Medicare Part A

What is Medicare Part A?

Two parts make up Original Medicare: Medicare Part A and Medicare Part B. Medicare Part A, also known as hospital insurance, provides coverage for Medicare inpatient care; this may include care received during hospital admittance, a skilled nursing facility, and, in specific situations care received at home. When most people turn 65, Medicare Part A eligibility is automatic if they have been receiving retirement benefits from the Railroad Retirement Board or the Social Security Administration. If you have amyotrophic lateral sclerosis (ALS), a disability or end-stage renal disease (ESRD) you may qualify for Medicare Part A before age 65. Other eligibility requirements include either being a citizen of the United States or maintaining five consecutive years of legal permanent residency.

Compare Medicare Part A Plans

2020 Medicare Part A, also known as hospital insurance provides coverage for care received in the hospital, in a skilled nursing facility and some situations home care.  Keep in mind; however, even if Medicare covers an item or service, you will generally have to pay a copayment, deductibles, and coinsurance.

What Does Medicare Part A Cover?

When visiting your doctor be sure to speak to them or other healthcare providers about the reasons you need specific services or supplies. Ask them if Medicare will cover your needs. It may be a situation where something that’s usually covered, but your healthcare professional thinks that Medicare may not cover it in your case. If this situation applies to you, then you’ll have to read and sign a notice. The notice will say that you understand that you may have to pay for the item, service, or supply.

In General, Services Covered under Medicare Part A:

• Hospital care (inpatient)
• Limited home health services
• Care in a skilled nursing facility (SNF), provided that custodial care not be the only care required
• Hospice care

Under each of those services, the following may be covered.

Medicare Part A hospital care coverage:

• Acute care hospitals
• Critical access hospitals
• Inpatient rehabilitation facilities
• Long-term care hospitals
• Mental health care
• Participate in a qualifying clinical research study

Medicare Part A home health care benefits:

• Intermittent or part-time skilled nursing care
• Physical therapy
• Speech-language pathology assistance
• Occupational therapy
• Medical social assistance
• Part-time or intermittent home health aide assistance

Medicare Part A nursing home coverage:

• Skilled nursing services
• Semi-private room
• Meals
• Medical social services
• Rehabilitation services, if medically necessary to treat your illness
• Medical supplies and equipment used in an SNF
• Medications received while in SNF care
• Dietary counseling
• Ambulance transportation to the closest provider if needed services are not provided at the SNF

Medicare Part A will not cover:

• Routine foot care
• Hearing aids and exams for fitting them
• Most dental care
• Cosmetic Surgery
• Acupuncture
• Long-term care
• Eye examinations related to prescribing glasses

Limits

Medicare Part A has restrictions, for example, if you are hospitalized for a stay of 90 days or more at one time, there are limits to the number of days of Part A cover. This is true regarding the amount of time spent at an SNF that Part A covers as well. Private Medicare Part A provides coverage for hospice care visits regardless of the number of visits and home health care visits; however, you must meet several conditions to receive either kind of help.

Does Medicare Part A Cover Emergency Room Visits?

Emergency room (ER) visits can hit even heftiest of budget hard. In 2015 almost 22% of Americans aged 65 and over had at least one trip to the ER. According to data provided by the Centers for Disease Control and Prevention (CDC), one in 10 seniors aged 75 and over have had at least two ER visits.

That means that if you’re in the age 65-and-up group, your chances of an emergency room visit are something to consider. Plus, emergency room visit costs are generally higher than a visit to your doctor, per reports to the U.S. Agency for Healthcare Research and Quality (AHRQ).

Medicare Part B could cover some of your emergency room expenses if you suffer a heart attack, stroke, or other sudden illness. However, if you’re admitted to the same hospital as an inpatient for a related condition within three days of your visit to the ER, Medicare Part A may cover the ER visit as part of your inpatient care, and you typically will have no copayment.

Providers

For Medicare Part A, beneficiaries may pick any qualified US provider that is accepting new patients or is approved by Medicare. Because Medicare Part A will offer the same benefits throughout the United States, the beneficiary is not limited to a particular region or state for your healthcare needs.

Medicare Part A Costs

Beneficiaries or their spouses who contributed to Medicare taxes while working, ordinarily do not have to pay monthly premiums their Medicare Part A coverage, or premium-free Part A.

How Much is Medicare Part A?

If you sign up for Part A, you may pay up to $426 each month, but, the majority people qualify for premium-free Part A. To qualify for premium-free Part A at age 65 you must meet the following criteria:

• You or your spouse-maintained Medicare-covered government job
• Currently, you receive retirement benefits from the Railroad Retirement Board or Social Security.
• You qualify for Railroad benefits or Social Security, but haven’t yet applied.

If you are not age 65, you could qualify for premium-free Part A if:

• You have a diagnosis for End-Stage Renal Disease (ESRD) and meet specific requirements.
• For 24 months you have gotten Railroad Retirement Board or Social Security benefits.
• In most situations, if someone decides to buy Part A, they also have to have Medicare Part B (Medical Insurance), and are required to pay the monthly premiums for each.

When will Coverage for Medicare Part A begin?

Medicare Part A coverage will begin during the first three months of the Initial Enrollment Period and goes into effect on the first day of your birthday month unless your birthday is on the first day of the month. Let’s say your 65th birthday is on July 20, 2020, and you sign up for coverage in April, May, or June, your coverage will begin on July 1st, 2020. However, if your date of birth is the first day of a month, then your coverage will start the first day of the previous month. For example, if your 65th birthday is July 1, 2020, and you sign up for Medicare in March, April, or May your coverage will begin June 1, 2020.

How to Apply for Medicare Part A

For most people, Medicare Part A enrollment is automatic. However, some scenarios require you to manually sign up for Medicare Part A during the Initial Enrollment Period (IEP), which is the seven-month period beginning three months before turning 65, including your 65th birthday month and ending three months later.

Situations where you may not be enrolled automatically in original Medicare:

If you aren’t already getting retirement benefits:

If you are near your 65th birthday and not yet receiving benefits, you can sign up for Medicare Part A during your IEP. If you chose to postpone your Social Security retirement benefits or Railroad Retirement Benefits (RRB) past age 65, you have the choice to enroll in just Medicare and apply for retirement benefits at a later time.

If you do not qualify for retirement benefits:

If you are not eligible for retirement benefits from Social Security or the RRB, you will not be automatically enrolled in Original Medicare. However, during your IEP you can still sign up for Medicare Part A. You may not be eligible for premium-free Medicare Part A if this is the case, your monthly Part A premium will be based on the length of time you worked and paid Medicare taxes.

Enroll in Medicare Part A

To learn more about eligibility for Medicare Part A, call us at 844-236-0228 for more information on health insurance programs.

Medicare Part A | Part A Costs | What does Medicare Part A Cost? | When will Coverage for Medicare Part A begin?