What is Medicare Part A?

Medicare Part A covers inpatient care a person receives at a hospital or skilled nursing facility (SNF). It also provides coverage for hospice and home healthcare.

A person may enroll in Original Medicare, which includes Part A and Part B, if they are aged 65 years or older. Some younger people with certain health conditions, such as end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), may also be eligible.

Most people are eligible for premium-free Part A because they have 40 work credits. However, people with insufficient work credits can enroll in Part A but may have to pay a monthly premium.

This article provides an overview of Medicare. It also discusses the details of Part A coverage and the differences between Part A and Part B. It also examines Part A eligibility and costs.

Glossary of Medicare terms

We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:

• Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.

• Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.

• Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.

• Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

What is Medicare?

Medicare is the federal health insurance program for people aged 65 years and older, as well as for younger individuals with certain disabilities or conditions.

The program consists of different parts, which includes:

• Original Medicare is Part A, or hospitalization insurance, and Part B, or medical insurance. It does not include prescription drug coverage.

• Part C, or Medicare Advantage, is an alternative to original Medicare and provides the same basic coverage. Medicare Advantage plans may also offer prescription drug coverage and extra benefits, such as vision, hearing, and dental care.

• Part D is prescription drug coverage. It is available to people enrolled in original Medicare. Part D plans generally include commonly prescribed medications.

• Medigap is Medicare supplement insurance, and it is available to people with original Medicare. It pays 50 to 100% of the parts A and B out-of-pocket costs.

What does Medicare Part A cover?

Medicare Part A covers several services, including inpatient care, hospice care, and home healthcare. The following sections will look at each of these aspects in more detail.

Inpatient care

Inpatient care generally involves services that a person receives in a hospital, psychiatric facility, or rehabilitation facility. Medicare Part A will also cover SNF care. However, it is only available for a limited time, under certain conditions.

Coverage includes:

• meals

• semi-private rooms

• general nursing

• medications that a person takes during a stay

• dietary counseling

• physical therapy

• occupational therapy

• speech therapy

• medical social services

Coverage does not include:

• private rooms

• private-duty nursing

• room televisions and phones

• personal care items, such as slipper socks

Hospice

If someone has a life expectancy of 6 months or under, Medicare covers hospice care, including:

• medical and nursing services

• pain medication

• symptom management

• durable medical equipment

• nurse aide services

• social services

• grief counseling for a person and their family

Coverage also includes short-term inpatient care in a hospice facility or hospital and short-term respite care, which is 5 days of inpatient care to give a person’s regular caregiver a break from their duties.

Home healthcare

Home healthcare may fall under original Medicare Part A, Part B, or both. Most of the time, a home health agency will coordinate the services for an individual. Coverage includes:

• physical therapy

• occupational therapy

• speech therapy

• part-time nursing care

• medical social services

• part-time home health aide services

• injectable osteoporosis medications

Home healthcare coverage does not include:

• 24-hour-per-day care

• custodial services, such as dressing or bathing, when this is the only care that a person needs

• homemaker services, such as cleaning or shopping, when this is the only care that a person needs

• meal delivery to the person’s home

What is the difference between Part A and Part B?

The main difference between parts A and B is that Part A involves coverage of inpatient care, while Part B involves coverage of outpatient care.

Part B also covers preventive services, such as screenings and flu shots, as well as the following services and treatments:

• doctor visits

• laboratory tests

• durable medical equipment

• partial hospitalizations, which provide mental health treatment

• limited outpatient medications

• ambulance services

• clinical research studies

Eligibility for Part A

People aged 65 years and older are eligible to enroll in Medicare Part A. Younger individuals with ESRD, ALS, or other disabilities are also eligible.

A person may get premium-free Part A if they or their spouse has 40 work credits. People earn these credits when they pay Social Security taxes on their income. People may earn four credits per year, so it takes 10 years of employment to earn 40. Some people may refer to this as 40 quarters of work.

If a person does not have the required work credits for premium-free Part A, they can still enroll if they pay the monthly premium. If they do not qualify, they can pay either $285 or $518 each month, depending on how long they or their spouse worked and paid Medicare taxes.

Part A costs

Part A hospital inpatient costs include:

• a $1,676 deductible for each benefit period

• a $0-per-day coinsurance for days 1 to 60 for each benefit period

• a $419-per-day coinsurance for days 61 to 90 for each benefit period

• a $838-per-day coinsurance for each lifetime reserve day after day 90

• after day 150, a person will pay all costs

Part A SNF costs include:

• a $0-per-day coinsurance for days 1 to 20 of each benefit period

• a $209.50-per-day coinsurance for days 21 to 100 of each benefit period

• all costs for days 101 and beyond

Parts A and B home health services costs include $0 for home health services and 20% of the Medicare-approved fee for durable medical equipment, such as a hospital bed.

Summary

Part A is the hospitalization insurance of original Medicare. A simple way to differentiate it from Part B is that it covers inpatient services, whereas Part B covers outpatient services.

Costs associated with Part A include deductibles and coinsurance. If a person is not eligible for premium-free Part A, the costs will also include the monthly premium.

View the original article on Medical News Today