Original Medicare consists of two parts, Medicare Part A and Medicare Part B. Part A (Hospital insurance) covers inpatient care, care at a skilled nursing facility, and at-home care (in limited circumstances).
To be eligible for premium-free Part A, you must be entitled to receive Medicare based on your earnings or those of a spouse, parent, or child. You must also have 40 of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. Most people will be automatically enrolled in Part A once they turn 65. You may also be automatically enrolled in Part B if you are already enrolled in Part A and receiving Social Security benefits.
In general, Medicare Part A covers inpatient hospital care, limited home health services, hospice care, and skilled nursing facility care. These benefits are covered based on your specific situation and only if certain conditions are met.
What Part A covers
- Hospital Care
- Acute care
- Critical access
- Inpatient rehabilitation facilities
- Long-term care
- Mental health care
- Qualifying clinical research study
- Home Health Care
- Part-time or intermittent skilled nursing care
- Part-time or intermittent home health aide care
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
- Nursing Home Coverage
- Semi-private room
- Meals
- Skilled nursing services
- Rehabilitation services
- Medical social services
- Medications received while in SNF care
- Medical supplies and equipment used in SNF
- Ambulance transportation
- Dietary counseling
- Hospice
- Doctor services
- Nursing care
- Pain relief medications
- Social services
- Durable medical equipment
- Medical supplies
- Hospice aide
- Homemaker services
- Physical and occupational therapy
- Dietary counseling
- Short-term inpatient care
- Short-term respite care
What is not covered?
Medicare doesn’t cover everything, so you may have to pay out of pocket for certain services. Even if Medicare covers the costs of a service or piece of equipment, you will most likely still have to pay your copayment, coinsurance, and the Part A deductible, which is $1,408. Talk to your doctor to find out specifics about what Medicare won’t cover.
Some examples of services that Part A does not cover are:
- A private room (unless medically necessary)
- Private-duty nursing
- Personal care items, like razors or slipper socks
- Extra charges, like a telephone or TV in your room
- Non-donated blood
- Meals delivered to your home
- 24-hour-a-day care at home
- Homemaker services
- Personal care
- Custodial (long-term) care
2020 Part A premium, deductible, and coinsurance
Premium. Most enrollees will not have a Part A premium, but those who don’t have 40 quarters of work history or a spouse with 40 quarters of work history will need to pay a premium. For 2020, the premium for people who have between 30 and 39 quarters of work history is $252 per month. For people with fewer than 30 quarters, it’s $458 per month.
Deductible. The Part A deductible for 2020 is $1,408 (up from $1,364 in 2019) and applies to each benefit period rather than calendar year, but many beneficiaries have supplemental coverage, such as Medigap, that pays for this deductible.
Coinsurance. If you need inpatient care, the deductible will cover your first 60 days. After that, you will be charged a daily coinsurance charge of $352 per day for days 61-90. After 90 days, the coinsurance rate is $704 per day.
Understanding Medicare Part A
Medicare Part A covers inpatient care like a skilled nursing facility, care received in a hospital, and some limited in-home care. You will probably be automatically enrolled in Part A whenever you turn 65. If you are not already enrolled in Part B and need to enroll manually, you can do so during your initial enrollment period, which is a six-month window that begins three months before you turn 65.
If you still have questions about your coverage or health care pertaining specifically to you, call 1-800-MEDICARE.
