Medicare Part A is hospital insurance. It’s the part of the Medicare insurance plan that pays for hospital stays, skilled nursing facility (SNF) care, hospice care, and home health care.1 If you have an illness or incident that results in hospitalization and need rehab afterward, this is the insurance that would cover it.
Who Can Sign Up for Medicare Part A?
You’re generally eligible for Medicare (including Part A) if you’re 65 or older, if you’re a younger person with a disability or you have end-stage renal disease (ESRD). People with Lou Gehrig’s disease (ALS) may also qualify.
What Does Medicare Part A cost?
For most people, Medicare Part A comes with no monthly premium payments — meaning you pay $0 for coverage.
To qualify for Medicare Part A with no premiums, you must be 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. At age 65, you can get Medicare Part A with no premiums if you’re receiving retirement benefits from Social Security or the Railroad Retirement Board (RRB), if you’re eligible for those benefits but haven’t filed for them yet, or you or your spouse had Medicare-covered government employment.2
If you’re younger than 65, you qualify if you’ve collected Social Security or Railroad Retirement Board disability benefits for 24 months, or if you have ESRD and meet certain requirements.3 If you have Lou Gehrig’s disease, you qualify the first month you get disability benefits.
What If You Don’t Qualify for Premium-Free Part A?
If you don’t qualify for premium-free Medicare Part A, you’ll pay the following amounts.
- If you paid Medicare taxes for 30 to 39 quarters: $252/month.
- If you paid Medicare taxes for less than 30 quarters: $458/month.4
Generally, if you buy Medicare Part A, you must also have Medicare Part B, which is medical insurance, and pay monthly premiums for that as well.
What Are Other Part A Costs?
Beyond the (usually free) premiums, Medicare Part A has a deductible and coinsurance that depend on how long you need coverage. That means you may have to pay a certain amount (the deductible) before Medicare kicks in, and you may have to pay some part of services (coinsurance). Those are explained below.
Medicare payment depends on how long you receive care within each benefit period. The benefit period also has nothing to do with the calendar year and applies only to hospital and SNF care.
What Does Medicare Part A Cover?
Your inpatient hospital care is covered when you’re admitted to the hospital after an official doctor’s order. You’re covered for things like semi-private rooms, meals, and general nursing, but not for services like TV in your room or personal care items. Part A also covers stays in inpatient rehab facilities and long-term care hospitals.7
|Medicare 2020 Hospital Costs||Your responsibility|
|Deductible per benefit period||$1,408.00|
|Daily copayment fee per benefit period|
|Days 91* +||$704.00|
|Beyond lifetime reserve days||All costs|
|* You pay $704 a day for up to 60 “lifetime reserve days”|
The inpatient deductible covers any admissions during a 60-day period. When the person has been out of the hospital for 60 days, that benefit period ends. However, if multiple hospitalizations occur with no 60-day break, the benefit period continues and copayments will apply when total hospital days hit 61.
Skilled Nursing Facility Care
Care in a skilled nursing facility is covered if you are admitted within 30 days of having a qualifying hospital stay — which means at least a three-day inpatient stay. The skilled services must be related to that hospital stay. You’re covered for semi-private rooms, meals, physical and occupational therapy, among other things.8
|Skilled nursing facility 2020 costs|
|Copayment per day for each benefit period|
Home Health Care Benefits
If your doctor has created a home health care plan that says you need intermittent skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy services at home, Medicare Part A covers those services. You must also be homebound. You are not covered, however, for 24-hour-a-day care at home.9
|Home health care 2020 costs|
|Durable medical equipment coinsurance||20%|
Medicare Part A covers hospice care if your hospice doctor and your regular doctor certify that you’re terminally ill and if you choose hospice care instead of other Medicare-covered benefits to treat your terminal illness. “Terminally ill,” in this case, means a life expectancy of six months or less. Once you choose hospice care, your hospice benefit generally covers everything you need for care and treatment of your terminal condition, with minimal cost sharing.10
|Hospice care 2020 costs|
|Prescription drugs copayment||No more than $5|
|Inpatient respite care||5%|
What Other Coverage Can Work With Part A?
There is additional coverage available that can help with Part A out-of-pocket costs.
Medicare Supplement or Medigap
A Medicare Supplement plan, also known as a Medigap policy, helps cover the cost sharing for hospitalization and skilled nursing facility care. The hospital or facility will submit the bill to Medicare first. Then, the supplement will pay its portion, depending on the specific plan. For example, Plan G will cover the hospital deductible, additional hospital days, and the SNF copayment.
Medicare Advantage or Part C
A Medicare Advantage plan is administered by a private insurance company. The plan must provide all the Part A services but determines how to do that and how much it will charge. Usually, plans charge a set rate per-day, such as $375 for the first four days of a hospital stay.
Part A does not cover medications once you’re discharged from the hospital or SNF. For that, you can enroll in Part D prescription drug coverage, either through a stand-alone plan or as part of a Medicare Advantage plan.
How Do You Enroll in Medicare Part A?
Signing up for Medicare Part A depends on your situation. In some cases, you’re enrolled automatically, and in others, you must apply. If you’re already receiving benefits from Social Security or the Railroad Retirement Board (RRB) for at least four months before you turn 65, you’ll be automatically enrolled. If that’s not the case, you can apply online at ssa.gov/medicare.11
If you have Lou Gehrig’s disease, end-stage renal disease, or you’re under 65 and you have a disability, find out about enrollment here.12
When Can You Sign Up for Medicare Part A?
Medicare Part A enrollment (when you’re 65) comes with a seven-month Initial Enrollment Period for signup. This includes the three months before and after the month you turn 65, plus the month of your birthday. For instance, if you turn 65 in April, your Initial Enrollment Period stretches from January through July.13
If you aren’t automatically enrolled, you can sign up for Part A any time during or after your Initial Enrollment Period starts, and your coverage start date will depend on when you enroll.14
If you must buy Medicare Part A, you miss your initial enrollment and aren’t eligible for a Special Enrollment Period (SEP), you can sign up for Part A during the General Enrollment Period (GEP), which is January 1 and March 31 each year. There are a variety of reasons you might get a SEP, including losing employer health coverage.15
There is no late enrollment penalty if you sign up during a SEP. However, if you must buy Part A, and you didn’t buy it when you were first eligible, you may pay higher premiums for a period of time when you do sign up.16
When Will Your Medicare Part A Benefits Start?
If you’re automatically enrolled, your benefits will start the first day of the month you turn 65. (Or if your birthday is the first day of the month, benefits start on the first day of the month before.17)
If you’re not automatically enrolled, you can apply for benefits online if you:
- Are at least 64 years and 9 months old,
- Do not have any Medicare coverage, and
- Are not getting any Social security retirement, disability or survivors benefits.18
You can also sign up for Medicare by phone by calling 800-772-1213 from 7 a.m. to 7 p.m. Monday through Friday. Or you can visit your local Social Security office. (Call first to make an appointment.)
When Will You Receive Your Medicare Card?
Once enrolled, you’ll receive a Medicare card that you will need to present to healthcare providers. If you are automatically enrolled in Medicare at age 65, you’ll get your card in the mail three months before your 65th birthday. If you’re disabled and qualify for Medicare that way, you’ll get a card in the mail three months before your 25th month of disability benefits.19 If you’re eligible for Medicare because you have ALS, you can get your card the same month your disability benefits start.20 If you must enroll in Medicare, you’ll get your card in the mail about two weeks after you sign up.21
You don’t have to sign up for Medicare annually, but each year you’ll have the chance to review your coverage. This is especially important if you know there’s a surgery in your future or your prescription drug needs are changing, so make a note in your calendar each year to go over your options.