Medicare Part A
What is Medicare Part A?
Medicare is a federal health insurance program. It is divided into multiple “Parts” that allow individuals to choose their coverage based on specific health and lifestyle concerns. Some parts – Parts A and B – are administered by the federal government, while others – Parts C and D, as well as Medicare Supplement coverage – are provided by private insurance carriers with oversight from the federal program. Parts A and B are sometimes called “Original Medicare.”
Medicare is managed by a federal department called the Centers for Medicare and Medicaid Services (CMS).
Medicare Made Easy Part Two: Medicare Part A vs. Medicare Part B
Who is Eligible for Medicare Part A?
Medicare coverage is available to people in the United States who are 65 and older. It’s also available to younger people who have a disability, End-Stage Renal Disease (ESRD), or ALS.
Many people are eligible for Medicare Part A with no premiums. Some of the taxes you pay if you are working go toward Medicare coverage. If you haven’t worked a total of ten years or longer, you may need to pay a premium for Medicare Part A.
What Does Medicare Part A Cover?
Medicare Part A is often described as “hospital” coverage in comparison to Medicare Part B, which provides more general health coverage, like doctors and medical equipment.
Medicare Part A covers these services:
- Inpatient care in a hospital
- Skilled nursing facility care
- Inpatient care in a skilled nursing facility (not custodial or long-term care)
- Hospice care
- Home health care
The full explanation of what Part A covers within those services is complex.
Two principles, medical necessity and duration, can help you get an idea of what might be covered and where you could be responsible for costs.
Medicare makes many coverage decisions based on whether a service is deemed “medically necessary.” In the case of a hospital stay, for example, your doctor may have to order hospitalization for it to be covered by Medicare.
The amount you may have to pay for care that is covered by Medicare Part A often depends on the duration of care. There is usually no coinsurance required for days 1-60 of a hospital stay, then daily coinsurance beyond day 60. Medicare does not usually cover additional expenses like a private room or personal care items.
Getting More Details
If you have questions or concerns about what will be covered or what you will pay with Medicare Part A coverage, you have a number of resources:
- Compare costs through your online Medicare account
- Ask your doctor or healthcare provider about what will be covered
- Talk to the hospital about their relationship with Medicare and what will be covered during your stay
Additionally, you may be able to get assistance with your Medicare Part A costs through a Medicare Supplement Plan, a Medicare Advantage Plan, and the Extra Help program.
How to Enroll in Medicare Part A
If you know that you already receive Social Security benefits, you may be signed up for Medicare Part A automatically at your 65th birthday.
If you don’t know whether you’re automatically eligible, it’s best to check! Your Initial Enrollment Period (IEP) will start three months before the month of your 65th birthday. For example, if your birthday is in April, your IEP would begin in January. Once that enrollment period starts, you can sign up for Medicare Part A, as well as Part B and private Medicare coverage.
You can enroll in Medicare Part A through the Social Security Administration:
- By phone: 1-800-772-1213 (TTY: 1-800-325-0778)
- In person at a local Social Security office
Your Initial Enrollment Period ends three months after the month of your 65th birthday. If you don’t enroll during this time – or have other coverage like an employer plan – you may have to pay late fees for Part A. If you miss enrollment during your IEP, you can enroll during the General Enrollment Period from January 1 – March 31 each year.
Your coverage will begin on the first of a month. In many cases, that will be the first of the month you turn 65. If you wait to enroll until after your birthday, your coverage may be delayed a month or two. If you enroll during the General Enrollment Period, coverage begins July 1 of that year.
What About Group Coverage?
If you’re still working and getting insurance through your employer at 65, you may decide that you want to stay with that coverage until you retire. However, that choice can significantly affect your coverage and costs, so we suggest reviewing your Medicare options during your Initial Enrollment Period and speaking with a licensed insurance agent and your financial advisor, if you have one.
Since Medicare Part A is premium-free for most people, you may be able to add it and just supplement your employer-provided coverage.
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Last Updated: November 1, 2022 MULTIPLAN_ETQEZMwebsite_0722_M