If you’re ready to learn about Medicare, Part A is a great place to start! Original Medicare contains two parts: Medicare Part A and Medicare Part B. Part A is also called inpatient insurance or hospital insurance.
What Does Medicare Part A Cover?
Let’s begin by talking about what Part A covers. To keep things simple, you can think of Part A as your “room and board” coverage when you stay at a hospital or skilled nursing facility. It won’t pay for things you get while you’re there, like x-rays, surgeries, and medications. Instead, it helps pay for costs associated with your stay.
Inpatient hospital care: This includes all the care you receive after being admitted into a hospital by a doctor. Medicare covers up to 90 days during each benefit period. You also receive an additional 60 lifetime reserve days that can be used if you surpass the 90-day benefit period allowance. Part A also covers up to 190 days (per lifetime) at a Medicare-certified psychiatric hospital.
Part A offers inpatient coverage in a variety of hospital settings, including:
- Critical access hospitals
- Acute care hospitals
- Inpatient psychiatric facilities
- Inpatient rehabilitation facilities
- Long-term care hospitals
Skilled nursing facility care: Part A covers your room, board, and certain services provided in a skilled nursing facility. This might include tube feedings, meals, and wound care. Medicare pays for up to 100 days per benefit period. To qualify for coverage in a skilled nursing facility, you must have spent at least three consecutive days in the hospital within 30 days of admission to a skilled nursing facility. Your doctor must also certify you need skilled nursing or therapy services.
Some of the skilled nursing services Part A covers include:
- Medical social services
- Medications
- Speech-language pathology services
- Dietary counseling
- Medical supplies and equipment used in the facility
- Ambulance transportation for services not provided at the facility
Home health care: Part B usually covers home health care, but Part A covers it if you’ve spent at least three consecutive days as an inpatient in a hospital within 14 days of receiving home care. Part A covers up to 100 days of daily care or an unlimited amount of intermittent care.
Hospice care: Hospice includes care received during end-of-life. Part A covers hospice care for as long as your doctor deems it necessary. This includes medications for symptom management and support care to make the individual as comfortable as possible. Respite care and counseling for you and your loved ones are also included in Part A benefits.
How Much Does Part A Cost?
Most Medicare beneficiaries don’t pay a premium for Part A. A current premium, at least. Certain taxes you paid during your working years were earmarked for your future Medicare coverage.
As long as you paid Medicare taxes for at least ten years (or 40 quarters) in your lifetime, you won’t pay a premium for Part A. The same is true if you don’t meet the requirement but you are married to someone who does.
If you haven’t paid taxes for ten years, you can purchase Part A as long as you are a citizen, a legal resident, or have had a green card for at least five years. The Centers for Medicare and Medicaid Services (CMS) sets the premium for Part A each year. Most years, there is a slight increase. There are two premiums: one for people who paid taxes for at least 30 quarters and one for people who paid taxes for less than 30 quarters.
Part A also has deductible and cost-sharing requirements. As with the premium, these costs can change each year.
The Part A deductible is different than most other deductibles in health insurance. It does not apply to a calendar year. Instead, it’s based on a benefit period. A benefit period begins the day you become an inpatient at a hospital or skilled nursing facility. It ends when you’ve been hospital-free for 60 consecutive days. Yes, it is possible to have multiple benefit periods in one calendar year.
Other cost-sharing for Part A depends on how many days you’ve spent as an inpatient. Hospital copays are different than skilled nursing facility copays. And remember, once you’ve used up all your lifetime reserve days for hospital stays, you’re responsible for the full amount of any hospital costs.
Enrolling in Medicare Part A
Most people “age into” Medicare when they turn 65. This is the age at which you become eligible for Medicare. Younger individuals with certain medical conditions and those who have been on disability for 24 months are also eligible to apply. Medical conditions at make you eligible for Medicare include End-Stage Renal Disease (ESRD) and amyotrophic lateral sclerosis (Lou Gehrig’s disease). You must be a United States citizen or legal permanent resident to enroll in Medicare.
Beneficiaries who have been receiving Social Security or Railroad Retirement Benefits for at least four months prior to their 65th birthday will be automatically enrolled in Medicare Part A and Part B. You can request to postpone your Medicare enrollment if you have other creditable health insurance.
If you are not yet taking retirement benefits, you will have to manually apply for Medicare. You can do so online at SSA.gov, over the phone, or at your local Social Security Administration office.
If you are aging into Medicare, you can begin your enrollment three full months before your birthday month. Coverage can start as early as the first day of your birthday month as long as you submit your enrollment before then. You have a total of seven months to apply for Medicare (called your Initial Enrollment Period). If you miss this window of time, you will have to wait until the General Enrollment Period (GEP) or for a Special Enrollment Period (SEP) to apply for Medicare.
Part A Frequently Asked Questions
Let’s review a few of the questions we get asked most often about Medicare Part A.
- Is Medicare Part A free? As long as you (or your spouse) paid Medicare taxes for at least ten years, you won’t pay a premium for Part A. However, there are other costs associated with using Part A benefits, including a deductible and copays.
- What does Part A cover? Medicare Part A covers inpatient costs incurred at a hospital or skilled nursing facility. The main services it covers are inpatient costs, skilled nursing care, hospice care, and home health care.
- When can I enroll in Medicare Part A? Most people become eligible for Part A when they turn 65. You can begin enrolling in Part A three full months before your birthday month.
- Does Part A cover 100 percent? No, there are cost-sharing requirements for Part A. There is a deductible that applies to each benefit period, as well as copays depending on how long you’ve been an inpatient and what type of facility you’re in.
Bobby Brock Insurance Makes Medicare Easy
Is your 65th birthday coming up? It’s never too early to start learning about Medicare. We usually start working with beneficiaries when they are 64 or younger. This allows you to have plenty of time to understand Medicare and choose the plans that will work the best for your situation.
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