What is Medicare Part A and what does it cover?
Medicare is the government health care program that provides basic medical insurance to individuals who meet certain criteria. It consists of the parts A through D. While most people will automatically be enrolled in part A and part B when they turn 65 and receive Social Security benefits, the parts C (Medicare advantage plans) and D (prescription drug coverage) are optional.
Medicare Part A is many times referred to as the ‘hospital’ part of Medicare. It covers hospital stays as inpatient, and also some nursing home and home health care as well as hospice care.
Medicare Part A coverage
The following services are covered by Medicare Part A (specific requirements and co-payments, coinsurance and deductibles may apply):
- First 3 units of blood as inpatient
- Hospital stay as an inpatient (up to 90 days, deductible/co-payments/coinsurance apply)
- Skilled nursing facility (this is NOT the typical custodial care for persons who need assistance with their daily life!)
- Home health care (must be medically necessary)
- Hospice services
You are eligible to receive Medicare Part A if you meet certain criteria and are either
- over the age of 65
- disabled and under the age of 65
- or suffer from End Stage Renal disease.
If you receive social security or RRB benefits, your Medicare Part A coverage will automatically start the month you turn 65. Usually, you will be mailed your Medicare card prior to your birthday. Persons who are younger than 65 and disabled qualify to receive Medicare Part A if they have been receiving Social Security or RRB benefits for more than 24 months. If you suffer from (Lou Gehrig’s disease) Amyothropic Later Sclerosis, you are immediately eligible for Medicare Part A when you begin receiving social security disability benefits.
In case you meet the citizenship/residency requirements and would like to get Medicare, but are currently not collecting Social Security or RRB benefits, for example when you are still working, you have 3 months before and after your 65th birthday to contact the social security office and learn how you may enroll.
If you or your spouse paid Medicare taxes during your working life, you don’t need to pay for Part A. However, co-payments, coinsurance, and deductibles apply. If you have to pay a premium for Part A, it can be quite expensive, and you are usually also required to purchase Part B.
If you don’t enroll in Medicare when you are initially eligible, you may be subject to a late enrollment penalty if you decide to get it at a later point in time, and you will have to pay an increased fee with your premium each month you stay enrolled in Medicare.
However, there is no late enrollment penalty if you or your spouse are at your 65th birthday still working and member of an employer’s group health insurance – your enrollment period will be delayed for up to 8 months after the employment or your enrollment in the group health plan ends.
For more specific details about Medicare Part A, please refer to the official ‘Medicare and You’ handbook, which you may download at http://www.medicare.gov/publications/pubs/pdf/10050.pdf
