What is Medicare Part A?

Medicare Part A is the first building block of your health insurance in retirement and is known as “Hospital Insurance”.

Part A Covers:

  • Inpatient care in hospitals.

  • Inpatient care in a skilled nursing facility.

  • Hospice care services.

  • Inpatient care in a Religious Non-medical Health Care Institution.

  • Home Health Services.

Part A may also cover (if admitted as an inpatient for a medically necessary need in a Medicare recognized health facility):

Room and Board Blood Transfusions Medical Social Services
Meals Physical Therapy Occupational Therapy
General Nursing Medications Speech-Language Therapy
Blood Medical Supplies Diagnostics
Anesthesia Hospice Alcohol or Substance Abuse Treatment
Chemotherapy Transportation Kidney Dialysis (Inpatient only)
What Medicare Part A does not cover while admitted as an inpatient:
  • Private duty nursing.

  • Private room.

  • A television or telephone in your room or personal care items like razors or slipper socks.

  • A private room unless medically necessary.

  • Custodial care, assisted living, adult daycare, or reimbursement for family members.

  • The first three pints of blood unless the blood deductible has been met.

The Costs of Medicare Part A in 2021 (broken into 5 parts):
1. The Premium:

Most people do not pay a monthly Part A premium due to qualifying through paying Social Security taxes while employed.

As long as you or your spouse of 10 or more years has 40 or more quarters of Medicare-covered employment completed by age 65 then Part A has no premium for coverage for both you and or your spouse.

If you have not met the specific requirements there is still an opportunity to enroll into Part A, the premiums in 2021 are:

  • If you have zero quarters: the premium is $471.00 per month.

  • If you have 30 to 39 quarters: $259.00 per month.

2. Inpatient Annual Deductible:

$1,484.00 per incident.

When you are admitted for a medically necessary need you may be charged this deductible. In the same year, if you are admitted again, after a 30-day period for the same ailment or for a new medically necessary need you may be charged this deductible again.

3. Co-Insurance for inpatient hospital stays:
  • $0.00 coinsurance for the first 60 days of each benefit period.

  • $371.00 a day for the 61st to 90th days of each benefit period.

  • $742.00 a day for days 91 and beyond per each lifetime reserve day of each benefit period (there are up to 60 lifetime reserve days).

  • After lifetime reserve days are used all costs are incurred.

4. Skilled nursing facility care (SNF):

According to CMS SNF is “nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel. It’s health care given when you need skilled nursing or skilled therapy to treat, manage, and observe your condition, and evaluate your care”.

The costs are:

  • $0 for days 1 to 20 for each benefit period.

  • $185.50 a day for the 21st to 100th days (skilled nursing facility coinsurance of each benefit period).

  • Days 101 and beyond: all costs.

5. Home Health Services:

There are $0.00 costs incurred for services rendered, but there is a 20% Co-pay.

Home Health Services covers:

Part-Time” Skilled Nursing Part-time Home Health Aide
Physical Therapy Injectable Osteoporosis Drugs for Women
Occupational and Speech Therapy Medical Social Services
Not covered by Home Health Services:
  • 24-hour-a-day care at home.

  • Meals delivered to your home.

  • Homemaker services (like shopping, cleaning, and laundry), if this is the only care you need.

  • Custodial or personal care (like bathing, dressing, or using the bathroom), if this is the only care you need.

To qualify for Home Health Services according to CMS:
  • A doctor, or other health care provider, must see you face-to-face before certifying that you need home health services.

  • A doctor or other provider must order your care.

  • A Medicare-certified home health agency must provide it.

  • You must be homebound which means:

    • You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) due to an illness or injury.

    • You are normally unable to leave your home because it’s a major effort.

Medicare Pro-Tip:

Certain Supplemental/Medigap Plans cover the majority of costs associated to Part A. For more information, please see the section on Supplement/Medigap Plans

Source: The official website of the U.S. Government, Medicare.gov.