Medicare Part A

Medicare Part A is one of the two components of “Original Medicare” coverage, the other being Part B. It is provided for free to most qualified individuals who have worked at least 10 years (40 calendar quarters) while paying taxes.

Part A is provided to all adults over age 65, and they will be automatically enrolled in it when they register for Social Security benefits, under most circumstances. The program is also available to certain individuals with qualifying disabilities, end-stage renal failure, or amyotrophic lateral sclerosis (ALS, also known as motor neuron disease, MND, or Lou Gehrig’s disease).

Medicare Part A coverage primarily applies to hospital stays and directly related inpatient services. Medicare Part A covers stays in a skilled nursing facility, as well, albeit not for custodial long-term care. It also provides coverage for hospice care and certain types of home health care.

The cost of Medicare Part A varies depending on your work history and how many days you spend as an inpatient. Most individuals will pay $0 in premiums, provided they worked the minimum amount of years while paying taxes.

Medicare Part A Eligibility

In order to qualify for Medicare Part A, you must be a U.S. citizen or a legal permanent resident who has lived in the U.S. continuously for at least five consecutive years.

Medicare Part A eligibility also requires that you are one of the following:

  • 65 or older
  • Receiving Social Security benefits for a qualifying disability for at least 24 months
  • Diagnosed with end-stage renal disease (ESRD)
  • Diagnosed with amyotrophic lateral sclerosis (ALS)

How to Apply for Medicare Part A

Most individuals who have lived and worked in the U.S. for at least 10 years will be automatically enrolled in Medicare Part A three months before their 65th birthday, with benefits coming into effect the month they turn 65. 

You may also be automatically enrolled in Medicare Part B, in many instances. You can elect to not have Medicare Part B or Part D coverage, but you will likely pay a penalty if you decide later that you need these plans.

Individuals who are below 65 but receiving a disability benefits check from the Social Security Administration may also be automatically enrolled in Part A after 24 months of receiving benefits.

If you are not sure if you have been automatically enrolled — or if you have just recently been diagnosed with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) — then you can manually sign up for Medicare Part A. 

To do so, contact the Social Security office online or call 1-800-772-1213 (TTY users 1-800-325-0778), Monday to Friday, 7 AM – 7 PM. You can also visit your local Social Security office for more information and to receive the paperwork you need to get started.

How Do I Sign Up for Medicare Part A Only?

If you elect to only sign up for Part A and not Part B, know that there will likely be a penalty if you want to sign up for Part B later.

To sign up for Part A only, simply elect to not sign up for Part B when filling out your initial eligibility forms.

If you have automatically been enrolled in both Part A and Part B, contact the Social Security office to receive instructions on how to submit a signed request asking to drop Part B.

You can contact the Social Security office online or call 1-800-772-1213 (TTY users 1-800-325-0778), Monday to Friday, 7 AM – 7 PM. You can also visit your local Social Security office for more information and to receive the paperwork you need to get started.

What Does Medicare Part A Cover?

You can think of “hospital insurance” as the Medicare Part A definition because it pays for the costs of your stay at a hospital or skilled nursing facility. 

Specifically, Medicare Part A covers:

  • Inpatient hospital care
  • Care at a skilled nursing facility
  • Inpatient services at a skilled nursing facility (except custodial or long-term care)
  • Certain types of home health care
  • Hospice care

Medicare Part A only covers the actual costs of your stay in a hospital or skilled nursing facility, not the procedures, treatment, or services you receive there. Those are generally covered by Part B, except prescriptions that are covered by Part D.

To give an idea of what Medicare Part A coverage applies to, specifically, here is what it will cover when you stay at a qualifying hospital that accepts Medicare:

  • A semi-private room
  • General nursing services
  • Meals
  • Drugs provided as part of inpatient treatment
  • Many other hospital services and supplies

This coverage applies to a range of medical facilities, including: 

  • Long-term care hospitals
  • Acute care hospitals
  • Inpatient rehabilitation facilities
  • Mental health care facilities
  • Critical access hospitals
  • Inpatient care as part of a qualifying clinical research study

Items not included include private-duty nursing staff, a private room (except in cases where it is medically necessary), and personal items that may be charged for separately, such as a television, phone, or personal care products like razors.

You can request to confirm what will and will not be covered during your stay with your provider. You can also lookup if the service or item is covered by visiting the coverage website.

The Cost of Medicare Part A

Medicare Part A generally does not charge you a monthly premium as long as you have worked at least 40 calendar quarters at a job that withheld part of your income to pay Medicare taxes.

For most individuals who did not work at least 30 quarters, the monthly premium cost of Medicare is $437 as of 2019. Those who worked 30-39 quarters but not the full 40 will typically pay $240 a month.

Medicare Part A cost-sharing includes both a deductible and coinsurance.

The Medicare Part A deductible is $1,364 for each benefit period.

Coinsurance for Medicare Part A starts at $0 but rises the more days you spend in the hospital or care facility per benefit period.

  • Day 1 – 60: $0
  • Day 61 – 90: $341 coinsurance per day
  • Days 91+: $682 coinsurance per day, which uses up your “lifetime reserve days”
  • Days 91+ with no lifetime reserve days left: full cost

Lifetime reserve days refer to the maximum amount of days you are allowed to stay in a hospital past 90 days, per benefit period, over your lifetime, and still receive coverage. You have 60 such days in your lifetime.

Note that your “days spent in a hospital” reset at the start of each benefit period, so even if you use up all “lifetime reserve days,” you can have up to 90 days covered per benefit period again once the period resets.

There is no annual maximum out-of-pocket cost limit for Original Medicare (Part A or Part B), so you may want to look into a Medicare Advantage or Medigap plan if you are worried about extended hospital stays and paying the coinsurance required.

If you aren’t sure you qualify for Medicare Part A or need help registering, contact us online or give our experts a call T (678) 807-8414 today. We’re here to help Protect What’s Ahead.

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