What Is Medicare Part A, Hospital Insurance?
Medicare Part A is one of the four components of the federal government’s health insurance program for senior citizens. Medicare Part A helps pay for bills related to hospital care, skilled nursing facility or nursing home care, hospice care, and home health services.
It covers expenses such as a semi-private room at a skilled nursing facility; inpatient care, supplies, and drugs during a hospital stay; physical and occupational therapy in your home if you are home-bound; and doctor’s services, medication, and grief-and-loss counseling for terminally ill patients.
- Medicare Part A pays for care at a hospital, skilled nursing facility, or nursing home, and for home health services
- Most people receive Part A free because they’ve paid the Medicare payroll tax during their working years.
- If you haven’t started collecting Social Security at age 65, you need to enroll in Medicare online, by phone, or at a Social Security office.
- Medicare doesn’t cover all services, such as simple custodial care in a nursing home if the patient doesn’t need other types of care.
Understanding Medicare Part A, Hospital Insurance
Medicare enrollees who paid Medicare taxes during their working years (which includes most people, but there are exceptions), or whose spouse paid such taxes, don’t pay premiums for Medicare Part A once they’re 65 years old. Basically, you’ve already paid your premiums through the 1.45% Medicare payroll tax that you and your employer each paid on all of your wages.
If you didn’t pay this tax during your working years, the premiums are several hundred dollars per month (up to $458 in 2020). Younger people who are receiving long-term Social Security disability benefits also qualify for premium-free Part A. Even when Medicare Part A is premium free, however, most people will still have out-of-pocket expenses for deductibles, co-payments and coinsurance.
Medicare Part A complements Medicare Part B, medical insurance, so most people who get one are required to get the other. Many people will be automatically enrolled when they qualify. A common situation where people need to enroll manually, which they can do online, by phone or at a Social Security office, is if they are 65 years old but haven’t started claiming Social Security benefits yet.
Special Considerations for Medicare Part A, Hospital Insurance
Medicare Part A covers many hospital-related services, but it doesn’t cover everything. Providers must ask patients to sign a notice in advance of receiving treatment when a service may not be covered. This procedure lets the patient choose whether to accept the service and plan to pay out of pocket or refuse the service.
To be proactive about keeping your medical bills down, it’s a good idea to find out before using a Part A service if Medicare will cover all, part or none of the cost. If Medicare won’t cover enough of the expense, find out why. There may be an alternative that would still help you that is covered, or you can file an appeal to try to get the coverage decision changed in your favor.
The three reasons why Medicare Part A might not cover something are:
- General federal and state laws
- Specific federal laws about what Medicare covers
- Local Medicare claims processors’ assessment of whether a service is medically necessary
One example of a service Medicare does not usually cover is custodial care in a skilled nursing facility—help with basic activities of daily living, such as getting dressed, bathing and eating—if it’s the only care you need. You must have more serious needs for Medicare to cover your nursing home stay.