What Is Medicare Part A? Hospital Coverage Explained
A plain-English guide to Medicare Part A -- what it covers, what it costs, and who qualifies for premium-free coverage.
What Is Medicare Part A? Hospital Coverage Explained
Medicare Part A is the hospital insurance portion of Original Medicare. For most Americans, it comes at no monthly premium -- but understanding what it covers (and what it doesn't) is essential before you need it.
What Medicare Part A Covers
Medicare Part A covers inpatient care in hospitals, skilled nursing facilities, hospice care, and some home health services.
Inpatient hospital care includes a semi-private room, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies.
Skilled nursing facility (SNF) care is covered after a qualifying 3-day hospital stay. Medicare covers up to 100 days per benefit period in a skilled nursing facility -- but only if you need skilled care (physical therapy, wound care, IV medications), not just custodial care.
Hospice care is covered for terminally ill patients with a life expectancy of 6 months or less. This includes pain relief, symptom management, and support services.
Home health care is covered when you're homebound and need skilled nursing or therapy services ordered by a doctor.
What Medicare Part A Does NOT Cover
Part A does not cover long-term custodial care (help with bathing, dressing, eating), private-duty nursing, a private room (unless medically necessary), or personal care items.
How Much Does Medicare Part A Cost?
Most people pay $0 in monthly premiums for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years (40 quarters).
If you have fewer than 40 quarters, you pay a monthly premium -- $226/month for 30-39 quarters, or $411/month for fewer than 30 quarters (2016 rates).
Cost-sharing in 2016:
- Hospital deductible: $1,288 per benefit period
- Days 1-60: $0 after deductible
- Days 61-90: $322/day
- Days 91-150 (lifetime reserve): $644/day
- Skilled nursing days 21-100: $161/day
The Benefit Period Explained
Medicare Part A uses "benefit periods" rather than calendar years. A benefit period begins the day you're admitted to a hospital or SNF and ends when you haven't received inpatient care for 60 consecutive days. You can have multiple benefit periods in a year -- and pay the deductible each time.
When to Enroll in Part A
Most people should enroll in Part A at 65 even if they're still working, since it's free and provides a safety net. The exception: if you have an HSA-eligible high-deductible health plan, enrolling in Part A disqualifies you from contributing to your HSA.
We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
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About the Author
William Gray
Independent Medicare BrokerUS Air Force Veteran · Florida Medicare Specialist
William Gray is an independent Medicare insurance broker based in Daytona Beach and Palm Coast, FL. A US Air Force veteran (A-10 crew chief, Germany), he spent years in corporate insurance before going independent to serve Florida seniors directly. He has helped more than 1,000 clients across Northeast Florida compare Medicare Advantage, Medigap, and Part D plans — always at no cost to the client.
