Understanding Medicare Part A
For Medicare recipients, Part A is your hospital insurance. It is one of two parts that make up Original Medicare.
Part A helps to cover costs for in-patient care in a hospital and skilled nursing facility, as well as home health care and hospice care services.
Am I Eligible for Medicare Part A?
Generally, if you are the age of 65 or older, a U.S. Citizen or Permanent Legal Resident of at least 5 consecutive years, you are eligible for Medicare Part A.
Some are eligible for Medicare before turning 65. If you are already receiving retirement or disability benefits, you are likely eligible for Medicare Part A.
The same is true if you have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease, ALS).
How Do I Enroll in Medicare Part A?
If you are already collecting benefits from Social Security or the Railroad Retirement Board at age 65, then you will be automatically enrolled in Medicare Part A at no additional cost.
3 months prior to your 65th birthday, you will receive your Medicare card in the mail. Your Part A benefits will begin on the 1st day of the month in which you turn 65.
Note: If your birthday falls on the 1st of the month, then your Part A benefits will begin the month before your 65th birthday month.
If you aren’t collecting these benefits, then you can enroll in Medicare during your Initial Enrollment Period, which begins three months prior to your 65th birthday.
To enroll in Medicare, you must sign up through Social Security. There are three ways that you can enroll:
The start date of your coverage will depend on when you enrolled during your Initial Enrollment Period.
This period is seven months long: it begins 3 months prior to your 65th birthday month, includes your birthday month, then extends 3 more additional months.
Important: If you miss enrollment during your Initial Enrollment Period, you won’t be able to sign up for Medicare until the General Enrollment Period that runs from January 1 – March 31. In this case, your coverage will start on July 1st.
Additional Part A Enrollment Scenarios:
If you are disabled –
Your Part A coverage begins once you have received Social Security disability benefits for 24 months, at the start of the 25th month. Your Medicare will arrive in the mail around 3 months prior to your coverage starting.
If you have ALS –
Your Part A coverage automatically begins the same month that your Social Security disability benefits do. Your Medicare card will arrive in the mail around one month after you have signed up for your Social Security disability benefits.
If you have End-Stage Renal Disease –
And require dialysis, your Part A effective date typically begins on the fourth month of your dialysis treatments. If you are younger than 65, you will need to apply for Medicare Part A benefits.
If you sign up for Medicare Part A, you will receive coverage for inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Inpatient Hospital Care:
For those admitted to a hospital by a physician, Part A covers certain services during your stay. This coverage extends for up to 90 days during each benefit period.
You also have an additional 60 lifetime reserve days. For inpatient care at a psychiatric hospital, Part A covers up to 190 lifetime reserve days.
Covered Inpatient Hospital Services Include:
Hospital services and supplies
How to Qualify for Inpatient Hospital Care –
Inpatient stay must be in a Medicare-covered hospital or psychiatric hospital.
A doctor must determine that hospital care is necessary for treatment.
Skilled Nursing Facility Care:
Part A will cover a range of services provided in a Skilled Nursing Facility by a skilled nurse of therapist.
This coverage extends for up to 100 days each benefit period and also covers your room and board in the facility. It does not, however, include custodial or long-term care.
Covered Skilled Nursing Facility Services:
How to Qualify for Skilled Nursing Care –
You have spent 3 consecutive days as an inpatient at a hospital.
You receive your skilled nursing care within 30 days of your inpatient stay.
A doctor has determined you require skilled care on a daily basis.
For those that are terminally ill, Part A will cover necessary care to manage symptoms and control your pain.
Part A also covers respite care and some medical equipment for use at your home. This coverage is extended for as long as your healthcare provider determines you need the care.
Covered Hospice Care:
Any items or services needed for pain relief or symptom management
Any medical, nursing, and social services
Durable medical equipment
Aide and homemaker services
Home Health Care:
For those that are homebound and in need of skilled care, Part A will cover part-time skilled care in your home.
For daily care, this coverage lasts for up to 100 days. For intermittent care, your coverage is unlimited.
How to Qualify for Home Health Care –
You have spent 3 consecutive days as an inpatient at a hospital.
You receive your home health care within 14 days of your inpatient stay.
How to Tell If Part A Covers What You Need:
1. Consult with your doctor or health care provider to find out if Medicare covers your needed services or supplies.
2. You can also always search your Medicare coverage by test, item, or service at this Medicare.gov coverage page.
How Much Does Medicare Part A Cost?
Most commonly, people that are eligible for Medicare Part A do not have to pay a monthly premium. That’s because the average Part A enrollee usually meets the criteria for premium-free coverage.
If any of the following criteria apply to you, then you qualify for premium-free Part A coverage:
You are 65 years old and you (or your spouse) have paid Medicare taxes (FICA) for 10 years.
You already receive benefits from Social Security or the Railroad Retirement Board.
You are eligible for benefits from Social Security or the Railroad Retirement Board but have not yet filed for them.
You are disabled and you (or a spouse) have paid FICA taxes for 10 years. In this case, you are eligible for Medicare once you have received Social Security benefits for 2 years.
Even if you find that none of the above criteria apply to you, there is still the option to purchase Part A coverage.
When you purchase Part A, however, you will need to pay a monthly premium. The amount your premium costs is based on how long you (or your spouse) have been paying Medicare taxes.
Purchasing Part A Coverage:
If you are purchasing Part A, your coverage will come with a monthly premium. The cost of your premium is based on the amount of time you paid Medicare taxes.
Here is how to determine the cost of your Part A premium:
Paid Medicare taxes for 40 quarters or more (10 years) = No Premium
Paid Medicare taxes for 30 – 39 quarters (7.5 – 9.75 years) = Standard Premium is $252
Paid Medicare taxes for less than 30 quarters (less than 7.5 years) = Standard Premium is $458