What Does Medicare Part A Cover?
Medicare Part A is a type of hospital insurance. Because of this, Medicare Part A Hospital Insurance is designed to primarily cover hospital-related expenses for inpatient care, including mental health.
If you want medical insurance, you must sign up for Medicare Part B. To do so, you must first be signed up for Part A. Many people sign up for both Part A and Part B so that they have the maximum amount of coverage that they can get through the Medicare system.
Inpatient Hospital Care
Your Medicare Part A Hospital Insurance will cover your inpatient hospital care costs when all three of the following are true:
- 1. A doctor puts in a doctor’s order that states that you should be admitted to the hospital as an inpatient so that your injury or illness can be treated.
- 2. The hospital where you are a patient accepts Medicare.
- 3. Your stay is approved by the hospital’s Utilization Review Committee, if applicable.
The following hospital-related costs will be covered by Medicare when you are being treated as an inpatient:
- Semi-private rooms in the hospital
- Meals while you’re in the hospital
- General nursing
- Medication that is required as a part of your inpatient treatment
- Basic hospital services and supplies
The following costs typically are not covered by Medicare Part A, even when you are being treated as an inpatient:
- Private room (unless it’s medically necessary)
- Private-duty nursing
- Telephone or television in your room
If you are unsure about what Medicare will and will not cover, don’t hesitate to ask your doctor or other healthcare providers. These healthcare professionals are typically very experienced in caring for patients who are covered by Medicare. In addition, they can help ensure that you are aware of any costs you will be responsible for on top of your Medicare Part A coverage.
Skilled Nursing Facility Care
Neither Medicare Part A nor Medicare Part B covers long-term skilled nursing services. However, short-term skilled nursing care in a skilled nursing facility is sometimes covered if all of the things listed below are true:
- You have Medicare Part A
- You still have days left in your Medicare Part A benefit period
- You have a qualifying hospital stay
- Your doctor has ordered daily skilled care for you, and this care is provided by or under the supervision of therapy staff members or skilled nursing staff members
- The skilled nursing facility where you are seeking treatment is Medicare certified
- The reason why you need these skilled services is related to a medical condition that is either a hospital-related medical condition or that started while you were already receiving care in a skilled nursing facility for a hospital-related medical condition
Hospice care is covered by Medicare Part A in the following situations:
- Your regular doctor or hospice doctor certifies that you are terminally ill and are expected to live for six months or less
- You accept palliative care, which is care that is designed to keep you comfortable, instead of seeking care to cure your illness
- You are willing to sign a statement that states that you choose hospice care over other types of Medicare-covered care that would be provided with the goal of curing your illness and any related conditions
A few things you’ll want to know about how Medicare Part A covers hospice care:
- You will not have to pay anything for your hospice care
- If hospice care is provided in your home or another facility where you reside (such as if you live in a nursing home), then room and board costs will not be covered
- If you are given a prescription or other medication for symptom control or pain relief while at home, you may have to pay a copayment of no more than $5 per medication. In some rare cases, medications are not covered by Medicare; if this is the case, your hospice provider can check to see if the medication is covered by your Medicare Part D prescription drug plan
- If you receive inpatient respite care, you may have to pay five percent of the Medicare-approved amount
Home Health Services
To make sure that you qualify for the maximum home health care benefits through Medicare, it is important to be signed up for both Medicare Part A and Medicare Part B. If you have both, the following things will be covered:
- Intermittent or part-time skilled nursing care
- Physical or occupational therapy
- Speech-language pathology services
- Medical social services
- Intermittent or part-time home health services from a home health aide
- Some medical equipment
The following types of care are typically not paid for by Medicare Part A or Medicare Part B:
- Around-the-clock home care
- Homemaker services
- Meals that are delivered to your home, even if you are unable to prepare your own meals
- Personal or custodial care with things like getting dressed or bathing if this is the only type of care that you need
Generally, the home health agency that provides your home health care services will coordinate the services you receive based on your doctor’s orders. Long-term care is not usually included; instead, home health services are typically received and covered by Medicare on a short-term basis.
Who Qualifies for Medicare Part A?
Most people are automatically eligible for Medicare Part A at age 65 if they’re already collecting retirement benefits from the Social Security Administration or the Railroad Retirement Board.
Some people qualify for Part A before they turn 65, such as many people on Social Security Disability. You may qualify for Medicare Part A before 65 if you:
- 1. have a disability
- 2. end-stage renal disease (ESRD)
- 3. amyotrophic lateral sclerosis (ALS)
You must be either a United States citizen or a legal permanent resident of at least five continuous years to be eligible to sign up for Medicare Part A.
Most people who receive Medicare Part A benefits do not have to pay a Part A premium. Typically, workers who pay into the Social Security system and who paid their Medicare taxes during their working years do not have to pay a premium. However, to be eligible for Medicare Part A without a premium, you must be entitled to these benefits because of funds that you paid in or that your spouse, parent, or child paid in during their working years.
If you are eligible for premium-free Part A, you can enroll any time after becoming eligible for coverage. If you must pay a premium for Part A or if you want to sign up for Part B — which everyone has to pay a premium for — then you must sign up during one of these periods:
- Initial enrollment period
- General enrollment period
- Special enrollment period
If you need to enroll in Medicare Part A, you can visit Medicare.gov to learn more, or call them directly at 1-800-772-1213 (TTY users 1-800-0778), Monday through Friday, from 7 AM to 7 PM.
Medicare Part A Enrollment Periods
Initial Enrollment in Medicare Part A
Many people sign up for Medicare Part A and Part B during their Initial Enrollment Period (IEP). This is a seven-month period that begins three months before you turn 65 and ends three months after you turn 65.
If you are eligible for Medicare because of a disability but are not 65 years old, then your IEP will begin on the 25th month that you are entitled to disability benefits.
It is typically best to sign up during this time period. Then, you’ll have your benefits right away. Also, be aware that if you sign up for Part B and Medicare Part A, you will be charged a late enrollment fee if you don’t sign up during your IEP. This is not a one-time fee; you will be charged this fee the entire time you have Part B coverage.
General Enrollment Period for Medicare Part A
The GEP is during the same time each year, and this period is the same for everyone. It begins on January 1st and ends on March 31st. If you sign up for premium Part A or Part B during this time, your coverage will begin on January 1st. If you missed your IEP, you can sign up for coverage during this period.
Special Enrollment Period for Medicare Part A
Suppose you did not sign up for Medicare when you first became eligible because you were performing volunteer service outside of the United States. In that case, you will have a six-month Special Enrollment Period to sign up.
Additionally, if you did not sign up for Medicare when you were first eligible because you were covered under a different health plan — such as if you were covered by insurance through your employer or your spouse’s employer — then you will have an SEP during which you can sign up. You can sign up anytime while still covered under a group health plan. You also have an eight-month period that begins either on the day that you or your spouse’s employment ends or that you no longer have coverage — whichever comes first — during which you can sign up for Medicare.
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