Medicare Part A overview
As one of four components of the Medicare program, Part A provides hospital insurance to beneficiaries. This insurance covers inpatient care at hospitals and skilled nursing facilities as well as hospice and home health care. Medicare Part A is one of two parts that make up what is known as original Medicare.
Medicare Part A premiums
For most Medicare beneficiaries, Part A is free. The premiums are covered by Medicare taxes paid while an individual or his spouse were employed. To be eligible for premium-free Part A coverage, an individual or spouse must have worked and paid Medicare taxes for at least 10 years.
Premium-free Part A benefits are also available to those who have received Railroad Retirement Board or Social Security disability benefits for at least 24 months. Individuals diagnosed with ALS, also known as Lou Gehrig's disease, are eligible for immediate premium-free Part A benefits. Kidney dialysis and kidney transplant patients also receive free Medicare Part A coverage.
Senior citizens older than age 65 who do not have the required work history to receive free Part A benefits may be able to purchase the coverage. Those who buy Part A coverage must also buy Part B coverage and pay a premium for both. Premiums are pro-rated based on the number of years of eligible work an individual has. According to the Health and Human Services Department, individuals buying Part A in 2011 paid monthly premiums of up to $450. Some states may offer financial assistance to help low-income seniors make these premium payments.
Applying for Medicare Part A
Individuals receiving Railroad Retirement Board or Social Security disability benefits will automatically be enrolled in Medicare Part A. Coverage begins 24 months after the start of disability benefits or the first day of the month in which the beneficiary turns age 65, whichever is earlier.
Other individuals must contact Social Security to apply for Part A benefits. There is a seven-month initial enrollment period that is includes a three-month window on either side of the month an individual turns 65. The government encourages individuals sign up during the three months before their birthday to avoid any delay in the start of Medicare coverage.
If an individual misses the initial enrollment period when they turn age 65, they can still enroll between January 1st - March 31st of each year. However, late enrollment can result in higher premiums.
Both individuals approaching their 65th birthday and those with End-Stage Renal Disease can apply for Medicare Part A through the Social Security website or by calling the agency's hotline at 1-800-772-1213.
Medicare Part A benefits
Medicare Part A covers inpatient care provided by many different institutions:
- General hospitals
- Critical access hospitals
- Long-term care hospitals
- Rehabilitation facilities
- Skilled nursing facilities
- Religious non-medical health care institutions
Not every overnight hospital stay is considered inpatient care. The government considers a visit to be inpatient once a doctor has formally admitted an individual to the hospital. Outpatient services are typically covered by Medicare Part B benefits. Part A benefits also cover hospice and home health care. However, Medicare does not pay for long-term care at a nursing home, adult foster care or assisted living facility.
There may be deductibles and co-pays associated with these covered Medicare services. For more information, on Medicare Part A coverage, refer to Medicare and You, published by the Centers for Medicare and Medicaid Services.
Disclaimer: Our content does not constitute medical or other professional advice, is not intended to be a substitute for professional diagnosis or treatment, and does not create a physician-patient relationship. Please seek the advice of your doctor or health care provider with any questions you may have.