Compare All Plans
Enroll And Save
(800) 257-8519 TTY 711

Medicare Part A Overview – Explaining The Basics

What is Medicare Part A?

Medicare Part A is medical insurance that helps patients pay for medically necessary care for a condition or illness that requires hospitalization. Inpatient hospitals can include the following:

Medicare Part A is provided by the federal government to most people who have reached the age of 65. Some who are under age 65 with certain disabling conditions qualify, as well.

Who is eligible?

Most beneficiaries are automatically enrolled in Part A when they apply for Medicare upon eligibility. You are eligible to be automatically enrolled in Medicare Part A free of premiums if:

You may still be able to enroll in Part A and pay a premium if you aren’t eligible for premium-free enrollment. This option is available to you if:

Have Medicare Questions? 1-800-257-8519 TTY 711

What are the costs?

Most retirees won’t pay any premiums if they paid Medicare taxes while they were employed. The premium you pay depends on the employment history of the qualifying employee. You will pay a late enrollment penalty of 10 percent of your current monthly premium if you enroll in Part A at least one year after your 65th birthday. For 2015, the premium costs were:

Hospital coverage

Deductible

There is a $1,260 deductible payable at the start of a hospital stay for each new benefit period for 2015.

Days 1 to 60 — After the deductible is met, Medicare covers, in full, the first 60 inpatient hospital days in the benefit period. The deductible is not an annual deductible. You may have multiple inpatient admissions during a benefit period. If so, you could pay up to four Part A deductibles in a calendar year, if more than 60 days separate each hospital stay.

Coinsurance for days 61 to 90 — A coinsurance payment of $315 per day is charged for days 61-90 per benefit period for 2015. Medicare covers the balance of the hospital bill.

Coinsurance for days 91 to 150 — A coinsurance payment of $630 per day is charged for days 91 to 150 to cover these “lifetime reserve days.” Medicare covers the balance of the hospital bill.

More than 150 days — The patient is responsible for any expenses accrued after the 150 days of inpatient care covered by Medicare Part A. A patient may leave the hospital for 60 consecutive days, and the benefit period ends. If so, they may then enter the hospital again, with another 90 days of coverage.

Nursing facility coverage:

Days 1 to 20 — The first 20 days of inpatient care in a skilled nursing facility are covered in full. There is no deductible for SNF coverage.

Coinsurance days 21 to 100 — In 2015, a coinsurance payment of $157 per day is charged for each of these days. Medicare covers the balance of the bill.

More than 100 days — You are responsible for all expenses accrued after the first 100 days if SNF care continues. The benefit period may end while the patient is away from an SNF or hospital for 60 consecutive days. If so, they will receive 100 additional covered skilled nursing facility days at the start of the next benefit period.

Have Medicare Questions? 1-800-257-8519 TTY 711

What is covered under Medicare Part A?

Medicare Part A helps pay for most care that a patient receives in a hospital or a skilled nursing facility. It also covers some home healthcare, hospice care and inpatient care in a religious non-medical health care institution (RNHCI). Certain conditions must be met in order to get these benefits. If you are an inpatient in a hospital or SNF, Medicare Part A will pay for:

In addition, Medicare Part A pays for inpatient care acute care hospitals, critical access hospitals, long-term care hospitals (LTCHs), inpatient rehabilitation facilities, inpatient care as part of a qualifying research study and mental healthcare. Inpatient mental health care in a psychiatric facility is covered for up to 190 days in a lifetime under Medicare Part A.

In some circumstances Part A will pay the expenses for home healthcare required after you leave a hospital or SNF. Covered items and services may include the following:

You may be required to pay for the first three units of blood (per calendar year) for blood transfusions received in a hospital or SNF during a covered stay. Most often, the blood is donated by a blood bank, at no charge to the hospital. In that case, you will not be required to pay for or replace it. However, if the hospital must purchase blood for you, you are required to pay the provider costs for the first three units of blood you get in a calendar year. Or, you may be required to donate blood to replace the units you have used. You may have someone else donate on your behalf, as well.

What isn’t covered?

Many doctor services are billed separately and are not part of the hospital services. Most of these doctor services are covered by Medicare Part B. You’ll have to pay the Part B deductible and 20 percent coinsurance. Part A won’t pay the cost of “custodial care.”

Custodial care is that provided by a caregiver to assist a patient with the functions of daily life, such as bathing, getting dressed and eating. Even if provided by a nurse, such care doesn’t require the same level of medical care provided in a hospital. So, it is not covered. Costs considered to be of a personal nature are also not covered, such as:

Can I continue to see my doctor? What providers must I see?
When you enroll in Medicare Part A, you will want to ask your current care providers if they accept Medicare patients. In 2013, there were more than 735,000 physicians throughout the United States who were accepted by the Medicare program. These physicians agreed to take Medicare patients, as well. You can choose any qualified provider in the United States who is accepting new patients.


Health Network Group
1199 S. Federal Highway,
STE 403,
Boca Raton, FL 33432
This website is privately owned and all information and advertisements are independent and are not associated with any state exchange or the federal marketplace. Additionally, this website is not associated with, sanctioned by or managed by the federal government, the Centers for Medicare & Medicaid or the Department of Health and Human Services.