Understanding Medicare coverage and qualifications for coverage can be difficult. There are a variety of Medicare plans with differences in coverage, as well as optional Medicare supplement plans. Original Medicare (Parts A & B) was established in 1965 to provide financial assistance for older Americans for increasing healthcare needs.
Medicare Part A provides coverage for hospital and inpatient treatment expenses.
Most Americans 65 and older qualify for Medicare Part A coverage with no monthly premium.
Deductible and co-insurance costs have increased slightly in 2023.
Americans age 65 and older, and some younger individuals with specific disabilities, qualify for Medicare Part A coverage. When deciding on your healthcare coverage options, it is essential to understand what Medicare Part A covers and does not cover.
What is Medicare Part A and what does it cover?
Medicare Part A is often referred to as “hospital insurance.” It pays for inpatient hospital stays, skilled nursing facilities, hospice care, and home healthcare.
Medicare Part A covers hospital stays and associated costs, including:
- Nursing care
- Semi-private rooms and meals
- Inpatient rehab
- Inpatient mental health care
- Medications and supplies used while hospitalized
What does Medicare Part A not cover?
Medicare Part A does not cover extra hospital amenities, private rooms, routine medical care, or durable medical equipment. Other costs not included are:
- Private nursing care
- Personal care items (razors, slipper socks, etc.)
- Home care extras like meal delivery and home care assistants
What does Medicare Part B cover?
Medicare Part B is often referred to as “medical insurance.” Medicare Part B covers outpatient care like wellness exams, lab work, diabetes screenings, and screening EKGs. It also covers durable medical equipment and medications used in machines like nebulizers. Some injectable drugs are also covered.
Medicare Part B also covers charges that may occur during hospital stays that Medicare Part A does not cover, such as anesthesia, hospitalists, doctors, and any care you received while in the hospital while under observation.
Services not covered by Medicare Parts A and B
While Medicare Parts A and B provide a wide range of coverage, there are several healthcare-related things that original Medicare does not cover. These include, but are not limited to:
- Long term care
- Dental care
- Eye exams
- Massage therapy
- Concierge medicine
How much does Medicare Part A cost?
Most Americans age 65 and older can get Medicare Part A coverage with no monthly premium. Premium prices are based on Medicare taxes paid while the individual is employed. If you paid Medicare taxes while working for at least 10 years, you likely qualify for a $0 per month premium.
Most Americans age 65 and older do not have to pay a monthly premium for Medicare Part A because they meet the requirement of paying Medicare taxes for at least 10 years (40 quarter) in their lifetime or were married to someone who paid Medicare taxes for at least 10 years (40 quarters). If you do not meet those criteria, you can still buy into Medicare Part A. The premium varies based on how long you have worked and paid Medicare taxes. Premiums have increased slightly from 2022 to 2023.
|Work History||2022 Premium||2023 Premium|
|40 quarters (10 years)||$0||$0|
|Less than 30 quarters||$499||$506|
While you likely won’t have to pay a monthly premium for Medicare Part A, you will be responsible for paying the deductible amount of $1,600 if you are hospitalized. The $1,600 deductible covers costs for the first 60 days of inpatient hospitalization. More extended hospitalizations require that you pay a per-day coinsurance. Days 61–90 require you to pay a $400 per day coinsurance.
If your inpatient hospitalization extends past 90 days, you can use your lifetime reserve days. Medicare enrollees get 60 days of lifetime reserve days that can be used at any time during the Medicare coverage period. However, you must pay an $800 per day coinsurance to use these days.
In addition to the $1,600 deductible and the per-day co-insurance required if your hospital stay extends past 60 days, you may have other out-of-pocket expenses. Items and services not covered by Medicare Part A must be paid out-of-pocket unless you have additional coverage through Medicare Part B, a Medicare Advantage Plan, or another retirement health insurance plan.
Who is eligible for Medicare Part A?
Medicare eligibility is based on age and is available to anyone age 65 and older who meets qualifications for Social Security benefits or Railroad Retirement Board benefits. There are specific disabilities that will qualify you for Medicare Part A coverage, even if you are under the age of 65.
Individuals age 65 and older enrolled in Social Security benefits at least six months prior to turning 65 are automatically enrolled in Medicare Part A at no monthly cost. If you are not enrolled in Social Security benefits before age 65, you must apply for Medicare Part A. Coverage for Medicare Part A begins the month you turn 65. If your 65th birthday falls on the 1st of the month, your coverage will begin the month prior to your birthday.
Individuals under age 65 who receive disability for 24 months also qualify for Medicare Part A. Certain conditions like ALS and end-stage renal disease qualify you for Medicare coverage, regardless of your age. Children under age 18 qualify if they have end-stage renal disease.
What is the maximum out-of-pocket for Medicare Part A?
There is no maximum out-of-pocket cost for Medicare Part A. Medicare Advantage plans typically have a maximum out-of-pocket cost, but the exact amount will vary based on your particular plan. Once you reach the maximum out-of-pocket cost for your Medicare Advantage plan, it will pay 100% of the remaining costs that are covered.
Is Medicare Part A free?
Medicare Part A does not have a premium if you have worked for 10 years. If you did not work for 10 years, your premium varies based on how many quarters you worked and paid Medicare taxes. You have to pay the deductible and any costs not covered by Part A unless you have other coverage.
What is the difference between Medicare Part A and Part B?
Medicare Part A covers inpatient hospitalizations. Medicare Part B covers outpatient care like doctors' visits. Individuals 65 and older who worked and paid Medicare taxes for 10 years are automatically enrolled in Medicare Part A for free. Medicare Part B is optional and requires a monthly premium.
- Centers for Medicare & Medicaid Services. 2023 Medicare Parts A & B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts.
- Medicare.gov. 2023 Medicare Costs.
- Medicare.gov. Medicare Part B Coverage.
- Medicare.gov. What's Not Covered by Part A and Part B?