Medicare Part A: Your Questions Answered
Key Takeaways
- Medicare Part AMedicare Part A is hospital insurance, which covers the care you receive while admitted to a hospital, skilled nursing facility, or other inpatient facility. Medicare Part A is part of Original Medicare.provides coverage to U.S. citizens and permanent residents age 65 and older for inpatient stays in hospitals and similar facilities.
- The vast majority of those eligible for Medicare Part A don’t have to pay a monthly premium, but they are responsible for a benefit period deductible for every qualifying hospital stay as well as daily coinsurance after 60 days.
- You can enroll in Part A at any time; if you do so less than six months before turning 65, coverage is retroactive to the first day of the month you turned 65.
- Part A, paired with Part B, provides extensive healthcare coverage and opens the door to add coverage.
What Is Medicare Part A?
For most U.S. citizens and permanent residents aging into Medicare, Part A is a cornerstone of healthcare that provides invaluable assistance with potentially devastating hospital bills.
Most people can first enroll in Part A, which is hospital insurance, at age 65. In most cases, you won’t pay a monthly premium as long as you or a spouse have worked and paid Medicare taxes for at least 10 years. You may incur some out-of-pocket expenses during a hospital stay while using Medicare Part A coverage, but those costs are generally a fraction of what they would be without health insurance.
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Get Help NowWhat Is the Main Benefit of Medicare Part A?
In a nutshell, Medicare Part A helps pay for hospital bills that can quickly run into the tens of thousands of dollars.
Healthcare.gov estimates that the average bill for a three-day stay is $30,000. For a Medicare-approved three-day stay in the hospital in 2024 — and for up to 60 days — a person with Medicare Part A would be responsible for the deductible of $1,632.
What Is Not Covered by Medicare Part A?
In the example above, keep in mind that Part A covers only the hospital bill itself. This means Part A may not cover some of the services or care you receive during your stay. However, Part B or Part D may cover some or all of these services and costs.
Medicare Part A is only a portion of your Medicare options, but it’s the one that nearly everyone should add at age 65. Here’s a snapshot of Medicare Part A coverage.
Does Part A Cover It?
Inpatient care in a hospital
- Yes, Part A covers
Skilled nursing facility care
- Yes, Part A covers
Nursing home care (not custodial or long-term)
- Yes, Part A covers
Hospice care
- Yes, Part A covers
Home health care
- Yes, Part A covers
Long-term care
- No, Part A does not cover
Medically necessary inpatient surgery
- Yes, Part A covers
Cosmetic surgery
- No, Part A does not cover
Inpatient lab tests
- Yes, Part A covers
Emergency room lab tests
- No, but Part B covers
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Find Plans TodayDo I Need Medicare Part A?
As long as you qualify for Medicare Part A without a monthly premium, there’s no reason to pass on the protection it provides. According to the Centers for Medicare and Medicaid Services (CMS), 99 of out 100 people on Medicare qualify for Part A without a monthly premium.
Even if you still have health insurance from an employer when you turn 65, Part A could help ease your out-of-pocket burden as a secondary payer.
Is Medicare Part A Free at Age 65?
Medicare Part A is not “free” because you are always responsible for at least the benefit period deductible if you make a claim, but carrying the protection provided by Part A comes without the expense of a monthly premium for most Americans.
How do you know if you will have to pay a premium for Medicare Part A?
- If you have paid Medicare taxes through an employer for 40 quarters (10 years) over your lifetime, you can enroll at age 65 and don’t have to pay a Medicare Part A premium.
- If you have paid Medicare taxes for 30-39 quarters, you have to pay a Part A premium of $278 a month in 2024. If you have paid Medicare taxes for less than 30 months, you have to pay a Part A premium of $505 a month in 2024.
Regardless of whether you pay a premium for Part A, you are responsible for certain costs associated with an inpatient hospital stay.
Hospital Stays and Medicare
Part A responsibilities
Inpatient hospital deductible
- $1,632
Daily coinsurance, Days 1-60
- $0
Daily coinsurance, Days 61-90
- $408
Daily coinsurance, up to 60 Lifetime Reserve Days
- $816
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Call TodayWhile most forms of insurance have an annual deductible, Medicare Part A is unique because you must meet a deductible every “benefit period.” So if you have two hospital stays within the same year, you have to pay the Part A deductible for each visit. However, you get the same break on coinsurance for each hospital stay.
- Let’s say you are admitted as an inpatient to the hospital in February in 2024 and spend 46 days there. For the hospital portion of your medical bills, you will be responsible for the benefit period deductible of $1,632.
- Let’s say you are admitted again in August of 2024 and again stay 46 days. For the hospital portion of your medical bills, you will be responsible for the benefit period deductible of $1,632. But even though your total days in the hospital for the year is now 92, you still don’t have to pay any daily coinsurance because each benefit period starts over at Day 1.
What Are Lifetime Reserve Days?
If any individual hospital stay lasts beyond Day 90, you can use some of your lifetime reserve days, although doing so triggers a significantly more expensive coinsurance responsibility. Medicare Part A allows you 60 of these days over your lifetime, and they can be used as a part of any number of hospital stays that surpass 90 days throughout your lifetime.
Once your lifetime reserve days are exhausted, Medicare Part A offers no further coverage.
Can I Enroll in Medicare Part A Anytime?
Leading up to your 65th birthday and anytime afterward, you can enroll in Medicare Part A if you aren’t required to pay a monthly premium. People who have to pay a Part A premium don’t have the same flexibility because they also are required to enroll in Medicare Part B, which is limited to specific enrollment periods.
Unless you qualify for Part A before age 65, your first window for enrolling is the Initial Enrollment Period, which includes the three months before your 65th birthday, birthday month, and three months after your birthday. Whenever you sign up, Medicare Part A provides retroactive coverage for up to six months, so your Part A coverage actually will “begin” the first day of the month you turn 65 as long as you enroll less than six months before your birthday month.
If, however, you wait to enroll in Part A until after your Initial Enrollment Period ends, you won’t be able to enroll in Part B (medical insurance) unless you happen to be in a different enrollment period. For people who want to or are required to add Part B in conjunction with Part A, enrollment after the Initial Enrollment Period is limited to:
- The General Enrollment Period, which runs from January 1 to March 31 each year.
- A Special Enrollment Period, which is granted under circumstances like the loss of employer health insurance.
What Is the Difference Between Medicare Part A and Part B?
Medicare Part A and Part B collectively make up Original Medicare and feature completely different coverages and costs. Often, people age 65 and older enroll in both to provide coverage for many healthcare needs.
While Part A provides hospital insurance, Part B provides medical insurance. Part B covers preventive screenings and medically necessary treatments, services and equipment.
The coverage provided by Part A and Part B doesn’t overlap per se, but one or the other may cover the same thing depending on the circumstances. For example, Part A covers surgery as a part of an inpatient hospital stay; the same surgery performed in an outpatient setting is covered by Part B.
Do the Part A and Part B Premiums Cost the Same?
While Part A doesn’t require a monthly premium for most people, Part B has a standard monthly premium. Medicare Part B was $174.70 a month in 2024 for individuals making $103,000 or less.
And while Part A has a benefit period deductible and coinsurance for hospital stays over 60 days, Part B has an annual deductible ($240 in 2024). After you pay the deductible, Part B pays 80% of the bill, and you pay 20% coinsurance.
Suppose you have Part A and Part B and decide to switch to a Medicare Advantage plan provided by a private insurance company. In that case, you will get at least the same coverage provided by Parts A and B but possibly at a different cost. Some Medicare Advantage plans help cover your monthly premiums.
Can I enroll in Medicare Part A before age 65?
Once you have collected Social Security disability benefits or Railroad Board benefits for 24 months, you can enroll regardless of age. You also qualify regardless of age if you have end-stage renal disease or Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.
Can I opt out of Medicare Part A?
As long as you don’t pay a Part A monthly premium, there’s no downside to enrolling in Part A. Even if you pay a monthly premium for Part A, the coverage may work to your benefit in some instances.
Can you lose Part A coverage?
What if I run out of my Part A lifetime reserve days?
If you have both Part A and Part B, you can add a Medigap supplement plan. All 10 of the standard Medigap plans offered by private insurance companies pay 100% of Part A and extend coverage for up to 365 days after you exhaust your lifetime reserve days.
Alternatively, having Part A and B provides the option to switch to a Medicare Advantage plan. Medicare Advantage plans must provide at least the same coverage as Parts A and B, including hospital coverage through your lifetime reserve days.
Medicare Advantage plans must include an annual out-of-pocket maximum. So the concept of lifetime reserve days might not matter because your hospital expenses should be 100 percent covered once you reach your out-of-pocket maximum.
A GoHealth licensed insurance agent can help identify a Medicare Advantage plan that fits your needs.
Sources
- Protection from high medical costs. HealthCare.gov.
- Medicare costs at a glance. Medicare.gov.
- When does Medicare coverage start?. Medicare.gov.
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