Understanding Medicare Part A: Eligibility, Costs, Enrollment, & More

• Medicare Part A (hospital insurance) consists of coverage for inpatient care such as skilled nursing care and many other health care services provided during an inpatient hospital stay.

• Medicare Part B (medical insurance) provides health coverage for outpatient services and preventive services.

• Part A usually does not require a premium payment.

This article will explain everything Medicare beneficiaries need to know about navigating Medicare Part A (hospital insurance).

In order to understand Part A, it is vital to first understand its place within The Federal Medicare Program. 

Medicare is made up of government-run health insurance plans for Americans aged 65 and up, as well as younger Americans with disabilities and those with end-stage renal disease (ESRD). While there are many types of Medicare plans, there are two primary ways to get Medicare coverage, either through an Original Medicare plan or a Medicare Advantage plan. 

What Is Original Medicare?

Original Medicare is the first iteration of Medicare, first created by the federal government in 1965. Original Medicare benefits are divided into two Medicare Parts: Medicare Part A and Medicare Part B. Each of these portions covers specific types of healthcare services. 

Neither Medicare Part A nor B includes prescription drug coverage. Medicare prescription drug coverage would fall under a Medicare Part D plan. 

Medicare Part A is Medicare’s hospital insurance. Medicare Part A covers hospital inpatient services such as:

• Inpatient hospital care

• Skilled nursing facility care

• Nursing home care (non-custodial or long-term care)

• Hospice care

• Home health care

Note: Learn more about Medicare Part A coverage at this resource.

2023 costs for Part A are provided below:

• Premium: $278 or $506 per month (Amount depends on how many quarters a beneficiary paid Medicare taxes) 

• Deductible: $1,600 for each benefit period

• Lifetime Reserve Day: All costs

Note: Not all Medicare beneficiaries are required to pay a premium for Medicare Part A. Learn more below.

Understanding Premium-Free Part A

Most Americans will be eligible to get premium-free Part A. Usually, premium-free Part A coverage is dependent upon how many years a beneficiary has worked and paid into their Medicare taxes. A beneficiary will be able to get premium-free Part A coverage at age 65 if: 

• They already receive retirement benefits from Social Security or the Railroad Retirement Board (RRB)

• They are eligible to get Social Security or RRB benefits but haven’t filed for them yet

• Either the beneficiary or their spouse paid Medicare taxes for at least 10 years

If an enrollee is under age 65, they can still get Part A without paying a premium if:

• They have had Social Security or RRB disability benefits for 24 months

• They have ESRD and meet certain requirements

Understanding Part A Premiums

Some Americans will not be entitled to premium-free Part A coverage. In this scenario, they would need to buy Part A. 

For those who need to purchase Part A, it will cost either $274 or $499 monthly. The amount will depend on how long either they or their spouse worked and paid Medicare taxes. For those who opt to buy Part A, they must also have Part B as well as pay the monthly premiums for both Parts.

That said, eligible Americans for Medicare do not have to buy Part A but they can still purchase Part B.

Note: Learn more about Part A premium costs and more at this resource.

Some Americans are automatically enrolled in Medicare Part A. This occurs when someone applies for retirement or disability benefits from Social Security or RRB. This doubles as their application for Medicare. 

Once someone is approved for Social Security benefits or Railroad Retirement Board benefits, they will automatically get Medicare Part A coverage (without paying a premium) as soon as they are eligible for Medicare, usually at age 65. Learn more about this process at this resource.

Those who are not automatically enrolled in Medicare Part A will need to enroll in Medicare during the correct enrollment period. (Note: Learn more about enrollment periods at this resource.)

Medicare Part B (medical insurance) covers outpatient care such as: 

• Medically-necessary doctor visits

• Preventive care and services 

• Durable medical equipment (DME)

Unlike Medicare Part A, Medicare Part B requires all of its beneficiaries to pay a monthly premium payment. In 2023, the standard monthly premium is $164.90. However, this Part of Medicare covers services Medicare Part A does not cover. 

Part D is Medicare prescription drug coverage. Medicare beneficiaries must either enroll in a separate Medicare drug plan to add on to their Original Medicare coverage or find a Medicare Advantage plan that includes drug coverage. Do note that not all MA plans provide coverage for prescription drugs. 

Note: Learn more about enrolling in Medicare Part D at this resource.

Medicare Advantage plans, also known as Medicare Part C or MA plans, are a type of Medicare supplement insurance plan. Medicare Advantage plans bundle Medicare Part A and Part B into one health insurance plan. MA plans are offered through private insurance companies that are Medicare-approved.

Most Medicare Advantage plans also have additional benefits, including dental, hearing, and vision coverage. MA plans also often include Medicare Part D, prescription drug coverage, within its policies. 

Beneficiaries should always check with the plan’s insurance company to confirm extra health care benefits. They should also understand the costs and expected out-of-pocket expenses will vary depending on the MA plan chosen.

Note: Learn more about Medicare Advantage at this resource.

• Research online: Visit The U.S. Centers for Medicare and Medicaid Services (CMS) official website for extensive information regarding Medicare benefits and coverage.

• Talk to family and friends: They understand your situation and healthcare needs, meaning they can help you navigate enrollment.

• Call State Health Insurance Assistance Program (SHIP): SHIP can provide free guidance in choosing a policy. Do note, not all states participate in SHIP. Learn more at this resource.

• Discuss options with a licensed insurance agent: Licensed insurance agents can help enrollees navigate their Medigap choices and help them make the best decision.

• Contact Medicare: Get the contact information for Medicare at this resource.