Medicare Part A

The purpose of Medicare Part A is to help cover expenses relating to care in hospitals, skilled nursing facilities, hospices, and some home health care.  It is important to note that Part A does not cover custodial or long-term care, although there may be coverage for this type of care under other provisions of Medicare.

Part A coverage generally is obtained without having to pay a monthly premium because the person covered by Part A and/or their spouse paid into Medicare through their payroll taxes while they were working.  A person who did not pay into Medicare through taxes, may become eligible for Part A coverage by paying a premium.

A person determine whether he/she is covered by Part A by taking a look at his/her Medicare Card.  Persons with Part A coverage will have “Hospital (Part A)” printed on their cards.  A person can also verify about the type of his/her coverage by calling the Social Security or visiting the Social Security website.

Most people do not need to pay a premium for Part A (hospital or skilled nursing coverage), since most people have paid into the Medicare system over the years through their payroll taxes.  A person who paid taxes to Medicare for 10 or more years, does not need to pay any premium for Part A coverage.

However, for persons who paid Medicare taxes for less than 10 years, there is a monthly premium based on the number of years they did pay taxes.   For example, there is a certain cut off amount that a person who paid taxes for at least 7½ years, but less than 10 years should pay and another cut off amount that a person who paid taxes for less than 7½ years should pay.   

In addition to monthly premiums (if any), Medicare recipients must meet a deductible before benefits begin.  This is the amount you must pay before Medicare pays anything.

The Part A deductible is fixed periodically per illness, and covers the first 60 days of a hospital stay. That is, if you are in the hospital for up to 60 days, you pay a certain amount and then Medicare pays the rest of the hospital bill.

If you are hospitalized for more than 60 days, then you pay a certain amount per day for the next 30 days (days 61 through 90).  If you are hospitalized for more than 90 days, you pay a fixed amount per day for each day after 90 days.  It is for this reason that many people carry supplemental private insurance, also known as ‘Medigap’ insurance in addition to the Medicare.

For a skilled nursing facility, Medicare covers up to 100 days. The co-insurance begins after day 21.

It is important to remember that Medicare is insurance.  Like any insurance, it has a monthly cost (your premium); annual deductibles (the amount you must pay each year before the insurance pays), and; co-pays (what you pay each time you get a service). However if you are on a limited income, Medicare also has programs that can help you pay these costs.

Inside Medicare Part A