Medicare Part A, Hospital Insurance

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 homebound; and doctor’s services, medication and grief and loss counseling for terminally ill patients.  

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 $422 in 2018). 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, copayments 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.

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, and 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 like 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.

Read more at Medicare 101: Do You Need All 4 Parts?