Medicare Part A
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Medicare Part A is one half of Original Medicare, the federal health-care program made up of Part A (hospital insurance) and Part B (medical insurance). Generally speaking, Part A covers hospital services and supplies considered medically necessary to treat a condition or disease.
If you’re enrolled in the Medicare Part C (Medicare Advantage) program, you can get your Part A and Part B coverage through a Medicare Advantage plan, instead of through the federally administered program. Medicare Advantage plans offer at least the same level of coverage you’d have under Original Medicare (except for hospice care, which is still covered through Original Medicare); these plans may also cover extra benefits, such as prescription drug coverage, hearing services, and routine vision or dental care.
What does Medicare Part A cover?
As mentioned, Medicare Part A covers a variety of health-care services and medical equipment that are medically necessary to treat your health condition or injury. This includes hospital services, skilled nursing facility care, hospice care, and certain home health services. Keep in mind that each covered benefit may come with its own separate costs, which may include deductibles, copayments, and/or coinsurance.
Medicare hospital coverage
Medicare Part A coverage includes inpatient hospital care you may need to treat your condition or injury. This includes the following types of facilities:
- General hospitals
- Long-term care hospitals
- Acute care or critical access hospitals
- Rehabilitation facilities (inpatient)
- Psychiatric hospitals
- Inpatient services you get through a qualifying clinical research study
- Semi-private room stays
- General nursing care
- Medications administered during your hospital stay
- Additional hospital services and supplies that are medically necessary for your care
Private hospital rooms are not covered unless medically necessary, and additional amenities, such as television, personal items (for example, toothbrushes or razors), and/or telephones, are not included; you’ll need to pay for these items out of pocket. In addition, Part A doesn’t cover private-duty nursing.
You’re covered for hospital care if you have Medicare Part A and all of the following are true:
- Your doctor officially orders two or more midnights of medically necessary inpatient hospital care to treat your injury or condition. In addition, you must be formally admitted by the hospital.
- The type of treatment you need can only be received in a hospital setting.
- The hospital providing your care accepts Medicare.
- Your hospital stay is approved by the hospital’s Utilization Review Committee.
Medicare skilled nursing facility coverage
Medicare Part A covers limited inpatient stays in a skilled nursing facility (SNF) following a qualifying three-day inpatient hospital stay. Your condition must require daily skilled care that only an inpatient setting in a skilled nursing facility can provide. Keep in mind that skilled care is different from custodial care, or personal care, which is the type normally provided in long-term care, such as a nursing home. Custodial care includes unskilled care and help with daily living tasks, such as eating or getting dressed; Medicare doesn’t cover this type of care if it’s the only care you need.
Part A coverage for skilled nursing facility stays include:
- Semi-private room
- Skilled nursing care
- Physical and occupational therapy, and speech-language pathology services if required to meet your health goals.
- Medications administered during your stay
- Medical social services
- Medical equipment and supplies that you use in the skilled nursing facility
- Ambulance transportation to the nearest facility for medical services that the skilled nursing facility doesn’t provide (this is covered when other types of transportation could be dangerous to your health)
- Nutrition counseling
Medicare inpatient mental health coverage
Medicare Part A covers inpatient mental health care services. This includes inpatient mental care that you get in either a general hospital or psychiatric hospital. If you get physician services while you’re a hospital inpatient, you’ll be covered under Medicare Part B. Similar to general hospital services covered under Part A, this would include general nursing care, meals, and/or a semi-private room. You’re not covered for private-duty nursing or personal items (for example, socks or toothbrushes).
If you’re getting care in a psychiatric hospital, Medicare Part A covers up to 190 days of inpatient hospital services in your lifetime.
Medicare hospice coverage
Medicare Part A covers hospice services for terminally ill patients, which may be provided in either your home or in an inpatient hospice facility. To qualify for hospice coverage:
- Your hospice doctor and regular doctor must verify that you are terminally ill and have a life expectancy of six months or less.
- You must agree to accept palliative care (for comfort) and forgo curative treatment. (Keep in mind that you may choose to stop hospice care at any time.)
- You must sign an agreement choosing to accept hospice care instead of other, Medicare-covered treatment for your terminal condition.
Part A-covered hospice services include:
- Physician services
- Nursing services
- Medical equipment and supplies (for example, wheelchairs)
- Physical therapy and occupational therapy
- eech-language pathology services
- Prescription drugs for the purpose of pain relief or controlling symptoms
- Hospice aide services
- Homemaker services
- Nutrition counseling
- Social work services
- Grief and loss counseling services
- Short-term inpatient care (for the purpose of pain relief or managing symptoms)
- Short-term respite care for caregivers
Medicare coverage of home health services
Medicare Part A covers certain home-health services, such as physical therapy, occupational therapy, speech-language pathology services, and part-time, intermittent skilled nursing care. You may be covered if you need the above types of services and your doctor certifies that you’re “homebound,” meaning that you have a health condition that makes it difficult to leave the house without assistance or major effort. You must be receiving the home health services through a Medicare-certified home health agency and be under a plan of care that is created by and regularly reviewed by your physician.
Medicare home health coverage doesn’t include round-the-clock home care, home-delivered meals, homemaker services, or custodial care.
Am I eligible for Part A coverage?
In order to be eligible for Medicare, you must be a United States citizen or a permanent legal resident of at least five continuous years. You must also be age 65 or older, unless you qualify by disability or have either end-stage renal disease or amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig’s disease. In this case, you may be eligible for Medicare at any age (see below for more information).
Most beneficiaries get Medicare Part A for free if they’ve worked at least 10 years (or 40 quarters) and paid Medicare payroll taxes. If you don’t have enough work quarters to get Part A without a premium, you may be able to qualify through your spouse’s work history. Otherwise, you can still sign up for Part A coverage and pay a premium for it; the amount you pay will depend on how long you worked and how many work quarters you have.
As mentioned, you are also eligible for Medicare if you are younger than age 65 with a disability and have received Social Security or Railroad Retirement Board disability benefits for 24 months. You’ll be automatically enrolled in the 25th month of disability benefits.
Additionally, you are eligible for Medicare at any age if you have amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) or if you have end-stage renal disease (ESRD). Those who qualify for Medicare because of Lou Gehrig’s disease will be automatically enrolled in Medicare in the first month of disability benefits.
If you qualify for Medicare because of end-stage renal disease, your Medicare benefits typically begin on the first day of the fourth month of kidney dialysis. In some situations, the timing of your Medicare coverage could start earlier. If you have end-stage renal disease and have questions about Medicare eligibility, you can contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. If you’re a TTY user, you can call 1-877-486-2048.
How do I get Medicare Part A?
If you’re receiving Social Security or Railroad Retirement Board benefits before you turn 65, you’ll be automatically enrolled in both Medicare Part A and Part B on the first day of the month that you turn 65. If your 65th birthday happens to fall on the first day of the month, then your Part A and Part B coverage starts on the first day of the month before you turn 65. You should receive a package in the mail with your red, white, and blue Medicare card three months before you become eligible for Medicare.
Some individuals may need to sign up for Part A and/or Part B coverage. If you aren’t yet receiving retirement benefits before you turn 65, you won’t be automatically enrolled in Part A (even if you’re eligible for premium-free Part A) and you won’t get any enrollment information from Medicare. Your first chance to apply for it is during your Initial Enrollment Period (IEP), which is the seven-month period that starts three months before you turn 65, includes your birthday month, and ends three months later. You will need to contact Social Security at least three months before you turn 65 to avoid penalties. If you worked for the railroad, contact the Railroad Retirement Board to sign up.
If you miss your Initial Enrollment Period, your next opportunity to sign up for Medicare Part A and/or Part B is during the General Enrollment Period (GEP) from January 1 to March 31. However, keep in mind that you may owe a late-enrollment penalty for Part A if you pay a monthly premium for it and didn’t sign up when you were first eligible.
If you’re still working when you turn 65 and have health coverage through an employer, you may delay enrollment in Part A (if you pay a premium for it) and/or Part B and sign up through an eight-month Special Enrollment Period (SEP) when that employer coverage ends or you stop working (whichever happens first). You generally won’t have to pay a late-enrollment penalty if you enroll in Medicare through a Special Enrollment Period.
If you qualify for premium-free Part A and need to manually enroll, you can also sign up for it any time during or after your IEP has ended without paying a late-enrollment penalty. However, if you pay a monthly premium for Part A, you can only enroll during your Initial Enrollment Period, the General Enrollment Period, or a Special Enrollment Period.
You may apply for Medicare through the Social Security Administration or the Railroad Retirement Board (if you worked for a railroad). If you’re not yet ready to retire, you can apply for just Medicare. There are a few options when it comes to applying for Medicare:
- Online: Submit an application through the Social Security website. If you’re not yet ready to retire, you can submit an application to apply for Medicare only.
- By phone: Call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778. Representatives are available Monday through Friday, from 7AM to 7PM.
- In-person: Visit your nearest Social Security office to apply in person. You can use the Social Security Office Locator tool to find the closest location to you.
- If you worked for a railroad, then you can apply for Medicare through the Railroad Retirement Board by calling 1-877-772-5772 (TTY users call 1-312-751-4701), Monday through Friday, from 9AM to 3:30PM.
Do you have questions about what Medicare Part A covers and how to get it? Once you’re enrolled in Part A and Part B, you may have other Medicare coverage options available to you, such as Medicare Supplement (Medigap) plans, which may help pay for certain out-of-pocket costs in Original Medicare. Medicare Advantage plans may be another option if you’re interested in getting coverage beyond Original Medicare. If you’d like to learn more about Medicare plan options that may fit your needs, contact eHealth to speak with a licensed insurance agent.
This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
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