Health & Benefits

Not everyone can enroll in Medicare Part A. If you enroll, you may or may not have to pay a premium. This depends on which of the categories below you belong to.

Free enrollment

You are eligible to enroll without paying a premium if any of the following apply to you:

• You are 65 or older and
  • You or your spouse are eligible to receive social security retirement, survivors benefits, or railroad retirement board benefits,
  • You or your spouse worked long enough at a government job while paying Medicare taxes, or
  • You are the dependent A person who relies on another for support, such as a child or person with a disability parent of a fully insured, deceased child.
• You are under 65 and
  • You have been entitled to receive Social Security Disability A federal program that gives money to people who cannot work because of a disability Insurance (SSDI) benefits or railroad retirement board disability A substantial impairment that functionally limits a person in carrying out major life activities, such as walking, lifting, seeing, or learning. benefits for at least 24 months,
  • You have been diagnosed with ALS and receive SSDI benefits, 
  • You are the child or surviving spouse, age 50 or older, of a worker who worked long enough under Social Security or in a Medicare-covered government job, and you meet the requirements of the SSDI program, or
  • You have kidney disease requiring dialysis or a transplant and
    • You have worked long enough under the Social Security or railroad retirement system,
    • You have worked long enough in a Medicare-covered government job, or
    • You are the child or spouse of a worker who worked long enough under Social Security or in a Medicare-covered government job. 

Enrollment with a premium

If you do not meet one of the above conditions, you may be able to enroll in Part A. You will have to pay a large monthly premium.

You can enroll with a monthly premium if:

• You are over 65 and either a US citizen or an alien lawfully admitted for permanent residence who has been present in the US for at least 5 years, or
• You are a person with disabilities who has stopped receiving Social Security Disability benefits because of your employment income.

For 2024, the premium cost is $505 per month for people who have less than 30 quarters of Medicare-covered employment. The price is $278 per month for people having 30-39 quarters of Medicare-covered employment. A quarter is 3 months in a year.

Services covered

You do not need to file a claim for coverage of a Medicare Part A covered service. The hospital, nursing home, or other provider submits the claim.

You will then receive a Benefits Notice explaining how much was paid. It will tell you the amount you are responsible for paying.

Services covered include:

• inpatient hospital care, including psychiatric care,
• skilled nursing facility care,
• hospice care, and 
• home health care, such as physical therapy, occupational therapy, and medical social services. Learn more about covered home health services on the Medicare website.  

Centers for Medicare and Medicaid Services (CMS) issues Medicare & You. It has a thorough summary of covered services.

Inpatient Hospital Care 

If treatment of an illness or injury is medically required, Medicare covers the hospital costs. But, the hospital stay must be medically necessary.

To understand how Medicare covers inpatient hospital care, you must understand benefit periods. A benefit period begins the day you enter the hospital. It ends when you have been out of the hospital or skilled nursing facility for 60 straight days. A new benefits period begins after the last one ends and you are newly admitted to a hospital.

There is no limit to the number of benefit periods you can have. Part A will only pay for up to 90 days of inpatient hospital care during a single benefit period. You have 60 lifetime reserve days that can be used to cover days beyond the 90th day.

During the first 60 days of your hospital stay, Medicare pays the entire costs. You pay a $1,632 deductible in 2024 and no coinsurance for days 1–60 of each benefit period.

During the 61st to the 90th days, you must pay a coinsurance amount. As of 2024, this amount is $408 per day. During any lifetime reserve days used beyond the 90th day, your coinsurance amount is higher. As of 2024, that amount is $816 per day. Unless you have supplemental insurance, you are responsible for all costs beyond your lifetime reserve days.

Part A pays for the following things:

• A semi-private room,
• Meals,
• Regular nursing and rehab services,
• Drugs and medical supplies administered during the hospital stay,
• Lab tests,
• X-rays,
• Operating and recovering rooms,
• Intensive care, and
• Other medically necessary services provided while you’re in the hospital.

Medicare does not cover:

• Personal convenience items,
• Telephone use or private duty A legal obligation to do something nursing, or
• Extra charges for a private room (unless medically necessary).

Psychiatric hospital care

Medicare helps pay for inpatient mental health services in a hospital. You can get this care in a general hospital or in a psychiatric hospital.

There’s no limit to the number of benefit periods when you get mental health care in a general hospital. You can have multiple benefit periods when you get care in a psychiatric hospital. There is a lifetime limit of 190 days.

As of 2024, you pay:

• $1,632 for each benefit period,
• $0 deductible for days 1–60 of each benefit period,
• $408 per day coinsurance payment for days 61–90 of each benefit period, and
• $816 per day coinsurance for each lifetime reserve day after day 90 of each benefit period.

For mental health insurance, add 20% of the Medicare-approved amount. 

Skilled nursing facility care

Medicare covers medically necessary care in a skilled nursing facility (SNF) if:

• You were hospitalized for at least 3 consecutive days before entering the nursing facility. This does not include the day of discharge,
• You’re admitted to the facility shortly after leaving the hospital (usually within 30 days), and
• The condition for which you are in the nursing facility was treated or arose while you were hospitalized.

Part A pays for the full cost of the first 20 days in an SNF. During the 21st to the 100th day, you must pay coinsurance. As of 2024, the amount is $204 per day. Medicare does not cover any days beyond the 100th day.

If you leave the SNF and are re-admitted within 30 days for the same condition, Medicare will resume coverage up to the 100th day.

Hospice care 

Medicare covers hospice care if you are terminally ill. This means a doctor confirms that the patient's life expectancy is 6 months or less. Hospice care is usually provided in your home. But, inpatient respite care is covered, too. Medicare covers:

• Homemaker services,
• Counseling, and
• Some prescription medications.

You may pay:

• A copayment of up to $5 for each prescription drug and other similar products for pain relief and symptom control while you are at home, and
• 5 percent of the Medicare-approved amount for inpatient respite care.

Home health care

To be eligible for home health care services, you must be confined to your home. Your doctor must establish a care plan. Medicare covers the following home health care items:

• Part-time or intermittent skilled nursing services,
• Home health aide service,
• Physical, speech-language, and occupational therapy, and
• Medical supplies provided by the home health agency.

Medicare covers 80% of durable medical equipment needed to enable you to remain in the home. It also covers all the costs for home health care services. The rate at which home health care agencies are reimbursed has been greatly reduced. As a result, it may be difficult to locate a provider for home health care services.

Starting in 2024, home health services will be covered for as long as part-time or intermittent skilled services are needed if you are "homebound." You are homebound if:

• You have trouble leaving your home without help because of an illness or injury, 
• Leaving your home is not recommended because of your condition, or 
• You are normally unable to leave your home because it is a major effort.

You may qualify for a personal attendant or other home services. State programs offering these services include:

• Illinois Department on Aging’s Community Care Program
• Illinois Department of Human Services’ Home Services Program