Medicare Part A
If you’re approaching retirement age, understanding the ins and outs of Medicare can be daunting. Medicare is a federal health insurance program designed for eligible individuals who are 65 or older, those with certain disabilities, and people with End-Stage Renal Disease. It is divided into four parts: Part A, Part B, Part C, and Part D.
Medicare Part A, also called hospital insurance, helps cover the costs of inpatient hospital care, skilled nursing facility care, hospice care, and home health care services. If you have paid Medicare taxes while working, you may qualify for Part A without having to pay a monthly premium. However, there are out-of-pocket expenses such as deductibles, copayments, and coinsurance. It’s important to understand how Medicare Part A works, so you can plan and prepare for your healthcare needs in retirement.
What Does Medicare Part A Cover?
Medicare Part A (Hospital Insurance) covers the following:
1. Inpatient Hospital Care
Medicare Part A offers coverage for a variety of inpatient hospital services, including semi-private rooms, meals, general nursing care, drugs (including methadone to treat an opioid use disorder), and other necessary hospital services and supplies. To qualify for Medicare Part A coverage, you must meet two conditions. First, you must be admitted to the hospital as an inpatient after an official doctor’s order indicating that you require inpatient hospital care to treat your illness or injury. Second, the hospital must accept Medicare.
It’s important to note there are some limitations to Medicare Part A coverage. For instance, private-duty nursing, a private room (unless medically necessary), and personal care items like razors or slipper socks are not covered by Medicare Part A. Additionally, if there’s a separate charge for television or phone in your room, those charges will not be covered either.
2. Skilled Nursing Facility Care (SNF)
Medicare Part A covers skilled nursing care for a limited time, typically on a short-term basis, provided that certain conditions apply. These include:
- Must have days left in your benefit period to use.
- Must have had a qualifying inpatient hospital stay.
- Doctor must have determined that you need daily skilled care.
- Care must be provided by skilled nursing or therapy staff.
- Services must be received in a Medicare-certified Skilled Nursing Facility (SNF).
It’s important to note that you must also need skilled services for a medical condition that is either a hospital-related medical condition treated during your qualifying 3-day inpatient hospital stay, or a condition that started while you were getting care in the SNF for a hospital-related medical condition.
Covered services in a skilled nursing facility include a semi-private room that you share with other patients, meals, skilled nursing care, physical therapy, occupational therapy, speech-language pathology services, medical social services, medications, medical supplies, and equipment used in the facility, ambulance transportation to the nearest supplier of needed services that aren’t available at the SNF, and dietary counseling.
3. Hospice Care
If you or a loved one are facing a terminal illness, hospice care may be an option worth considering. Hospice care is a type of specialized healthcare that focuses on the comfort and quality of life of individuals who have been diagnosed with a terminal illness. If you have Medicare Part A, you can qualify for hospice care if you meet all the required conditions.
To be eligible for hospice care, your hospice doctor and regular doctor must certify that you have a life expectancy of six months or less. You must also choose to receive palliative care rather than curative care, and sign a statement indicating that you have chosen hospice care as your primary form of treatment.
Hospice care can be provided in a variety of settings, including your home or a nursing home. If you require inpatient hospice care, you can receive it at a hospice facility. Medicare will cover the costs of hospice care, including medications, symptom management, grief counseling, and respite care for your caregiver.
However, it is important to note that Medicare will not cover room and board if you receive hospice care in your home or a facility (i.e nursing home) where you live. This means that you or your family will be responsible for covering these costs.
4. Home Health Care
Medicare Part A and/or Part B can help cover the cost of home health services if you’re homebound and unable to leave your home without significant effort and assistance. To receive these services, you must be under the care of a doctor who has approved the situation, and you must use a Medicare-certified agency to coordinate the services.
The home health services covered by Medicare include part-time skilled nursing and home health aide care, occupational therapy, physical therapy, speech-language pathology services, medical social services, and injectable osteoporosis drugs for women, durable medical equipment (DME), and medical supplies for at-home use. These services can help you receive quality care in the comfort of your own home, making it easier to manage your health conditions and maintain your independence.
However, it’s important to use caution when planning for home health services, as Medicare does not cover certain services. For example, 24-hour-a-day care at home, meal delivery, and homemaker services that are not related to your care plan are not covered. Additionally, if you require only custodial or personal care, such as help with bathing or dressing, Medicare will not cover it.
Before receiving home health services, it’s essential to do your research and ensure that you understand which services are covered under Medicare Part A and which ones would be your responsibility. Working with a Medicare-certified agency can also help ensure that you receive the appropriate services and that they’re specific, safe, and effective for your condition.
How Much Does Medicare Part A Cost?
Most people don’t pay a Part A premium because they or their spouse paid Medicare taxes for at least ten years while working. However, if you don’t qualify for premium-free Part A, you might have to buy it, paying either $278 or $506 each month, depending on your work history.
To buy Part A, you also need to sign up for Part B, which covers medical services and supplies. It is important to note that if you fail to enroll in Part A during your initial eligibility period for Medicare, you may face a penalty. So, it’s essential to learn more about how Medicare works and when to enroll in different parts of Medicare.
Once you have Part A, you’ll have to pay a deductible of $1,600 each time you’re admitted to the hospital or skilled nursing facility (SNF) before Medicare will start to pay. The benefit period comes to an end once you haven’t received inpatient hospital care or skilled care in a skilled nursing facility for at least 60 consecutive days.
There’s no limit to how many benefit periods you can have each year, which means you may have to pay the deductible more than once a year. If you stay in a hospital for up to 60 days, you’ll pay nothing after you’ve paid your Part A deductible. But, if your hospital stay exceeds 60 days, you’ll pay a $400 copayment each day from days 61 to 90. If you need to stay in the hospital for more than 90 days, you’ll pay an $800 copayment each day using your 60 lifetime reserve days. After day 150, you’ll have to pay all the costs.
Similarly, if you need skilled nursing facility care, you’ll pay nothing for the first 20 days, but from days 21 to 100, you’ll pay a $200 copayment each day. After 100 days, you’ll have to pay all the costs. For home health care, you’ll pay nothing for covered services, but you’ll have to pay 20% of the Medicare-approved amount for durable medical equipment, such as wheelchairs, walkers, hospital beds, and other equipment.
For hospice care, you’ll pay nothing for covered services. But you may pay a copayment of up to $5 for each prescription drug or other products that are used for pain relief and to control your symptoms while you’re at home. In addition, you may be responsible for a 5% payment of the Medicare-approved amount for your inpatient respite care.
Medicare Part A Eligibility
To be eligible for Medicare Part A, you generally need to have worked and paid into the Social Security system for at least 10 years (or 40 quarters). If you haven’t worked enough to qualify, you may still be able to get Medicare Part A if you’re the spouse or ex-spouse of someone who has, or if you have a qualifying disability.
Additionally, you must meet at least one of the following to be eligible:
- You must be 65 years or older.
- You have been receiving disability benefits for a minimum of two years due to permanent disability.
- You have been diagnosed with Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease) or End-Stage Renal Disease (ESRD).
If you meet any of the above criteria, you’ll be automatically enrolled in Medicare Part A. However, if none of these apply to you, then you’ll need to apply for Medicare Part A.
Medicare Part A Enrollment Deadline
If you’re already receiving Social Security or Railroad Retirement Board benefits when you turn 65, you’ll be automatically enrolled in Medicare Part A and Part B. However, if you’re not receiving these benefits, you’ll need to actively enroll during your IEP or another enrollment period to avoid penalties and gaps in coverage.
The first important deadline to be aware of is your Initial Enrollment Period (IEP). Your IEP begins three months before the month of your 65th birthday and lasts for seven months. During this time, you can enroll in Medicare Part A and other components of Medicare, including Part B (which covers doctor visits and other outpatient care), Part C (also known as Medicare Advantage, which is offered by private insurance companies), and Part D (which covers prescription drugs).
If you miss your IEP, you may be able to enroll during the General Enrollment Period, which runs from January 1 to March 31 each year. However, if you do enroll during the General Enrollment Period, your coverage won’t begin until July 1 of that year, and you may have to pay a late enrollment penalty.
There are also Special Enrollment Periods (SEPs) that may apply to you if you experience certain life events, such as moving to a new area, losing your health insurance coverage, or qualifying for Medicaid. If you’re eligible for an SEP, you’ll typically have a 2-month window to enroll in Medicare Part A (or other components of Medicare) without penalty.
It’s essential to have a clear understanding of the type of coverage that will be available to you when you turn 65 and whether you’ll be eligible for a special enrollment period. This will help you make informed decisions about your healthcare coverage, so you can avoid potential gaps in coverage.
How To Sign Up For Medicare Part A
You can sign up for Medicare through the Social Security website. To get started, simply create a secure my Social Security account and follow the prompts to enroll in Medicare. Alternatively, you can call the Social Security Administration at 1-800-772-1213 for assistance. Regardless of which method you choose, the Social Security Administration is available to help you navigate the enrollment process and answer any questions you may have.
How To Get Help With Medicare Part A
Don’t navigate the complexities of Medicare alone. Our licensed agents at Senior Healthcare Solutions are here to help. Call us today at 866-MEDIGAP (866-633-4427) for fast and reliable assistance from knowledgeable Medicare experts. We’re here to ensure that you have the peace of mind that comes with knowing you’re making informed decisions about your healthcare coverage. So, contact us today and let us assist you every step of the way.
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Frequently Asked Questions
Is Medicare Part A free?
Medicare Part A, also known as Hospital Insurance, is available at no cost if you paid Medicare taxes or had a spouse do so while employed for a minimum of 10 years. Additionally, if you get Medicare before age 65, there’s no Part A premium (i.e. premium-free Part A).
Is Medicare Part A or B better?
Medicare Part A and Part B are both important components of your healthcare coverage, and they are designed to complement each other. Medicare Part A provides coverage for hospitalization, skilled nursing facility care, hospice care, and some home health services. Medicare Part B, on the other hand, covers doctor visits, outpatient care, preventive services, and medical equipment. While the coverage provided by each plan may differ, they work together to ensure that you have comprehensive healthcare coverage. In most cases, enrolling in both Medicare Part A and Part B is recommended to ensure that you have a well-rounded healthcare plan that meets your needs.
Can you have Medicare Part A only?
When you are eligible for premium-free Medicare Part A, you have the option to decide whether to enroll in Part B. However, it’s important to carefully consider your healthcare needs and budget when deciding whether to enroll in both Part A and Part B or just Part A. If you decide to only enroll in Part A, you’ll need to pay out of pocket for medical services covered by Part B.
Is Medicare Part A enrollment automatic?
If you are already receiving Social Security benefits, your enrollment in Medicare Part A will be automatic. However, if you’re not receiving Social Security benefits, you’ll need to actively enroll in Medicare Part A during your Initial Enrollment Period, which is typically the seven-month period that begins three months before you turn 65.
What are the main benefits of Medicare Part A?
Medicare Part A provides coverage for hospitalization, hospice care, skilled nursing facility care, and some home health services. It’s important to note that while Medicare Part A provides coverage for many healthcare services, there may be deductibles, copayments, and coinsurance that you will need to pay out of pocket. Nonetheless, having Medicare Part A can provide significant financial assistance and peace of mind when it comes to your healthcare needs.
Can I enroll in Medicare Part A at any time?
No, you can’t enroll in Medicare Part A at any time. You are eligible to enroll in Medicare Part A during your Initial Enrollment Period, which is a seven-month period that begins three months before you turn 65. If you do not enroll during your Initial Enrollment Period, you may be able to enroll during the General Enrollment Period, which takes place from January 1st to March 31st each year. In some cases, you may also be able to enroll in Medicare Part A during a Special Enrollment Period, such as if you lose employer-sponsored health coverage or move to a new area.
Why would you not qualify for Medicare Part A?
To be eligible for Medicare Part A, you must meet certain criteria. If you are under the age of 65, don’t have a qualifying disability, or didn’t pay Medicare taxes for a minimum of 10 years (or 40 quarters), you may not be eligible for Medicare Part A. Furthermore, if you don’t qualify through the work history of a current, former, or deceased spouse, you may not be eligible for Medicare Part A.
Does Medicare Part A pay 100% after deductible?
No, Medicare Part A does not pay 100% of your healthcare costs after you’ve paid the deductible. For inpatient stays, you would be responsible for paying copayments depending on the length of your stay. For the first 60 days, you would pay $0 after paying your Part A deductible. For days 61-90, you would pay $400 each day. For days 91-150 while using your 60 lifetime reserve days, you would pay $800 per day. After day 150, you would be responsible for paying all costs.
How do I decline Medicare Part A?
If you’re eligible for premium-free Medicare Part A but don’t wish to enroll, you can opt out of the coverage by completing and submitting a Medicare Part A and B voluntary refusal form. This form is available on the Social Security Administration website or at your local Social Security office. It’s important to note that if you opt out of Medicare Part A, you may also lose any Social Security or Railroad Retirement Board (RRB) benefits that you’re receiving or may become eligible for in the future. In addition, if you decide to enroll in Medicare Part A later, you may be subject to a late enrollment penalty.
How do I file a claim with Medicare Part A?
If you need to file a claim with Medicare Part A, you can usually do so through the healthcare provider or facility that provided you with the service or treatment. In most cases, the provider will submit the claim on your behalf. If you receive services from a provider who does not accept Medicare, you may need to submit a claim directly to Medicare. To do so, you can complete and submit a Patient Request for Medical Payment form to your Medicare Administrative Contractor (MAC).