Medicare Part A: What It Covers & How It Works
Retirement can seem like a maze, considering the complexity of Medicare and other similar programs. You suddenly have important decisions to make about Parts A, B, C, and D, even if you’re still asking yourself, "What is Medicare Part A?"
If you want to know more about how Medicare Part A works, we’ve provided a detailed, easy-to-follow synopsis below.
What Is Medicare Part A?
Medicare Part A is one of the two parts of Original Medicare, consisting of Part A and Part B. As of 2022, half of all Medicare beneficiaries chose Original Medicare for their healthcare. The other half chose Medicare Part C, also known as Medicare Advantage.
Two major benefits are covered with Medicare Part A: hospital and skilled nursing facility stays. This involves room and board expenses, while Part B covers costs involving treatment and doctor visits.
Most Americans 65 years of age and up qualify for premium-free Part A. Usually, this is because they (or their spouse) paid for Medicare through taxes before retirement. When you’re exempt from the premium, the only remaining out-of-pocket expenses are a deductible and copay. The way that Original Medicare calculates your use of inpatient services is through what’s called a “benefit period,” which begins on the day you’re admitted as an inpatient to a hospital or skilled nursing facility. You are obligated to pay one deductible per benefit period, and at certain stages of the benefit period, you may have to pay a daily copay. The benefit period ends when you haven't received any inpatient care for 60 consecutive days.
Medicare Part A Coverage
You can think of Medicare Part A as being a type of hospital insurance. Part A typically offers comprehensive coverage for your hospital room and board costs, depending on the length of your stay. This includes regular meals, nursing, stays in the ICU, or a private room if medically necessary. During certain lengths of stays in hospitals or skilled nursing facilities, you’ll have to pay a copay each day.
If you’re curious about Part A deductibles, as of 2023, there’s a Medicare Part A hospital deductible of $1,600 for each benefit period. The current copays are as follows:
- $0 per day for the first 60 days in the hospital, the first 20 days in a skilled nursing facility, or 101+ days in a skilled nursing facility
- $200 for days 21-100 in a skilled nursing facility
- $400 copay per day for 61st-90th days in the hospital
- $800 copay per day when you use your lifetime reserve days
Lifetime reserve days are a special, limited resource for Medicare beneficiaries. You’re only allowed a total of 60 days, but you can use them to reduce your costs during an extremely long benefit period. If you’ve stayed more than 90 days in a hospital during a benefit period, you can start using your lifetime reserve days. However, a day is gone forever once you use it. After you use them all, you’ll have no Part A coverage after the 90th day of treatment during a single benefit period.
What's Covered with Part A?
Knowing what is covered with Medicare Part A is essential when planning for retirement and considering supplemental insurance plans. Part A covers expenses like:
- In-patient meals
- Regular nursing services
- A private room, if medically necessary
- Stays in the ICU
The extent to which Medicare Part A covers these expenses is listed below.
All room and board expenses for:
- The first 60 days in a hospital
- The first 20 days in a skilled nursing facility
And part of all room and board expenses for:
- Days 21 to 100 in a skilled nursing facility
- Days 61 to 90 in the hospital
- Your lifetime reserve days at the hospital
What Is Not Covered in Part A?
Since Medicare Part A covers very specific expenses, there's a lot that it doesn't include. For starters, hospital stays of more than 90 days per benefit period aren't covered unless you still have lifetime reserve days — totaling 60 days that can be used only once, however they needn’t be consecutive — but most care simply doesn't fall under Part A.
For instance, other parts of Medicare cover the following:
- Treatment costs
- Doctor visits
- Prescription drugs
There are also medical services that no part of Medicare covers, including, but not limited to:
- Non-emergency vision care
- Most dental services
Medicare Part A Eligibility
If you’re a U.S. citizen or resident over the age of 65, suffer from end-stage renal disease (ESRD), or have certain disabilities, you’re most likely eligible for Part A. If you're already receiving Social Security or Railroad Retirement Board benefits by this time, then the organization paying your benefits will automatically enroll you into Medicare. If you aren't, you'll need to enroll manually up to three months before you turn 65. You’re eligible to get premium-free Part A if:
- You or your spouse paid taxes for Medicare during at least 10 years of employment
- You’re receiving retirement benefits from Social Security or the Railroad Retirement Board
- You are eligible to receive Social Security or Railroad Retirement Board benefits, but you have not yet filed for them
- You or your spouse had Medicare-covered government employment
How to Apply for Medicare Part A
One thing that can catch people by surprise is how to use Medicare. Part A enrollment is sometimes automatic, but many people have to enroll manually. This is because the Social Security Administration and the Railroad Retirement Board automatically sign you up for Part A if you’re already receiving benefits. They’ll enroll you as soon as you become eligible, three months before you turn 65.
Those who aren’t retired yet also become eligible at the age of 65. However, they have to enroll manually. Your first step is contacting the government agency responsible for your retirement. You can do it over the phone or apply online by taking the following steps:
OpenMedicare Is Here to Help
You deserve a smooth transition into your golden years, and OpenMedicare is here to help you achieve just that. We connect you with experts who are licensed agents who can assist you in all facets of Medicare, and we know how to untangle the different options and make everything clear.
After speaking with you to understand your budget, medical history, and priorities, a licensed agent will make recommendations and help you narrow the selection down to your best choices. Call today to get the right start on retirement with OpenMedicare!
OpenMedicare helps seniors navigate some of their most important decisions around health and wellness.