) for at least 24 months, or have a diagnosis of amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD).
Thus, the qualification requirements for Medicare Part A are the same as those for Medicare Part B.
Most people will have premium-free Medicare Part A. However, not everyone qualifies for this perk. To be eligible for premium-free Medicare Part A, you or your spouse must work at least ten years (40 quarters) paying Medicare tax.
If you do not meet this requirement, Medicare Part A could cost up to $499 a month in 2022. Additionally, the premium is subject to increase each year.
What Does Medicare Part A Cover?
What is covered under Medicare Part A:
- Hospital meals
- Semi-private room
- Special care units
- Drugs, supplies, and equipment
- Operating room and recovery room
- Rehabilitation services during your stay
- Some blood transfusions
- Hospice care
- Skilled nursing care on a part-time basis
Medicare Part A will not cover a private room, private nursing, or any personal care items. After the Medicare Part A deductible is met, Medicare pays the first 60 days of your benefit period in full.
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For days 61-90, you must pay a hospital coinsurance of $389 per day. Then, Medicare will cover up to 60 extra lifetime reserve days.
For days 91 and beyond, the coinsurance is $778 per day. After 60 days over your lifetime benefit, ALL costs are your responsibility.
To start a new benefit period, you must stay out of the hospital for at least 60 consecutive days. Additionally, beginning another benefit period means paying the Part A deductible again.
Who Qualifies for Medicare Part A?
If you receive disability benefits, you become eligible for premium-free Medicare Part A after two years of receiving those benefits. Also, if you or your spouse has Medicare-covered government employment, you get premium-free Part A.
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Those with amyotrophic lateral sclerosis do not need to wait two years before becoming eligible for Medicare. Medicare Part A and Medicare Part B benefits begin immediately and automatically. Those with end-stage renal disease can apply upon diagnosis, but Medicare enrollment isn’t automatic.
When Should I Enroll in Medicare Part A?
In addition, when you should enroll in Medicare Part A depends on whether your employer is large or small. When you work for a small employer, you may HAVE to get Medicare Part A and Part B as soon as you’re Medicare-eligible. It is best to talk to the benefits administrator at your place of employment to figure out your options
Do I Have to Pay for Medicare Part A?
On the other hand, if you or your spouse did not work at least ten years in the United States paying Medicare tax, you will not be eligible for premium-free Part A. In this case, you could be responsible for up to $499 each month in Medicare Part A premiums.
If you did not work at least ten years paying Medicare tax, the premium you pay is based on the number of years you did work. If you worked more than 7.5 years but fewer than ten, your Medicare premium is $274 each month. Those with fewer than 7.5 years of contributing to Medicare taxes are responsible for the full Medicare Part A premium of $499 monthly.
What is the Medicare Part A Deductible?
To receive help covering this deductible, many beneficiaries enroll in a Medicare Supplement plan. The Medicare Part A deductible benefit period begins when you become an inpatient in the hospital.
Then, the benefit period continues until you’ve been out of the hospital for a minimum of 60 days. Any care in a skilled nursing facility after your hospital stay counts toward the benefit period.
Every time a new benefit period starts, you must meet the Part A deductible. Meaning, if you are out of the hospital for at least 60 days and then need to be re-admitted, you must meet the deductible again.
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Sources:
MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.
- What Part A Covers, Medicare.gov. Accessed February 2022.
https://www.medicare.gov/what-medicare-covers/what-part-a-covers - Original Medicare Eligibility and Enrollment, CMS. Accessed February 2022.
https://www.cms.gov/Medicare/Eligibility-and-Enrollment/OrigMedicarePartABEligEnrol - An Overview of Medicare, KFF. Accessed February 2022.
https://www.kff.org/medicare/issue-brief/an-overview-of-medicare/
So where do I find the most current INPT only list for surgery? And so starting Jan 1 it doesn’t matter if the Surgery is on the list or not? If pt needs INPT care and it is not on the list you can still do INPT?
Hi Amanda! CMS released document 1736 that contains a table of services removed from the inpatient-only list for CY 2021.