Comparing Medicare plans in Virginia
Medicare Part A is the foundation of the federal Medicare program, traditionally functioning as your hospital insurance. If Medicare is a puzzle, Part A is the first and largest piece you put on the table. It is designed to protect you from the catastrophic costs of inpatient hospital care, skilled nursing facility stays, hospice care, and specific types of home health care.
However, understanding what Part A is and what it does is only half the battle. The financial mechanics of Part A—how it calculates out-of-pocket costs, when its coverage triggers, and exactly where its coverage stops—are incredibly specific, highly regulated, and frequently misunderstood by beneficiaries navigating the system for the first time. The difference between an “inpatient admission” and an “observation stay” can dictate whether you owe a flat deductible or thousands of dollars in separate medical bills. The rules surrounding “benefit periods” mean that your cost-sharing resets based on time out of the hospital, not the turning of the calendar year.
This guide provides a complete, top-to-bottom overview of Medicare Part A for Virginia residents. It covers the precise scope of Part A benefits, the mechanics of how it calculates your out-of-pocket obligations, the critical difference between skilled and custodial care, and how Part A interacts with broader coverage decisions like continuing to work, contributing to an HSA, or enrolling in a Medicare Advantage plan.
Part A is fundamentally facility-based insurance. Unlike Part B (which follows you to the doctor’s office or the outpatient clinic), Part A triggers when you are inside a recognized inpatient or specialized care facility. The government dictates exactly what Part A covers across four main categories: Inpatient Hospital Care, Skilled Nursing Facility (SNF) Care, Home Health Care, and Hospice Care.
When you are admitted to a hospital, Part A covers the massive overhead costs associated with your stay. It is important to note that Part A covers the facility costs, not necessarily the professional fees of the surgeons or independent specialists who treat you while you are there. Their billing generally falls to Part B.
If you are formally admitted as an inpatient, Part A covers:
Types of Hospitals Covered: Part A coverage is valid in acute care hospitals, critical access hospitals (small rural facilities), inpatient rehabilitation facilities, and long-term care hospitals. It also covers psychiatric hospitals, though Medicare applies a strict 190-day lifetime limit on inpatient psychiatric hospital care.
After a severe illness or major surgery, you may no longer need the intensive resources of a hospital, but you may not be well enough to go home. A Skilled Nursing Facility (SNF) provides 24-hour skilled medical care and rehabilitation. Part A covers SNF stays under incredibly strict rules.
To qualify for Part A SNF coverage, you must meet all of the following conditions:
If you meet these requirements, Part A covers a semi-private room, meals, skilled nursing care, physical and occupational therapy, speech-language pathology services, medical social services, medications, medical supplies, and dietary counseling.
The 100-Day Limit: Part A only covers up to 100 days of SNF care per benefit period. It does not pay for long-term residential care. Furthermore, you must actually need daily skilled care to maintain this coverage. If your condition stabilizes and you only require “custodial care” (help with bathing, dressing, or eating), Medicare Part A will immediately terminate its coverage of your stay, even if you have not reached the 100-day limit.
Hospice care is end-of-life care focused on comfort (palliative care) rather than a cure. To qualify, a hospice doctor and your regular doctor (if you have one) must certify that you are terminally ill, with a life expectancy of six months or less if the illness runs its normal course. You must also formally agree to forgo curative treatments for your terminal illness.
Under Part A, hospice coverage is comprehensive and heavily subsidized. It covers:
Respite Care: While hospice is usually provided in your home, Part A recognizes the toll it takes on family caregivers. Part A covers short-term inpatient respite care—up to five consecutive days at a time in a Medicare-approved hospital or SNF—so that your primary caregiver can rest. You may be responsible for a nominal 5% coinsurance for respite care.
Part A works alongside Part B to cover specific home health services. To qualify, you must be certified by a doctor as “homebound”—meaning it takes a considerable and taxing effort for you to leave your home, and you normally require the assistance of another person or medical equipment to do so.
Part A covers:
Importantly, Part A does not cover 24-hour-a-day care at home, meals delivered to your home, or homemaker services like shopping and cleaning if they are unrelated to your care plan.
If you require a blood transfusion during an inpatient stay, the hospital generally provides it from a blood bank at no cost. However, if the hospital has to buy the blood, Original Medicare expects you to pay for or replace the first three pints of blood per calendar year. After the first three pints, Part A covers the rest.
A frequent source of confusion is the assumption that a hospital admission means Part A covers absolutely everything that happens to you while you are in the building. This is false. Understanding the boundaries of Part A is critical to predicting your true out-of-pocket costs.
Part A does not cover:
One of the most consequential administrative details in Medicare is the distinction between inpatient admission and observation status. You can spend three nights in a hospital bed, receive intravenous drugs, and undergo extensive testing, yet still be classified as an “outpatient under observation.”
Medicare uses the “Two-Midnight Rule” to guide hospital physicians. Generally, if a doctor expects you to require hospital care spanning at least two midnights, they should formally admit you as an inpatient, triggering Part A. If they expect you to recover and go home in less time, they will place you in observation status, triggering Part B.
This distinction has enormous financial ramifications. Under Part A, you pay a single flat deductible for the entire stay. Under Part B, you pay 20% of the Medicare-approved amount for every individual service, test, and drug you receive. More importantly, time spent in observation status does not count toward the 3-day inpatient stay required to unlock Part A coverage for a Skilled Nursing Facility. If you are discharged to an SNF after three days of observation, Medicare will pay absolutely nothing for your SNF stay.
Hospitals are legally required to give you a Medicare Outpatient Observation Notice (MOON) if you receive observation services for more than 24 hours. If you receive this notice, you must immediately understand that Part A is not covering your hospital stay.
Unlike standard health insurance or Medicare Part B, which operate on an annual calendar-year deductible, Part A out-of-pocket costs are anchored to a concept called the “Benefit Period.” Understanding how a benefit period opens and closes is the key to understanding Part A mechanics.
A benefit period begins the exact day you are admitted to a hospital or a skilled nursing facility as an inpatient.
The benefit period ends when you have not received any inpatient hospital care or skilled nursing facility care for 60 consecutive days.
If you go to the hospital, recover, are discharged, and stay out of any hospital or SNF for 60 days in a row, your benefit period ends. If you are hospitalized on day 61, a brand-new benefit period begins.
Because benefit periods are tied to specific episodes of care rather than the calendar, you can experience multiple benefit periods in a single calendar year. Conversely, if you are continuously hospitalized or transferred between facilities without a 60-day break, a single benefit period can stretch across multiple calendar years.
You must pay the Part A inpatient hospital deductible for each separate benefit period. This deductible is a flat fee, not a percentage, and it is significant (historically adjusting upward each year, often running over $1,600 per benefit period).
Because the deductible is per benefit period, not per year, you could potentially pay this massive deductible two, three, or even four times in a single year if you have distinct, separated medical emergencies.
Once you meet the benefit period deductible, Part A pays 100% of covered inpatient hospital services for the first 60 days of that benefit period. If your stay extends beyond 60 days, you begin paying daily coinsurance fees.
The structure of Original Medicare Part A costs follows a strict timeline:
| Length of Inpatient Stay | Your Out-of-Pocket Cost | Notes |
|---|---|---|
| Days 1 – 60 | $0 after paying the Part A Deductible | The deductible covers the first 60 days in full. |
| Days 61 – 90 | A substantial daily coinsurance amount | You pay a fixed dollar amount for each day. |
| Days 91 and beyond (Lifetime Reserve Days) | An even higher daily coinsurance amount | You have 60 lifetime reserve days. Once they are used, they are gone forever. |
| Beyond Lifetime Reserve Days | 100% of all costs | Medicare Part A coverage exhausts entirely. |
Skilled Nursing Facility (SNF) Coinsurance: SNF stays follow their own timeline within the benefit period, assuming you met the 3-day qualifying hospital stay:
For the overwhelming majority of Virginians, Medicare Part A is premium-free. If you have to pay for it, it is usually because of a lack of qualifying work history.
You are eligible for premium-free Part A at age 65 if you, or your current, deceased, or former spouse, worked and paid Medicare taxes for at least 40 calendar quarters (which equals roughly 10 years of employment). Over 99% of Medicare beneficiaries qualify for premium-free Part A.
If you do not meet the 40-quarter requirement, you can still enroll in Part A at age 65 by paying a monthly premium. The cost is prorated based on the number of quarters you actually worked:
If you must buy into Part A, you are required to enroll in Part B as well.
Virginians under age 65 can become eligible for premium-free Part A under specific, severe circumstances:
Missing your Medicare enrollment windows can lead to permanent financial penalties and coverage gaps. However, because Part A is usually premium-free, the rules around when you must enroll are slightly different than Part B.
1. Automatic Enrollment: If you are already collecting Social Security retirement benefits or Railroad Retirement Board benefits before you turn 65, you do not have to lift a finger. The government will automatically enroll you in both Part A and Part B, and your red, white, and blue Medicare card will arrive in the mail about three months before your 65th birthday. Your Part A coverage begins on the first day of the month you turn 65.
2. Manual Enrollment (Initial Enrollment Period): If you are not collecting Social Security by age 65, you must proactively apply for Medicare. Your Initial Enrollment Period (IEP) is a seven-month window that centers on your 65th birthday. It includes the three months before your birthday month, your birthday month, and the three months after.
Because Part A is free for most people, there is generally no penalty for enrolling late if you qualify for premium-free Part A. You can enroll at any time after your IEP, and your Part A coverage will even be applied retroactively for up to six months (but no further back than your 65th birthday).
Warning for those who must buy Part A: If you do not qualify for premium-free Part A and you fail to buy into it during your IEP, you will face a late enrollment penalty. Your monthly premium will increase by 10%, and you will have to pay this penalty for twice the number of years you delayed enrollment.
Many Virginians continue to work past age 65 and carry employer-sponsored health insurance. If you fall into this category, you have a crucial decision to make regarding Part A.
Because Part A is usually free, conventional wisdom suggests you should go ahead and enroll in it at 65, even if you are still working. It will act as secondary insurance. If your primary employer plan doesn’t cover an entire hospital bill, Part A may pick up some of the remaining costs.
However, there is one massive exception: Health Savings Accounts (HSAs).
Under IRS rules, it is illegal to contribute pre-tax dollars to a Health Savings Account if you are enrolled in any part of Medicare.
If you have a High-Deductible Health Plan (HDHP) through your employer and you want to continue funding your HSA, you must not enroll in Medicare Part A or Part B. You must actively delay your enrollment.
Furthermore, you must be incredibly careful when you eventually decide to retire or drop your employer coverage. Because Part A applies retroactively for up to six months, you must stop all contributions to your HSA at least six months before you apply for Medicare or Social Security. If you do not observe this 6-month lookback buffer, you will be subject to IRS tax penalties on the contributions you made during that retroactive coverage window.
Part A rarely exists in a vacuum. Most Virginians rely on additional insurance to either replace Original Medicare’s structure or cover the massive gaps (like the benefit period deductible and daily coinsurance) that Part A leaves behind.
Medigap policies are sold by private insurance companies to cover the out-of-pocket costs of Original Medicare. Because Part A has no out-of-pocket maximum, a severe illness could theoretically bankrupt you through deductibles and coinsurance.
Medigap plans are standardized by letters (Plan G, Plan N, etc.). Nearly all modern Medigap plans completely cover the Part A inpatient hospital deductible and all Part A coinsurance. Furthermore, they provide an additional 365 lifetime reserve days for hospital care once Medicare’s standard coverage is exhausted. If you rely on Original Medicare (Part A and Part B), a Medigap policy is the standard financial shield used to protect your assets.
A Medicare Advantage plan completely replaces the administrative structure of Original Medicare. If you enroll in a Medicare Advantage plan, you still legally have Part A and Part B, and you must continue to pay your Part B premiums, but your private insurance company (such as UnitedHealthcare, Humana, or Anthem Blue Cross and Blue Shield) takes over the administration of your benefits.
Virginia has a highly active Medicare Advantage market, with 141 real MA plans available across the state depending on the county. Carriers operating in the state include Aetna Medicare, Anthem Blue Cross and Blue Shield, Anthem HealthKeepers, Devoted Health, HealthSpring, Humana, Johns Hopkins Advantage MD, Kaiser Permanente, and UnitedHealthcare.
If you choose a Medicare Advantage plan, the traditional Part A “benefit period” mechanics are often discarded. Instead of a massive flat deductible per stay, many Medicare Advantage plans in Virginia charge a daily hospital copayment (for example, $300 a day for days 1 through 5 of an inpatient stay, and $0 thereafter). These plans also feature a hard annual out-of-pocket maximum, ensuring that no matter how many times you go to the hospital, your financial liability is capped for the calendar year.
Because Part A is tied to facility care, disputes generally center around two issues: the hospital trying to discharge you before you feel ready, or a skilled nursing facility declaring that you no longer need “skilled” care. Original Medicare gives you powerful rights to appeal these decisions.
When you are admitted to a hospital, you must receive a document called the Important Message from Medicare within two days of admission. This document outlines your rights as an inpatient. If the hospital informs you that it is time to be discharged, but you believe you are too sick to leave, you have the right to request an immediate, expedited review by a Quality Improvement Organization (QIO)—an independent group of doctors that contracts with Medicare.
While the QIO reviews your case, the hospital cannot force you to leave, and Medicare Part A will continue to cover your stay.
Similarly, if you are receiving care in a Skilled Nursing Facility, or receiving home health care, the provider must give you a Notice of Medicare Non-Coverage at least two days before they terminate your Part A services. The facility usually issues this notice when they believe your condition has plateaued and you now require only custodial care.
Like the hospital discharge process, this notice gives you instructions on how to request a fast appeal to the QIO. The facility is required to keep you and provide care while the independent doctors review whether your Part A coverage should continue.
If you are approaching age 65 in Virginia, your relationship with Part A depends entirely on your working status and your health insurance setup.
Review these common scenarios to determine your next step regarding Part A.
Navigating Medicare requires matching the federal rules to your specific physical location, carrier networks, and financial situation. If you are comparing your options for supplementing Part A in Virginia—whether through a Medigap policy to cover the deductibles or a Medicare Advantage plan to restructure the costs—the next step is to look at the concrete plans available in your specific zip code.
Compare local Medicare Advantage and Medigap options with a licensed agent to ensure your Part A deductibles and hospital costs are fully managed.
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