Medicare Part A provides coverage to U.S. citizens age 65 and older for inpatient stays in hospitals and similar medical facilities.
Part A covers Inpatient surgeries and lab tests, as well as drugs related to the inpatient stay.
Even for Medicare-approved stays, Medicare Part A doesn’t cover doctors’ services; Part B of Original Medicare or other medical insurance may provide coverage.
Medicare generally defines a hospital stay that qualifies for Part A coverage as “2 or more nights of medically necessary hospital care.”
Medicare Part A covers hospital stays, providing invaluable assistance with potentially crippling bills for U.S. citizens age 65 and older.
While people who have paid Medicare taxes through work for at least 10 years don’t have to pay a monthly premium, Medicare Part A doesn’t cover everything related to hospital stays. It’s essential to understand what’s covered and what’s not covered and understand what defines a qualifying hospital stay.
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Medicare Part A is commonly referred to as “hospital insurance” because its primary function is to help older adults manage the cost of hospital bills. Medicare Part A covers some expenses you incur at what you think of as a traditional hospital, but it also covers similar inpatient services in semi-private rooms at similar facilities, including: [i]
- Acute care hospitals.
- Critical access hospitals.
- Inpatient rehabilitation facilities.
- Inpatient psychiatric facilities.
- Long-term care hospitals.
- Inpatient care as part of a qualifying clinical research study.
Regardless of the facility used, hospice care is covered by Medicare Part A if you are terminally ill and accept palliative care for comfort instead of treatment for your illness. Some home health care is covered as well.
Short-term care in a skilled nursing facility or nursing home may also be covered by Medicare Part A if it’s a doctor-approved treatment for a medical condition stemming from an inpatient hospital stay. [i]
As a part of treatment in Medicare-approved facilities, Medicare Part A covers meals, general nursing and drugs that are part of your inpatient treatment as well as surgery and lab tests.
What does Medicare Part A cover and not cover based on your status as a patient? If, for example, you need chemotherapy, Part A will cover it if it’s administered as a part of an inpatient hospital stay; if it’s done on an outpatient basis, Part A won’t cover it (but Part B will).
Even in the case of an inpatient stay that Medicare Part A covers, Part A won’t cover:
- A private room (unless medically necessary).
- Private-duty nursing.
- Television and phone in your room (if there’s a separate charge for these items).
- Personal care items (like razors or slipper socks).
Being surprised that a couple of items on your bill aren’t covered by Part A is one thing; discovering that the stay isn’t covered by Part A at all is quite another thing.
Medicare literature on what qualifies as a covered stay states, “An inpatient admission is generally appropriate for payment under Medicare Part A when you’re expected to need 2 or more midnights of medically necessary hospital care, but your doctor must order this admission and the hospital must formally admit you for you to become an inpatient.” [i]
Does Medicare Part A Cover Doctor Visits?
Part A covers qualifying hospital visits; Part B, rather than Part A, covers doctors’ services at the hospital, much like Part B covers non-emergency visits to your doctor’s office.
If you go to the hospital and your stay doesn’t meet the requirements of an “inpatient stay,” you usually need Part B for Medicare to provide coverage. Commonly known as “medical insurance,” Part B covers many outpatient expenses.
Are you eligible for cost-saving Medicare subsidies?
For a qualifying inpatient stay, Medicare Part A covers 100 percent of hospital-specific costs for the first 60 days of the stay — after you pay the deductible for that benefit period. Part A doesn’t completely cover Days 61-90 or the 60 “lifetime reserve days” you can use after Day 90. After 60 days, you must pay coinsurance that Part A doesn’t cover.
For hospital expenses covered by Part B, you have to pay 20 percent coinsurance after meeting your annual deductible. Part A and B are collectively known as Original Medicare and work hand-in-hand to help cover hospital stays. Alternatively, some people opt to use Part A in conjunction with employer medical insurance for hospital coverage.
Now that you know all about Medicare Part A coverage, it’s time to learn more about Part A costs and enrollment.
What Does Medicare Part A Cost?
Most people don’t have to pay a monthly premium for Part A. If you or your spouse have worked 40 quarters (10 years) while paying Medicare taxes, you receive Part A without the cost of a monthly premium.
However, there are costs related to Part A, like deductibles and coinsurance. These costs are part of the cost-sharing agreement between you and the plan’s carrier.
How to Enroll in Medicare Part A?
If you believe you would benefit from Part A coverage and qualify for it, the final step is the Part A enrollment process. If you are near the Medicare eligibility age of 65, it’s crucial to understand how your Initial Enrollment Period (IEP) works.
Your IEP begins three months before the month you turn 65. The IEP is open for a total of seven months and allows you to enroll in Medicare Part A and Part B. During your IEP, and after you enroll in Part A and Part B, you can choose to add coverage like Part D or enroll in a Medicare Advantage plan (Part C) that replaces Parts A and B.
What extra benefits and savings do you qualify for?
If you, like most people, don’t have to pay a monthly premium for Part A, there is no downside to enrolling when you become eligible at age 65. You don’t have to pay a premium if you have paid Medicare taxes for at least 10 years.
If you face an inpatient hospital stay and have Part A, you will still be responsible for some costs. Those costs, however, are significantly reduced.
While Part A covers a significant portion of a typical hospital bill and usually provides coverage for U.S. citizens age 65 and older without a monthly premium, your bill could still be costly without other coverage.
Part B of Original Medicare helps cover the “medical” portion of hospital bills. Part B usually does require a monthly premium.
Enrolling in Part A and B of Original Medicare opens the options for you to add a Medigap supplemental plan to help with Part A deductibles and coinsurance.
Those with Part A and B can switch to a Medicare Advantage plan from a private insurance company that replaces Original Medicare and provides the same coverage as Parts A and B while offering additional coverage.
Medicare Advantage plans protect you with an annual out-of-pocket maximum — a dollar amount specific to your plan that defines the most money you will have to pay out of your pocket for the plan year for healthcare. Original Medicare doesn’t have an out-of-pocket maximum, although if you have Parts A and B, you can add one of the two standard Medigap plans that include an out-of-pocket max.
While Medicare Part A coverage is standard across the board, Medicare Advantage plans that replace Original Medicare come in all shapes and sizes. Some Medicare Advantage plans, for example, provide coverage for all hospital visits, regardless of their length or whether they’re considered to be inpatient or outpatient.
If you are looking for a specific level of coverage from a Medicare Advantage plan, a GoHealth licensed insurance agent can locate the right plan for your situation.