Medicare is federal health insurance for people 65 and older and individuals with qualifying disabilities.
Generally applying to care in institutions, Medicare Part A covers inpatient hospitals, skilled nursing facilities, hospice, inpatient rehabilitation, and select home health care services.
When Am I Eligible for Medicare Part A?
You become eligible for Medicare at age 65. If you are currently receiving Social Security benefits, you will be enrolled automatically in Medicare Part A as well as Medicare Part B.
Learn more on ElderLawAnswers.com about Medicare enrollment and what you need to know in order to sign up.
What Does Medicare Part A Cover?
Medicare Part A covers expenses for 60 days of hospitalization. Then coinsurance kicks in, and beneficiaries contribute to some of the cost.
Those enrolled in Part A also get 60 lifetime reserve days with a coinsurance. They can use them all at once or through individual episodes of illness. Coverage includes semi-private rooms and private rooms when medically necessary, meals, general nursing, medications, and psychiatric treatment.
If the hospital gets blood from a free blood bank, individuals do not have to pay for it. Otherwise, they must make up for the first three units of blood they receive by paying for the blood, donating blood within the calendar year, or having someone donate on their behalf.
In addition to paying for hospitalizations, Medicare Part A pays for the first 20 days in a skilled nursing facility in which trained nurses provide medical care before coinsurance payments start.
Unlike nursing homes and assisted living facilities, skilled nursing facilities are for short-term medical assistance. Although Part A covers skilled nursing care, it does not cover long-term care in a nursing home or assisted living.
Stays in skilled nursing facilities typically follow hospitalizations. To be eligible for skilled nursing coverage, enrollees must have stayed in a hospital for at least three days and demonstrate that they need skilled nursing to improve or maintain a current condition. The program includes semi-private rooms, meals, skilled nursing, and therapy services.
Home Hospice Care
Although Medicare Part A mainly encompasses care in institutions, it does pay for in-home hospice care when a doctor certifies that an individual is terminally ill. Health care must not prolong the beneficiary’s life but rather help the beneficiary be comfortable when approaching death.
Per Medicare.gov, coverage includes:
- Pain relief and symptom management
- Medical, nursing, and social services
- Pain-relieving drugs with a $5 copay
- Medical equipment for pain relief and symptom management
- Home aid services
- Grief counseling
Although Medicare does not cover hospice care in a facility, it does allow beneficiaries five days of respite care, relieving their primary caregivers.
Religious, Nonmedical Health Care Institutions
Some recipients qualify for inpatient care in religious, nonmedical health care institutions. In those cases, the insurance only covers nonreligious items that do not need a doctor’s prescription, like room and board, wound dressings, and the use of a simple walker.
2023 Premiums, Hospital Deductible, and Coinsurance Amounts
Any person who has reached age 65 and who is entitled to Social Security benefits (i.g., has 40 quarters of Medicare-covered employment) is eligible for Medicare Part A without charge. According to the Centers for Medicare & Medicaid Services (CMS), 99 percent of all enrollees do not pay a premium for Part A.
Others must pay a premium. Medicare also counts a spouse’s work for qualifying purposes.
- Individuals with at least 30 quarters of Medicare-qualifying work can purchase Part A at a reduced monthly premium rate of $278 in 2023.
- Uninsured older adults and qualifying individuals with disabilities can buy into the program at $506 a month in 2023.
For 2023, Part A beneficiaries are responsible for the following amounts:
- There is a $1,600 inpatient hospital deductible. Beneficiaries must pay this amount before the insurance kicks in and covers hospital expenses.
- Medicare Part A covers the first 60 days in a hospital or skilled nursing facility. Then, enrollees must pay a daily coinsurance, which is $400 for days 61 to 90, and then $800 when it taps into the 90 lifetime reserve days.
- Medicare Part A pays for the first 20 days when a patient resides in a skilled nursing facility. Then, the individual must pay $200 until the 100th day, after which the individual must bear the entire cost.
- Individuals are responsible for 5 percent of the Medicare-approved amount for respite care.
Medicare is a complex topic. You can consult with an elder law attorney to receive expert guidance. Find a qualified attorney near you.