Medicare Part A Coverage: An Expert Guide (2023)

Medicare consists of four main parts – Medicare Part A, Medicare Part B, Medicare Part C, and Medicare Part D. Some health insurance companies also provide supplemental Medicare plans.

When you sign up for Medicare, you should have a basic understanding of the coverage that each part covers. Read more below to get answers to the question, “What is Medicare Part A?”

Enter your ZIP code into our free quote comparison tool above to find health insurance or a supplemental Medicare plan from a company near you.

What is Medicare Part A?

Medicare Part A is one of the four parts of Medicare that provides inpatient or hospital care coverage. Medicare Part A and Medicare Part B make up what is known as Original Medicare (also known as Traditional Medicare or Fee-for-Service Medicare).

Medicare is a health insurance program for people over the age of 65. However, some people younger than 65 may qualify for Medicare if they have a disability or permanent kidney failure.

What does Medicare Part A cover?

Medicare Part A covers the following:

• Inpatient hospital care if a doctor deems it necessary to treat an injury or illness.
• Skilled nursing facility (SNF) care if you have already had a qualifying hospital stay and still have days left in your benefit period.
• Long-term hospital care for people who need more than 25 days of care.
• Nursing home care, if it is not custodial care or long-term care.
• Hospice care if you are terminally ill and you sign away your rights to Medicare coverage for other treatments.
• Eligible home health care after a hospital stay including, but not limited to, part-time skilled nursing care, physical therapy, occupational therapy, speech-language pathology services, medical social services, and more.

If you wonder if Medicare covers a specific product or service, you can begin by discussing your options with your doctor. Your doctor may be able to help you find something that is covered.

You can also use the Medicare coverage search to learn the details of your coverage.

Medicare coverage is based on federal and state laws, national coverage decisions from Medicare, and coverage decisions made by companies that process Medicare claims.

How much does Medicare Part A cost?

Is Medicare Part A free? In some cases, individuals can receive Medicare Part A without paying a premium, sometimes known as premium-free Medicare.

Who qualifies for free Medicare Part A? Most people will be eligible for premium-free Medicare.

If you are 65 and receive retirement benefits, are eligible to receive retirement benefits, or you or your spouse had Medicare-covered government employment, you will receive premium-free Medicare.

If you are under 65 and have received disability benefits for at least 24 months or have End-Stage Renal Disease, you will receive premium-free Medicare.

If you do not qualify for premium-free Medicare Part A, you can pay a premium of $274 or $499 per month in 2022, depending on how long you or your spouse worked and paid Medicare taxes. If you go this route, you will also have to purchase Medicare Part B.

Even if you qualify for premium-free Medicare Part A, you may still have to pay a health care deductible, copayment, or coinsurance.

For inpatient hospital care, the deductible is $1,556 in 2022 for each benefit period. For days 1-60, you do not have to pay coinsurance. For days 61-90, you have to pay $389 per day. For over 90 days, you have to pay $778 per day for up to 60 days, after which you will have to pay all costs.

The costs of long-term hospital care are the same as inpatient hospital care. However, you will not have to pay an additional deductible if you are admitted to the long-term hospital facility within the same benefit period as a regular hospital stay.

There is no deductible for skilled nursing facility (SNF) care. For days 1-20, you do not have to pay coinsurance. For days 21-100, you have to pay $194.50 per day in 2022. For over 100 days, you will have to pay all costs.

There is no deductible or coinsurance for hospice care. However, you may have to pay a $5 copayment for some outpatient drugs and 5% of the Medicare-Approved Amount for inpatient respite care.

There are no costs associated with home health care, but you may have to pay 20% of the Medicare-Approved Amount for durable medical equipment (DME). If you face any costs out-of-pocket, the home health care agency should notify you of this beforehand.

How do I receive Medicare Part A?

If you don’t qualify for premium-free Medicare Part A, you must sign up and pay the premium. However, if you are eligible for premium-free Medicare Part A, you may receive it automatically or need to sign up for it manually.

To receive Medicare Part A automatically, you will need to receive social security or disability benefits from Social Security or the Railroad Retirement Board. Your application for these benefits will also serve as your Medicare application.

Suppose you need to apply for Medicare manually. In that case, you can complete the forms online, call Social Security at (800) 772-1213, contact your local Social Security office, or contact the Railroad Retirement Board at (877) 772-5772 if you or your spouse worked for a railroad.

If you need to purchase health insurance or a Medicare supplement plan, enter your ZIP code into our free quote comparison tool below to find a plan that works for you.

Case Studies: Medicare Part A Coverage

Case Study 1: Aetna Health Insurance

John, a Medicare beneficiary enrolled in Aetna Health Insurance, experienced an unexpected hospitalization. As he required an extended stay, John relied on his Medicare Part A coverage for inpatient hospital services. This case study delves into John’s journey, outlining the process of navigating Medicare coverage while managing his health and financial obligations.

Case Study 2: Blue Cross Blue Shield

Sarah, a Medicare beneficiary covered under Blue Cross Blue Shield, underwent surgery and required rehabilitative care at a skilled nursing facility. This case study explores the intricacies of Medicare Part A coverage for post-hospitalization care, highlighting Sarah’s experience with coordination of benefits, coverage limitations, and the duration of skilled nursing facility services.

Case Study 3: UnitedHealthcare

Mark, a Medicare beneficiary enrolled with UnitedHealthcare, reached a point in his illness where he needed hospice care. This case study delves into Mark’s journey through the Medicare Part A coverage for hospice services, discussing the eligibility criteria, the role of the interdisciplinary hospice team, and the financial aspects of end-of-life care.

Case Study 4: Humana

Maria, a Medicare beneficiary with Humana coverage, required home health services after a major surgery. This case study explores Maria’s experience with Medicare Part A coverage for home health services, including the eligibility criteria, covered services, and the coordination of care between healthcare professionals and Medicare-certified agencies.

Case Study 5: Cigna

Robert, a Medicare beneficiary with Cigna, required intensive inpatient rehabilitation services following a severe stroke. This case study explores his experience with Medicare Part A coverage for inpatient rehabilitation, emphasizing the significance of meeting criteria, coverage duration, and the role of healthcare professionals in optimizing rehabilitation outcomes.