Part A: What’s Covered?
Medicare Part A helps pay for:
- Hospital inpatient care
- Skilled nursing facility care (SNF) — not custodial or long-term care
- Home health care
- Blood for transfusions
- Hospice care
Part A is premium free if you or your spouse have worked and paid social security taxes for at least 40 quarters or 10 years.
If you don’t qualify for premium-free Part A, you can buy Part A.
Getting Care & Benefit Periods
Benefits are paid on the basis of “benefit periods.” Benefit periods measure your use of inpatient hospital and skilled nursing facility (SNF) services.
Begins: 1st day you are admitted to a hospital or SNF as an Inpatient
Ends: After 60 consecutive days you have been out of a hospital or SNF
Lifetime Reserve Days
Lifetime reserve days are additional days that Medicare will pay for when you are in a hospital for more than 90 days.
You have a total of 60 reserve days that can be used during your lifetime. These days are nonrenewable, meaning you will not get them back when you become eligible for another benefit period.
Impatient or Outpatient
Whether you’re an inpatient or an outpatient affects how much you pay for hospital services and if you qualify for Part A SNF coverage.
Inpatient: You’re an inpatient when the hospital formally admits you with a doctor’s order.
Outpatient: If you’re getting emergency or observation services, lab tests, or X-rays, without a formal inpatient admission (even if you spend the night in the hospital).
If you’re under observation more than 24 hours, you must get a Medicare Outpatient Observation Notice (MOON). This tells you why you’re an outpatient and how it affects what you pay for your care in the hospital and after you leave.
Skilled Nursing Facility Benefits
Medicare covers semi-private rooms, meals, skilled nursing and therapy services, and other medically necessary services and supplies in a SNF
You must meet all the following conditions:
- Covered only after hospitalized for 3 consecutive inpatient overnights
- Admitted to SNF within 30 days after leaving hospital
- Receive care in the SNF for the condition treated in the hospital.
- Require daily skilled services
- Must be a Medicare participating SNF
Home Health Care Benefits
Must meet the following four conditions:
- Must be under the care of a doctor
- Must need skilled services
- Must be homebound
- Must use a Medicare approved agency
Prior hospitalization is not required to receive home health services under Medicare.
Hospice Care Benefits
To qualify for hospice care, a hospice doctor and your doctor must certify that you are terminally ill, meaning you have a life expectancy of 6 months or less. After 6 months, you can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies that you are still terminally ill.
Part A Costs
The following table shows costs broken out by the type of coverage/benefit.
|Part A Premiums|
|Paid Social Security taxes for:||Cost:|
|At least 40 quarters or 10 years by you or your spouse||Free|
|Fewer than 30 quarters||$471/month|
|NOTE: If you worked fewer than 40 quarters, you may be entitled to a portion of your spouse’s coverage without impacting your spouse’s benefits.|
|Inpatient Hospital Care Costs|
|For each benefit period:||You Pay:|
|Days 1-60:||$1,484 deductible, paid upon admission as a hospital inpatient / $0 co-pay|
|Days 61-90:||$371 per day co-pay|
|Lifetime reserve days (LRDs): 60 days for each beneficiary||$742 Co-pay per day|
|Beyond lifetime reserve days:||All Costs|