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Section 2: The Parts of Medicare 
 

Part A: Hospital Coverage

Part A helps pay for inpatient stays in hospitals and skilled nursing facilities, home health services, and end-of-life hospice care


ESTIMATED READ TIME: 4 MINUTES

  

IN THIS ARTICLE

 

•  What Part A does, doesn’t cover
•  What you pay for Part A
•  When should you sign up for Part A?

 

DEFINITIONS

 

A new term you’ll encounter in this article:

 

Hospice care: Care for terminally ill patients who choose to receive comfort care rather than care to treat their illness, including services and medications to manage their symptoms and control pain.

illustration of a hospital next to the letter a

What Part A does, doesn’t cover

 

Medicare Part A helps pay many of your expenses if you’re admitted as an inpatient to a hospital that accepts Medicare, such as:

 

  • A semiprivate room and meals
  • Nursing services
  • Drugs, supplies and other hospital services  
  • Lab tests and X-rays
  • Some blood transfusions  
  • Inpatient rehabilitation services
  • Most hospital services for the first 60 days

 

Part A also can cover some care in other settings, such as:

 

  • The first 20 days of care in a skilled nursing facility — such as physical and occupational therapy — after being hospitalized, but you generally need to have been an inpatient in a hospital for at least three days to qualify
  • Some part-time, skilled home care for people who are homebound and meet other requirements
  • Hospice care for people who are terminally ill

 

What Part A doesn’t cover:

 

  • Personal expenses while hospitalized — such as a TV or phone — that are separately charged
  • A private room, unless it’s medically necessary or the only room available
  • Services you receive from doctors while you’re in a hospital, which are covered under Part B
  • Long-term care, also called custodial care, if nursing care or rehabilitation is not also needed
  • Most care outside of the United States

 

What you pay for Part A

 

PREMIUM

 

If you or your spouse had Medicare taxes deducted from your paycheck for at least 10 years, you won't be billed for a Part A premium. Someone who has worked an entire year is credited with four quarters, but the 40 quarters total don't need to be consecutive. If you or your spouse have paid Medicare taxes for fewer than 40 quarters, you will have to pay to receive Part A.

 

If you have to pay premiums to get Part A, the monthly bill could be $274 or $499 in 2022, depending upon the number of years Medicare taxes were deducted from your paycheck. And your Part A premium may be higher if you don't sign up for Medicare when you are first eligible. 

 

DEDUCTIBLE

 

The deductible is the amount you pay before Medicare will handle any expenses. In 2022, the Part A deductible is $1,556 per benefit period. A benefit period begins the day you are admitted to a hospital as an inpatient or become a patient in a skilled nursing facility, and ends when you’ve been out of the hospital or skilled nursing facility 60 days in a row.

 

You pay a single deductible even if you have more than one hospital stay during a benefit period. However, be aware that you may pay more than one deductible in a calendar year, which may be different from private insurance plans you have had at work.

 

COPAYMENTS

 

A copay is a portion of the cost that you pay yourself even after you’ve met your deductible. Part A has no copay for hospital stays up to 60 days in one benefit period. Copays for a longer stay in 2022 may include these:

 

  • $389 a day for days 61 to 90 
  • $778 a day after day 90 for up to 60 lifetime reserve days 
  • All costs after use of lifetime reserve days

 

Each lifetime reserve day may be used only once, but you may apply the days to different benefit periods.

 

Copays for skilled nursing facility stays in 2022:

 

  • $0 for days 1 to 20
  • $194.50 a day for days 21 to 100
  • All costs beyond day 100

 

Copays during hospice care may include up to $5 per prescription for pain and symptom management. Supplemental insurance, known as Medigap, can cover some of the deductible and out-of-pocket costs.

 

When should you sign up for Part A?

 

If you’re already receiving Social Security retirement benefits, you’ll be enrolled automatically in Part A at the beginning of the month you turn 65 or, if your birthday is on the first day of a month, during the previous month. You can’t delay Part A if you’re already getting Social Security unless you decide to stop your monthly checks and repay what you’ve already received.

 

Unless you decline, you’ll also be enrolled automatically in Part B, except in Puerto Rico, where everyone has to take steps to sign up for Part B.

 

Be aware: If you and your younger spouse both receive Social Security retirement benefits, your spouse cannot enroll in Medicare when you do unless your spouse has received Social Security Disability Insurance payments for 24 months or otherwise qualifies for Medicare early, such as having end-stage kidney disease or amyotrophic lateral sclerosis, better known as Lou Gehrig’s disease. Medicare is not a family plan, so your spouse will have to maintain the coverage you have now or look for an alternative while you explore your Medicare options.

 

If you’re not already receiving Social Security, in many instances you should sign up for Medicare Part A during your initial enrollment period, the seven months that start three months before the month in which you turn 65 and end three months after your birth month. If you get health care from the following places, you might have less coverage or different costs at age 65 and older than before you became eligible for Medicare:

 

  • The Affordable Care Act’s health insurance marketplace
  • COBRA from a former employer
  • A Medicaid program from a state, territory or the District of Columbia
  • A retiree health plan from a previous job or union
  • Tricare military health coverage
  • U.S. Department of Veterans Affairs health benefits 

 

If you have health insurance through your employer, you still should sign up for Part A during your initial enrollment period. It’s even more important if you work for a company that has fewer than 20 employees, because Medicare will pay a claim before your company’s insurance. If you don't sign up for Part A, you could have a gap in coverage when your plan at work becomes secondary.

 

If you or your spouse have worked for 10 years and have been paying Medicare taxes during that time, Part A is free, so it’s often a good idea to enroll when you become eligible.

 

However, some people who work for a large employer choose to delay signing up for Part A and Part B so they can continue to contribute to a health savings account (HSA). HSAs are tax-advantaged savings accounts available to people who have high-deductible health plans.

 

Employers sometimes contribute to these plans in addition to employees. While the money has to be used for health care expenses, it does not have to be used in the year it is deposited. After you enroll in Medicare, an HSA can still be used for eligible expenses, but you can no longer make new contributions to the HSA.
 


 

2. The Parts of Medicare
Part B: Doctor and Outpatient Services