PART A: HOSPITAL INSURANCE

In general, Part A covers:

• Inpatient care in a hospital

• Skilled nursing facility care

• Inpatient care in a skilled nursing facility (not custodial or long-term care)

• Hospice care

• Home health care

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Medicare Part A is free if you:

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• Have at least 40 calendar quarters of work in any job where you paid Social Security taxes in the U.S.

• Are eligible for Railroad Retirement benefits

• Or, have a spouse that qualifies for premium-free Part A

 

You may also be eligible for premium-free Part A if you were a federal employee anytime after December 31, 1982, or a state or local employee anytime after March 31, 1986.

If you do not meet the criteria above, you will likely pay a monthly premium for Part A. Your monthly Part A premium will depend on how many years you or your spouse worked in any job at which you paid Social Security taxes in the U.S.

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In 2022, your monthly Part A premium will be:

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$0: If you or your spouse worked for 40 quarters (10 years) or more or you were a federal employee on January 1, 1983, or a state or local employee anytime after March 31, 1986.

$274: If you or your spouse worked between 30 and 39 quarters (7.5 and 10 years)

$499: If you or your spouse worked fewer than 30 quarters (7.5 years)

If your income is low, you may be eligible for the Qualified Medicare Beneficiary (QMB) program, which pays for your Medicare Part A and B premiums and other Medicare costs.

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Part A  Benefits Breakdown

 

Inpatient hospital care

$1,556 deductible for each benefit period

No coinsurance for days 1 to 60

$389 daily coinsurance for days 61 to 90

$778 daily coinsurance for 60 lifetime reserve days

 

Skilled nursing facility (SNF) care

No deductible for each benefit period

No coinsurance for days 1 to 20

$194.50 daily coinsurance for days 21 to 100

 

Home health care

No deductible or coinsurance

 

Hospice care

No deductible

Small copayment for outpatient drugs and inpatient respite care

 

2 ways to find out if Medicare covers what you need

 

1. Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that's usually covered but your provider thinks that Medicare won't cover it in your situation. If so, you'll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.

2. Find out if Medicare covers your item, service, or supply.

 

Medicare coverage is based on 3 main factors

 

1. Federal and state laws.

2. National coverage decisions made by Medicare about whether something is covered.

3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.