Medicare Part A (Hospital Insurance)
Medicare Part A is hospital insurance and is part of Original Medicare. Part A includes medical services related to inpatient hospitalization, skilled nursing facilities, and home health care.
What does Medicare Part A Cover?
- Inpatient hospital stays
- Skilled nursing facilities
- Hospice care
- Some home health care
Note: Restrictions may apply. For more information, consult the Medicare & You handbook or visit medicare.gov.
How much does the Medicare Part A premium cost?
Fortunately, Part A has no premium for most people in the United States. You usually will not have to pay a premium for Part A if you or your spouse:
- pays into Social Security taxes for at least 40 quarters
- had Medicare-covered government employment
OR if you:
- are already receiving social security benefits or RRB (railroad retirement board) benefits
- are eligible to receive social security benefits or RRB (railroad retirement board) benefits
But, what if you are a U.S. citizen or permanent resident and do not meet this criteria? You may still be able to enroll in Part A. However, you will likely pay a premium for it.
For example, let’s say you do not qualify for a no premium Part A plan, but you paid social security taxes for less than 30 quarters. In this scenario, your plan premium will likely be $499 per month in 2022.
What if you do not qualify for a no premium Part A plan but paid into Social Security taxes for more than 30 quarters but less than 40 quarters? Then your premium will likely be $274 per month in 2022.
What are the Part A deductibles, co-pays, and co-insurances?
- You will pay a deductible of $1556 in 2022 if you are in the hospital for 1-60 days.
- The deductible may apply each time you are admitted to a hospital
- You will pay a copay of $389 per day in 2022 if you are in the hospital for days 61-90.
- For days 91-150, you will pay a copay of $778 dollars per day in 2022.
- You will pay a copay of $194.50 per day in 2022 if you stay more than 20 days in a skilled nursing confinement.
Special rules may apply, so make sure to visit Medicare.gov for details or call Medicare directly at 1-800-MEDICARE.
A note on skilled nursing facility coverage:
In order to qualify for coverage for a skilled nursing facility, certain conditions must be met. It is usually covered only after following a 3-day inpatient hospital stay and for a related medical condition OR while you were being treated in a skilled nursing facility for a hospital-related condition. You must have a qualifying hospital stay and your physician must prove that you need the care. The skilled nursing facility must also be certified by Medicare.
Plans are available to help cover these extra costs
Most people will choose a Medicare Supplement Plan or Medicare Advantage (Part C) plan to help cover the deductibles, co-pays, and co-insurances that Medicare Part A does not cover. You can learn more about these coverage options and pros and cons of each on the article we wrote here:
When can I enroll into Medicare Part A?
You become eligible for Medicare Part A during your Initial Enrollment Period (IEP). This is a 7 month period. It includes the three months before the month of your 65th birthday, the month of your birthday, and the three months after your birthday.
Usually, social security will automatically enroll you in Medicare Part A if you already receive social security benefits. If not, you will need to enroll. To enroll, call social security at 1-800-772-1213. Or enroll online through the social security website at ssa.gov/benefits/medicare. As an alternative option, you can enroll by visiting your local social security office. Just note that wait times can be long.
Note: due to the COVID-19 pandemic, social security is not accepting face to face appointments. You may still call and schedule a phone appointment if you would like to speak with a social security agent directly.
What is the Part A Late Enrollment Penalty?
If you do not qualify for Premium free Part A, and do not buy Part A when you are first eligible, then you may have to pay a late enrollment penalty. If Medicare determines you owe a late enrollment penalty, your premium may go up by 10% for twice the number of years you were eligible for Part A and did not sign up.
Those that have limited income may be able to get help paying this cost through the Medicare Savings Program. This program may vary by state. Contact us if you think you may qualify and need help applying.
Thriving Seniors is here to help you with your enrollment process. Our services are 100% free of charge! Call us today at 1-808-650-5939 to speak with a licensed, independent insurance agent. You can also contact us via email by filling out our form on our contact us page.
Our office is located in Honolulu, HI and licensed in multiple states. We offer our services by appointment in person, over the phone, or by video call. We look forward to helping you!