Medicare Part A covers inpatient hospital care, limited time in a skilled nursing care facility, limited home health care services, and hospice care. Services include semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. This includes the care you get in an acute care hospital, critical access hospital, inpatient rehabilitation facilities and long-term care hospitals. It also includes inpatient care as part of a qualifying clinical research study and inpatient mental health care given in a psychiatric hospital or other hospital.
What is not covered by Part A is private-duty nursing, private rooms (unless medically necessary), televisions and phones in your room (if there's a separate charge for these items), and personal care items, like razors or slipper socks. All people with Part A are covered when:
- A doctor makes an official order that says you need two or more midnights of “medically necessary” treatment to help your illness or injury and
- The hospital formally admits you need the kind of care that can be given only in a hospital; the hospital accepts Medicare, or the Utilization Review Committee of the hospital approves your stay while you're in a hospital.
Part A premiums
You usually don't pay a monthly premium for Medicare Part A coverage if you or your spouse paid Medicare taxes for a certain amount of time while working. This is sometimes called "premium-free Part A."
You can get premium-free Part A at 65 if:
- You already get retirement benefits from Social Security or the Railroad Retirement Board.
- You're eligible to get Social Security or Railroad benefits but haven't filed for them yet, or
- You or your spouse had Medicare-covered government employment.
If you're under 65, you can get premium-free Part A if:
- You got Social Security or Railroad Retirement Board disability benefits for 24 months. On the 25th month you automatically qualify for Medicare.
- You have End-Stage Renal Disease (ESRD) and meet certain requirements.
If you have to buy Medicare Part A because you don’t qualify for the premium-free program, you'll pay up to $413 each month in 2017. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $413. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $227.
In most cases, if you choose to buy Part A, you must also have Medicare Part B and pay monthly premiums for both.
Your costs with Original Medicare Part A
Many people choose to supplement their Part A Medicare with a private Medigap Insurance plan or a Medicare Advantage Plan. For those that choose to use only Original Medicare Part A, with no additional coverage, there are costs involved. You will be subject to a deductible, and a copay for each day you are in the hospital after the first 60 days. After 90 days, you pay a higher daily copay, and begin using your 60 "lifetime reserve" days. If you are in the hospital for over 150 days, you will be responsible for all costs.
If you have questions about how hospital or skilled nursing benefit periods work or would like additional information about how to cover the costs listed above, please contact us by calling (408) 647-7873.
