MEDICARE PART A
Medicare Part A
What it covers: Hospital Insurance
Inpatient hospital care
Which can include semi-private rooms, meals, nursing services, and prescription drugs. Inpatient care in long-term care hospitals, mental health hospitals, acute care hospitals, and critical access hospitals also may be covered by Part A insurance.
Skilled nursing facility care
Semi-private room, meals, skilled nursing care, prescription medications, medical supplies and equipment, and ambulance transportation could be included in your Part A coverage if medically necessary.
Nursing home care
Skilled nursing facility care could be covered for a short period of time if ordered by your doctor.
Part A coverage may cover doctor services, nursing care, durable medical equipment, medical supplies, and other things if you have six months or less to live.
Home health services
Medicare part A coverage may incorporate at-home skilled nursing care, physical therapy, and occupational therapy when medically necessary, but only for a limited period time.
Who does it cover
Medicare Part A is health insurance offered by the federal government to United States citizens and legal immigrants. You’re eligible if you’re 65 and older. Also certain disabilities can qualify you under age 65. If you worked for a least 10 years and pay medicare taxes you qualify for premium-free Part A coverage.
Medicare Part A provides coverage for hospital related costs such as hospital stays, nursing care, hospice, and home-health care. Medicare Part B covers outpatient medical services.
Medicare Part A counts as minimum essential coverage and satisfies the law that requires people to have health insurance.
Medicare Part A – Coverage and Payments
In general, Medicare Part A covers:
- Hospital care
- Skilled nursing facility care
- Nursing home care (as long as custodial care isn’t the only care you need)
- Hospice stays or services, if you have 6 months or less to live.
- Home health services
While Medicare Part A covers the majority of expenses for medically necessary services, there is an initial deductible of $1,316 before any Medicare payments are made. After this deductible is met, you often pay about 20% of the Medicare-approved amount. This is for most doctor services (including services while you’re a hospital inpatient), outpatient therapy, and durable medical equipment.
After you’ve met your deductible, you are responsible for hospitalization coinsurance payments according to the following schedule for each benefit period:
- First 60 days, $0 coinsurance
- 61-90 days, $329 a day
- 91 and beyond, $658 a day (for a lifetime reserve of up to 60 days)
- After the 60 lifetime reserve days are used up, You pay all costs
Similarly, for skilled nursing facility care, coinsurance payments are:
- $0 coinsurance for days 1 to 20
- $164.50 each day for the 21st to 100th days
- You are responsible for all costs for days 101 and beyond
Who Signs Up Automatically
If you are already collecting Social Security or Railroad Retirement Board (RRB) retirement benefits when you turn 65, you will automatically be enrolled in Medicare Part A.
When Do You Need to Sign Up Manually
While most people are enrolled in Medicare Part A automatically, you can also manually sign up for coverage. If you don’t receive either Social Security or RRB (possibly because you are still working), then you will have to sign up manually.
You can enroll in Medicare Part A three months before you turn 65 for coverage that starts when you turn 65.
If you are not enrolled automatically, be careful as you should sign up manually at least 3 months before you turn 65 to avoid possible penalties.
Where to Sign Up Manually
You can do this online at www.SocialSecurity.gov
You can also do so at your local social security office or by calling the national hotline at 1-800-772-1213 (TTY users 1-800-0778) weekdays between 7AM and 7PM eastern time.
Your coverage for Medicare Part A can begin as early as 6 months before the time you filed, but no earlier than the month you meet all Part A requirements.
You must have worked 10 years under Medicare Covered Employment by the time you are 65 to receive free Medicare Part A.
If you are not eligible for free Medicare Part A, you can purchase it along with Medicare Part B during the general enrollment period or the special enrollment period.
The general enrollment period is every year January 1st to March 31.
The special enrollment period can occur for a number of different reasons. If you or your spouse continue to work and receive health insurance coverage from an employer, your Special Enrollment Period continues indefinitely. If you lose your job or your health coverage with that job, you have a Special Enrollment Period for 8 months. There are other exceptions, so check with your Social Security office if you have questions.