Part A

What is Medicare Part A Insurance?

Medicare Part A is hospital insurance. Part A generally covers inpatient hospital stays, skilled nursing care, hospice care, and limited home healthcare services. In addition, you typically pay a deductible, coinsurance, and/or copayments.

What does Medicare Part A Insurance cover?

Medicare Part A covers the following services:

  • Inpatient hospital care: This is care received after you are formally admitted into a hospital by a physician. You are covered for up to 90 days each benefit period in a general hospital, plus 60 lifetime reserve days. Medicare also covers up to 190 lifetime days in a Medicare-certified psychiatric hospital.
  • Skilled nursing facility (SNF) care: Medicare covers room, board, and a range of services provided in an SNF, including administration of medications, tube feedings, and wound care. You are covered for up to 100 days each benefit period if you qualify for coverage. To qualify, you must have spent at least three consecutive days as a hospital inpatient within 30 days of admission to the SNF, and need skilled nursing or therapy services.
  • Home health care: Medicare covers services in your home if you are homebound and need skilled care. You are covered for up to 100 days of daily care or an unlimited amount of intermittent care. To qualify for Part A coverage, you must have spent at least three consecutive days as a hospital inpatient within 14 days of receiving home health care. (Note: You can get home health care through Medicare Part B if you do not meet all the requirements for Part A coverage.)
  • Hospice care: This is the care you may elect to receive if a provider determines you are terminally ill. You are covered for as long as your provider certifies you need care.

Keep in mind that Medicare does not usually pay the full cost of your care, and you will likely be responsible for some portion of the cost-sharing (deductibles, coinsurances, copayments) for Medicare-covered services.

Who is eligible for Medicare Part A Insurance?

Starting at 65 years of age, most people are eligible for Medicare Part A coverage. To be eligible, a person must be a citizen of the U.S. or have been a legal resident for 5 consecutive years.

People below the age of 65 years may meet eligibility requirements based on their medical status.

Medicare Part A eligibility requirements for people under 65 years of age include those collecting Social Security Insurance (SSI) or Railroad Retirement Board (RRB) for 24 months due to a disability.

There are also special rules for people under 65 years of age who have either end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). People with ALS can receive Medicare Part A the first month after qualifying for SSI benefits.

The rules for people with ESRD are more complicated. The waiting period varies according to how long they have been on dialysis, with eligibility beginning after the third month following dialysis. However, if a person has completed self-dialysis training, eligibility starts during the first month.

Coverage will also kick in during the month of a kidney transplant or earlier if a person requires hospitalization 2 months before a kidney transplant to prepare for the procedure.

Medicare Part A Insurance FAQs

Does it make sense to enroll in Medicare Part A and postpone the rest?

For those getting health care from a large employer, enrolling in Part A and delaying the rest until retirement might seem like a no-brainer — but there are caveats.

“We used to tell people, go ahead and get into Medicare A, there’s no fee,” says Katy Votava, author of the book “Making the Most of Medicare: A Guide for Baby Boomers.”

“But you don’t want to enroll in Medicare [Part] A if you have an employer plan that lets you put money into health savings accounts.” That’s because you won’t be able to make tax-free contributions to your HSA while enrolled in Medicare, she notes.

These types of plans — high-deductible health plans with HSAs — have become more common in recent years, Votava notes. Even if you don’t have one now, your company might change its coverage options and you might end up in one before retirement, she adds.

If you’re unsure of how your coverage might change, it may be best to wait until your special enrollment period and sign up for parts A and B at the same time.

What isn't covered by Part A?

Here’s what’s not covered in Part A:

Deductibles and coinsurance You’ll have to cover deductibles (and, potentially, coinsurance) if you’re hospitalized, for instance. In 2021, that deductible for hospital care is $1,484 per benefit period, which starts on the day you’re admitted and ends when you haven’t received inpatient hospital care or care in a skilled nursing facility for 60 days. If your hospital stay exceeds 60 days, you’ll have to start paying coinsurance.

Outpatient hospital service These are covered by Part B and include same-day surgeries or emergency services and X-rays ordered by your doctor, for instance.

Long-term care While Part A covers a limited amount of time spent at skilled nursing facilities, it doesn’t cover long-term care in nursing homes.

Custodial care Custodial care, or help with eating, getting dressed or bathing, isn’t covered by Part A.

When should I enroll in Medicare Part A?

If you’re already receiving Social Security or Railroad Retirement Board benefits, you’ll automatically start receiving Original Medicare — including Medicare Part A coverage — the month you turn 65, in most cases.

If not, here’s when you can enroll:

Initial Enrollment Period
This is the seven-month period starting three months before the month you turn 65, including your birthday month and ending three months after your birthday month.

Special Enrollment Period (if you qualify)
This is the eight-month period starting at the month after your employment ends or the month after losing your qualifying employer insurance, whichever happens first. You can generally qualify for this special enrollment period if you or your spouse are receiving health care from a large employer when you turn 65.

General Enrollment Period

This runs from Jan. 1 through March 31 every year. If you didn’t sign up when you were first eligible and weren’t eligible for a special enrollment period, you’ll have to wait for the general enrollment period to sign up. However, you may have to pay penalties for late enrollment, and your coverage would start only on July 1. So, for example, if you were to realize on April 1 that you needed to sign up for Medicare during the general enrollment period, you’d have to wait over a year to actually get that coverage — even if you signed up as soon as possible during the general enrollment period the following January.

Those who aren’t eligible for a special enrollment period and miss the initial enrollment period are really in trouble. They’ll not only pay penalties for the rest of their life, [but they’ll] have to wait long periods of time — it could be months, a year, or more than a year — before [they’re] eligible to start coverage. And in the meantime, she notes, they’ll be covering 100% of their medical costs out-of-pocket.

While there aren’t penalties for Part A if you’re getting it premium-free, there are penalties for enrolling late in Parts B and D, which grow larger the longer you postpone your enrollment. Before turning 65, make sure you understand the type of coverage you have and whether you’re eligible for a special enrollment period.

If I have employer health insurance, do I have to enroll in Medicare at 65?

The answer depends on the size of your employer.

Enrolling in premium-free Part A and postponing the other parts of Medicare has long been a strategy used by folks to get more coverage at no upfront cost. But it may not work in all cases.

If you have a small employer (fewer than 20 employees): Yes.
It might seem redundant since you already have coverage, but you should enroll in Medicare parts A, B and D — or a Medicare Advantage plan that covers these — when you’re first eligible to avoid costly penalties. Once enrolled, Medicare will generally be your primary coverage, meaning it will pay first, and your employer coverage will be secondary.

If you have a large employer (20-plus employees): No.
You can generally postpone enrollment in Medicare in this case with no penalties. After your coverage ends, you’ll get a special enrollment period, at which time you can enroll in Medicare and choose plans without late penalties. (If you were to enroll and keep your employer coverage, your Medicare would be secondary and your employer coverage would be primary.)

Medicare overall is not easy to understand, and you need to consider many factors before finalizing which one is the right fit for you. Our experts can help guide you. Talk to us today to know more.

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