Medicare Part A (Hospital Insurance)

By: Agnus Smith
Published: Tuesday, July 24 2018
Last Updated: 3 years ago

Across America, millions of seniors or disabled individuals depend on Medicare for their healthcare coverage. For those of you who are still a little unclear about this program, the following information will go into detail about Medicare Part A coverage to help you learn more about it all.

What Is Medicare Part A

Medicare Part A is also known as hospital insurance. It involves providing coverage for situations such as hospital visits, inpatient care, hospice care, and more.

With that said, the hospital insurance provided by Medicare Part A still may not cover exactly what you need. It's always important to check with your hospital or doctor in your state to see if a specific service you need is eligible for Medicare Part A coverage.

What Is Covered Under Medicare Part A

With Medicare Part A coverage, you can receive help for a number of various hospital-related visits, home health care, nursing home, or even hospice care.

Medicare Part A: Hospital Coverage

Hospital insurance with Medicare covers a number of services and facilities. Generally, the following is covered:

  • Drugs (as long as they're a part of your inpatient care)
  • General Nursing
  • Meals
  • Semi-Private Rooms

Coverage for this hospital insurance will also help with additional hospital services and supplies. This includes acute, critical, and long-term hospital care.

There are various inpatient-related services that your hospital insurance pays for. This includes rehabilitation facilities, mental health care (regular hospital or psychiatric hospital), and clinical research studies.

You can typically receive this coverage as long as a hospital accepts this insurance, you require care that can only be received in a hospital setting, or there is a doctor order involved.

As for what is not covered under this Medicare plan, you will most likely have to pay for a private room out-of-pocket (unless it is medically necessary). Also, private-duty nursing is not generally paid for by your hospital insurance.

Medicare Part A: Limited Home Health Services

Your Medicare Part A coverage comes with limited home health service coverage. These services include:

  • Medical Social Services
  • Occupational and Physical Therapy
  • Part-time/intermittent skilled nursing/home health aide care

Coverage for limited home health services does not include 24-hour care at home or personal care. Usually, Medicare also doesn't pay for homemaker services or any type of meals delivered to your home.

Medicare Part A: Nursing Home/Skilled Facility Coverage

With Medicare Part A coverage, you can also receive help paying for a skilled nursing facility (SNF). However, certain conditions must be met, and it is generally only covered for a limited amount of time.

Coverage includes:

  • Ambulance Transport
  • Dietary Counseling and Meals
  • Medical Social Services
  • Medical Supplies and Facility Equipment
  • Medications
  • Physical and Occupational Therapy
  • Skilled Nursing Care
  • Speech-Language Pathology Services

There are certain hospital situations that can occur that will affect your SNF coverage. Much of this is connected to whether or not you are seen as an inpatient or outpatient.

Medicare Part A: Hospice Coverage

When it comes to your Medicare Part A hospice coverage, your plan will be set up by your family and a hospice team. Your hospice team can include a number of people from doctors, nurses and nurse practitioners, social works, counselors, and more.

Compared to other coverage under your Medicare plan, hospice care is only granted to those who are terminally ill. Generally, the life expectancy is six months or less. You also typically receive this Medicare Part A coverage care in your own home, but you can be sent to an inpatient facility under the arrangements of your doctor.

Medicare Part A Eligibility

Although this type of coverage is counted as the minimal essential coverage to satisfy the law, there are still certain eligibility requirements that you must meet.

Age to Enroll in Medicare Part A

Your age plays an important factor with Medicare Part A eligibility. Generally, this coverage is granted to those who are 65-years-old or older. If you are already receiving Social Security benefits or Railroad Retirement Board (RRB) benefits, then you will automatically be enrolled upon the first day on the month of your 65th birthday. For those whose birthday falls on the first, you'll receive it the month prior.

Other Eligibility Factors

Beyond your age, there are other Medicare Part A eligibility factors to consider when enrolling. For one thing, you can be well under the age of 65 and still receive Part A coverage.

Individuals who are disabled can meet Medicare Part A eligibility requirements. There are other situations that factor into your eligibility as well. Those with end-stage renal disease (ESRD) meet Medicare Part A eligibility requirements as well. This includes permanent kidney failure that requires either a transplant or dialysis treatment. Your Medicare enrollment is not automatic, however.

Another Medicare Part A eligibility factor that can play a role is in the case of Lou Gehrig's disease. In other words, Amyotrophic Lateral Sclerosis (ALS). You are automatically enrolled once your disability benefits begin.

Medicare Part A Cost

Medicare Part A cost factors depend on a number of situations. Most of the individuals that qualify for this plan receive premium-free coverage. In this case, there is no monthly premium cost to pay. This generally only occurs if you or your spouse paid for Medicare taxes while working for a set amount of time.

Otherwise, for those who buy into this plan, the Medicare Part A cost of premiums depend largely on whether or not you paid for the taxes beforehand. For instance, for 2018, you can see a monthly premium of $422. However, if you paid the insurance taxes for 30-39 quarters, the Medicare Part A cost for premiums is usually $232 a month.

In addition to the premium, with this hospital insurance, you also have to deal with a standard Medicare Part A deductible.

You must also keep in mind that if you buy into this insurance, then you also are required to have Medicare Part B coverage.

Medicare Part A Deductible

Another issue that comes to play with your Medicare Part A cost is your deductible. Medicare Part A deductible costs are done on a "benefit period" rather than a yearly basis like other insurance plans. For 2018, the Medicare Part A deductible is $1,340.

You also have to consider coinsurance along with the Medicare Part A deductible. Other conditions that factor in are the specific Medicare Part A coverage options you use such as hospital stays, hospice care, nursing home care, and more.

Qualifying for Free Medicare Part A

Though there is a usual Medicare Part A cost that you have to deal with, there are ways you can qualify for premium-free coverage.

For those of you who are 65-years old or older, you meet Medicare Part A eligibility requirements for premium-free coverage under the following conditions:

  • You are eligible for Social Security or RRB benefits, but you haven't filed them yet.
  • You are receiving Social Security or RRB benefits.
  • You or your spouse previously had Medicare-covered government employment.

You can also qualify for premium-free Medicare Part A if you are under the age of 65 in certain situations. This includes individuals with ESRD and those who have received Social Security or RRB benefits for 24 months.