What is Medicare Part A and What Does it Cover?
Medicare Part A, otherwise known as “hospital insurance,” provides coverage for hospital stays, nursing home care, and some home health services. It works together with Part B, or “medical insurance,” to provide broad health care coverage for people age 65 and older.
To fully answer “what is Medicare Part A?” we will cover who is eligible, what it covers, how to enroll, and more. below
Who can get coverage?
Medicare Part A coverage is available for US citizens who meet one or more of the following criteria:
- You are 65 or older
- You have a disability
- You have End-Stage Renal Disease (ESRD)
What does Medicare Part A cover?
Medicare covers services and supplies that are medically necessary to treat a condition or illness. For Medicare Part A, the following are often covered:
- Hospital care. This includes long-term care hospitals as well as inpatient rehab facilities.
- Short-term skilled nursing facility or nursing home care. Meals, facility supplies, and nurse-administered IV injections are generally all included under skilled nursing facility care. However, if you only need custodial care—help with bathing, dressing, eating, and general day-to-day tasks—that isn’t covered.
- Hospice. Hospice care is for patients who are terminally ill and have decided that they no longer want to seek treatment for their illness. If you elect to use hospice care, coverage for treatment aimed at curing your terminal illness may be restricted unless you stop hospice care.
- Home health services. It may help cover intermittent or occasional home health care needs, like nursing care, physical therapy, and occupational therapy.
What is not covered by Part A Medicare?
There are limitations to its benefits. Some things that are not covered include the following:
- Custodial care
- Most dental care, including dentures
- Eye exams for the prescribing glasses or contacts
- Most cosmetic surgery
- Hearing aids and some hearing exams
- Routine foot care
Enrollees should pay special attention to custodial care, which includes things like bathing and eating assistance. Stays in nursing homes and assisted facilities will only be covered if you need medical care in addition to custodial care.
How do I sign up?
Automatic enrollment:Many people are enrolled in coverage automatically. This may happen in the following situations:
- You turn 65 and are eligible to receive Social Security or Railway Retirement Board (RRB) benefits.
- You haven’t yet turned 65, but you have a disability.
- You have Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis (ALS).
- You live in Puerto Rico and get Social Security or RRB benefits.
If one of the above situations applies to you, you can expect your card in the mail either three months before your 65th birthday or in the 25th month of your disability benefits.
Manual enrollment:There are some situations where you won’t qualify for automatic enrollment, though, and you’ll need to sign up. You may need to sign yourself in the following cases:
- You aren’t getting Social Security or RRB benefits, as can happen if you’re 65 but still working.
- You qualify because you have ESRD.
When can I enroll in Part A?
If you need to manually enroll, you’ll have to do so during one of these three enrollment periods:
- Initial Enrollment Period. The Initial Enrollment Period runs for seven months, starting three months prior to the month of your 65th birthday and closing three months after your birthday month.
- General Enrollment Period. This period falls between January 1 and March 31 each year. You can enroll during this period if you didn’t sign up during your Initial Enrollment Period and you aren’t eligible for a Special Enrollment Period.
- Special Enrollment Periods. These apply for a variety of reasons, including if you are covered under a group plan by an employer, your employment ends, or you are in a foreign country as a volunteer.
What are the alternatives?
Together, Part A and Part B make up what is known as Original Medicare. If you want coverage different from that offered, you can choose an Advantage (MA) Plan, sometimes called Part C. These plans offer coverage through private insurers that have contracted with Medicare to provide you the benefits. The benefit of this type of plan is that it bundles your Part A and Part B—and sometimes Part D (prescription drug)—coverage under one plan. There are downsides, though, including the fact that some MA plans have limited provider networks.