What Does Medicare Part A Cover? A Comprehensive Guide

Introduction

Medicare is the federal health insurance program for people age 65 and older, as well as certain younger individuals with disabilities or end-stage renal disease. Medicare Part A is the hospital insurance portion of the program, covering inpatient care in hospitals and skilled nursing facilities, hospice care, and some home health care services. In this article, we’ll explore what Medicare Part A covers, how much it costs, when you can enroll, and how to maximize your benefits.

Explaining What Medicare Part A Covers

Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services. Here’s a closer look at each type of coverage:

• Inpatient hospital care: This benefit covers medically necessary care that you receive in a hospital, such as surgery and overnight stays. It also covers care received in critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals.
• Skilled nursing facility care: If you require skilled nursing care on an intermittent basis, Medicare Part A will cover up to 100 days of care in a nursing facility. You must meet certain criteria to qualify for coverage, such as having been an inpatient in a hospital for at least three days prior to admission to the nursing facility.
• Hospice care: If you are diagnosed with a terminal illness and have a life expectancy of six months or less, Medicare Part A will cover hospice care. This includes visits from a hospice team, medications, medical equipment, and short-term respite care.
• Home health care: Medicare Part A covers certain home health care services, such as physical and occupational therapy, skilled nursing care, and medical social services. To qualify, you must be under the care of a doctor and require skilled care, as well as be homebound and unable to leave without assistance.

Comprehensive Guide to Medicare Part A Coverage

If you’re enrolled in Medicare Part A, here’s what you need to know about your coverage:

• Deductibles and coinsurance: For most services covered by Medicare Part A, you’ll pay a deductible and coinsurance. The exact amounts vary depending on the type of service you receive. For example, there is a $1,408 deductible for hospital stays of one to 60 days.
• Maximum coverage limits: Medicare Part A has maximum coverage limits for certain services. For example, there is a lifetime reserve day limit of 60 days for inpatient hospital care. After you use these days, you’ll be responsible for all costs associated with any additional days spent in the hospital.
• Gap coverage: Medicare Part A does not cover all costs associated with a hospital stay or other covered services. For example, it does not cover long-term care or custodial care. To bridge this gap, you may want to consider purchasing supplemental insurance.

Common Services Covered by Medicare Part A

Here are some of the most common services covered by Medicare Part A:

• Hospital stays: Medicare Part A covers inpatient hospital stays, including those in critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals. It also covers related services, such as lab tests and X-rays.
• Nursing home care: Medicare Part A covers up to 100 days of skilled nursing facility care on an intermittent basis. To qualify, you must have been an inpatient in a hospital for at least three days prior to admission to the nursing facility.
• Rehabilitative services: Medicare Part A covers physical and occupational therapy and speech-language pathology services if they are medically necessary and ordered by a doctor. It also covers durable medical equipment, such as walkers and wheelchairs.
• Home health care: Medicare Part A covers some home health care services, such as skilled nursing care, physical and occupational therapy, medical social services, and durable medical equipment.
• Hospice care: If you are diagnosed with a terminal illness and have a life expectancy of six months or less, Medicare Part A will cover hospice care. This includes visits from a hospice team, medications, medical equipment, and short-term respite care.

How Much Does Medicare Part A Cost?

Most people who are eligible for Medicare Part A don’t have to pay a premium for coverage. However, there are other costs associated with Medicare Part A, including deductibles, coinsurance, and maximum out-of-pocket expenses. Here’s a breakdown of the costs:

• Premiums: Most people who are eligible for Medicare Part A don’t pay a premium. However, if you are not eligible for premium-free Part A, the standard monthly premium is $471 in 2021.
• Deductibles: You’ll pay a deductible for most services covered by Medicare Part A. The amount you’ll pay depends on the type of service you receive. For example, the deductible for hospital stays of one to 60 days is $1,408.
• Coinsurance: After you meet your deductible, you’ll be responsible for paying coinsurance for certain services. For example, you’ll pay a coinsurance of $352 per day for the 61st through 90th day of a hospital stay.
• Maximum out-of-pocket expenses: Medicare Part A has a maximum out-of-pocket limit of $6,220 in 2021. Once you reach this limit, you won’t have to pay any more for covered services for the rest of the year.

When Can You Enroll in Medicare Part A?

You can enroll in Medicare Part A during your initial enrollment period (IEP), which begins three months before the month you turn 65 and ends three months after the month you turn 65. During this time, you can apply for Medicare Part A and other parts of Medicare, such as Part B and Part D. You may also be able to enroll in Medicare Part A outside of your IEP during a special enrollment period.

How to Maximize Your Medicare Part A Benefits

Here are some tips for getting the most out of your Medicare Part A coverage:

• Understand your coverage: Make sure you understand your Medicare Part A coverage, including deductibles, coinsurance, and maximum out-of-pocket limits. This will help you make informed decisions about your care.
• Take advantage of preventive care: Medicare Part A covers many preventive care services, such as flu shots, cancer screenings, and cardiovascular screenings. Taking advantage of these services can help you stay healthy and avoid costly treatments down the road.
• Get the right care at the right time: Choosing the right care setting can help you save money and get better outcomes. For example, if you have a minor injury or illness, an urgent care center may be a more cost-effective option than an emergency room.

What to Do If Medicare Part A Doesn’t Cover a Service

If Medicare Part A doesn’t cover a service you need, there are several options available to help you pay for it. These include supplemental insurance, Medicare Savings Programs, and Medicaid.

• Supplemental insurance: Supplemental insurance can help bridge the gap between what Medicare Part A covers and what you need. These plans provide additional coverage for services such as long-term care and custodial care, as well as prescription drugs.
• Medicare Savings Programs: Medicare Savings Programs are state-run programs that can help pay for Medicare premiums, deductibles, and coinsurance. To qualify, you must meet certain income and asset limits.
• Medicaid: Medicaid is a joint federal and state program that helps pay for medical care for people with limited incomes and resources. Depending on your state, Medicaid may cover services that Medicare Part A does not, such as long-term care.

Conclusion

Medicare Part A is the hospital insurance portion of Medicare, covering inpatient care, skilled nursing care, hospice care, and some home health care services. It has deductibles, coinsurance, and maximum coverage limits. It also has a maximum out-of-pocket limit of $6,220 in 2021. To maximize your benefits, make sure you understand your coverage and take advantage of preventive care services. If Medicare Part A doesn’t cover a service you need, there are several options available, such as supplemental insurance, Medicare Savings Programs, and Medicaid.