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Health Care Reform:

Health Insurance & Affordable Care Act

Medicare Part A: Hospital Care and Services

Medicare Part A generally covers inpatient services. This includes stays in a hospital or nursing facility. It also pays for some home care and hospice.

Medicare Parts A and B are sometimes called "Original Medicare." Original Medicare is very different from private insurance plans like health maintenance organizations, or HMOs. HMOs often restrict you to doctors or hospitals in their network. Traditional Medicare allows you to go to any doctor or hospital that accepts Medicare. Original Medicare is also called "fee-for-service," which has to do with how the doctor or hospital gets paid.

The Social Security Administration handles Medicare enrollment. You are automatically enrolled in Medicare Part A and Part B if you're 65 and receive Social Security checks. Typically, you'll get your Medicare card three months before your 65th birthday. If you have private health insurance and don't want Part B coverage -- for which there is a monthly premium -- follow the instructions on the card you'll receive in the mail; you must notify Medicare that you are opting out of Part B.

If you have a disability, Lou Gehrig's disease (ALS), or kidney failure, you may get Medicare even when you're younger than 65. And if you are 65 or older but don't get Social Security payments, you can still enroll in Medicare. Call Social Security at 800-772-1213, visit the web site, or apply at your local Social Security office.

The vast majority of people over 65 get Medicare Part A for free. But if you or your spouse worked and paid Medicare taxes for less than 10 years total, you will have to pay a monthly fee of $441 in 2013, down from $451 in 2012. If you enroll late, you will be penalized by paying a higher monthly amount.

 

Medicare Part A pays some of the charges for:

  • Hospital stays. The amount covered depends on how long you're in the hospital. In 2013, for the first 60 days, you pay a maximum of $1,184 ($28 more than in 2012) and Medicare pays the rest. After that, the longer you stay, the more you pay. You pay $296 per day for days 61 through 90. After that, you pay $592 per day until the 60 days of "lifetime benefits" run out. Then,you pay all the costs.
  • Skilled nursing facility care. This is to allow you to recover after a stay in the hospital; Medicare does not pay for long stays in a nursing facility. Medicare pays for the first 20 days. From the 21st to 100th day, you pay a co-pay of $148 per day. After that, you pay all the costs of your stay in a skilled nursing facility. 
  • Home health care. If you are recovering from an illness or injury -- and your doctor says you need short-term skilled care -- Medicare Part A pays for nurses and some therapists to provide services in your home. As long as the treatment is Medicare-approved and the provider is certified by Medicare, you pay nothing -- except for 20% of the Medicare-approved amount for some medical equipment, such as wheelchairs and walkers.
  • Hospice care. This covers some care for people who are terminally ill. Medicare Part A covers most drug costs, as well as medical and support services. Hospice care is usually given at home or in the facility where you live. But Medicare also covers most of the charges for short stretches in a hospice facility to manage pain and other symptoms -- and to give the regular caregiver a break. There may be a $5 maximum co-pay per prescription for outpatient drugs for pain and symptom management, and you pay 5% of the approved Medicare amount for inpatient respite care services.
  • Blood transfusions. After you pay for the first three pints, Medicare Part A pays 80% of any additional blood you need in the hospital. In most cases, the hospital gets blood from a blood bank at no charge, and you won’t have to pay for it or replace it. If the hospital has to buy blood for you, you must either pay the hospital costs for the first three units of blood you get in a calendar year or have the blood donated.

For more information about Medicare Part A, see the Medicare web site or call 800-MEDICARE.

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