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Medicare Part A Guide

Medicare Part A is one of two parts of Original Medicare, the federal health care program for people over age 65 and those with certain disabilities. Part A, often referred to as “hospital insurance,” covers inpatient hospital care, home health care, skilled nursing facilities, and other services. Part B, known as “medical insurance,” covers services and supplies that are deemed medically necessary to treat a condition or illness.

Most people will be eligible for premium-free coverage once they turn 65. If you are not eligible for premium-free coverage, you can still enroll at age 65, but you’ll pay a monthly premium for coverage.

What Medicare Part A covers

Although your coverage will not apply to a simple visit to the doctor (that’s what Part B is for), it will cover your health care costs if you’re admitted to a hospital for at least two nights. Skilled nursing facility care, home health services, and hospice care are also covered under Part A.

medicare part a coverage

 

 

 

 

In general, it covers the following services:

  • Hospital care: If you are admitted to a hospital for at least two nights, it will cover the costs of a semi-private room, meals, regular nursing services, lab tests, and more related services.
  • Skilled nursing facility care: If you’ve been in the hospital for at least three days and your doctor certifies that you need follow-up care that you cannot receive at home, it will cover skilled nursing facility care.
  • Home health services:  It covers certain home health services such as skilled nursing care or physical and speech therapy.
  • Hospice: If you have been diagnosed with a terminal illness and decide that you want hospice care, it will cover those costs—provided the hospice care focuses on comfort and quality of life, as opposed to a cure.

For more in-depth information, visit our in-depth guide to coverage.

Medicare Part A eligibility & costs

Most people get no-cost coverage based on their work history, or their spouse’s work history. This is called “premium-free Part A.” If you are 65 or older, you are eligible for any of these reasons:

  • You receive retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible for retirement benefits from Social Security or the Railroad Retirement Board but have not yet received these benefits
  • You or your spouse paid Medicare taxes while being employed by the government.

If you are younger than 65, you are eligible for premium-free coverage if any of the following applies to you:

  • You received Social Security or Railroad Retirement Board disability benefits for two years (24 months)
  • You have End-Stage Renal Disease (ESRD)

If you are not eligible, your premium will be $413 per month in 2017.

Even those who get premium-free coverage may still have to pay additional costs, including a yearly inpatient deductible of $1,316. Other costs include the following:

  • Inpatient days 0 through 60: $0 coinsurance
  • Inpatient days 61 through 90: $329 coinsurance per day
  • Lifetime reserve days: $658 coinsurance per day (after 90 days of inpatient stay for up to 60 days)
  • Skilled nursing facility coinsurance: $164.50 coinsurance per day

These costs can add up, but Medicare Savings Plans may be able to provide financial assistance. These plans vary from state to state.

How and when to sign up for Part A

If you live in the United Statesand have been receiving Social Security or Railroad Retirement Board benefits for at least four months before becoming eligible for Medicare, you will automatically be enrolled in both premium-free Part A and Part B.

If you are not getting Social Security or Railroad Retirement Board benefits, you will not be automatically enrolled. To apply, you must contact Social Security.

There are three enrollment periods that apply:

  • Initial Enrollment Period (IEP)
  • General Enrollment Period (GEP)
  • Special Enrollment Period (SEP) for the working aged, working disabled, and international volunteers

1. Initial Enrollment Period

The Initial Enrollment Period (IEP) is the seven-month period that begins three months prior to your 65th birthday month, includes your birthday month, and ends three months after. If you’re younger than 65 and are eligible based on disability, your IEP begins three months before the 25th month you receive disability benefits, includes the 25th month, and ends three months after.2

Your beginning coverage date depends on when you enroll during the IEP. If you enroll in the first three months, your coverage will begin the first month you are eligible for Medicare. If you enroll in any other month of the IEP, your coverage will be delayed.

If you have a disability, you will automatically be enrolled in Part A and Part B after you have received disability benefits from Social Security for two years.

If you do not buy Part A when you are first eligible, and you do not qualify for premium-free coverage, your monthly premium may go up by 10%. This late enrollment penalty means you’ll have to pay that higher premium for twice the number of years you could have had coverage but didn’t sign up. For example, if you waited two years to enroll, you could pay the 10% penalty for four years.

2. General Enrollment Period

The General Enrollment Period (GEP) takes place each year from January 1 to March 31. Part A and Part B coverage begins on July 1 of that same year.

3. Special Enrollment Period

Once your IEP ends, you may be able to sign up during a Special Enrollment Period (SEP). If you’re covered under a group health plan based on your current employment, you can sign up for Part A and/or Part B anytime as long as the following situations apply:

  • You or your spouse is employed
  • You are covered by a group health plan through the employer or union based on your work

If you or your spouse loses employer-based hospital insurance, or if you were volunteering in a foreign country, you are also eligible to enroll during an SEP. This SEP is an eight-month period with either of these begin dates:

  • The month after the employment has ended
  • The month after the group health plan insurance ends

If you qualify for an SEP, you typically do not have to pay the late-enrollment penalty.

More questions?

If you’d like to learn more about your options, we can help. You may be able to sign up for an Advantage Plan, a Supplement Plan, or a Part D Prescription Drug Plan. Use our Suggest-A-Plan tool to help find a plan that may be right for you.


Disclaimers:

1 Excludes residents of Puerto Rico. People living in Puerto Rico who are eligible for automatic enrollment are only enrolled in premium-free Part A.
2 The IEP for people with ESRD or ALS varies.

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