What is Medicare Part A all about?
Are you approaching the age of 65 or live with a condition that makes you eligible for Medicare?
If so, it's important to... understand your options, including Original Medicare (Part A and Part B), the Medicare Advantage Plan (Part C) and Prescription Drug Coverage (Part D). Focusing on Part A, we'll uncover the aspects of this, as well as what you should be aware of prior to making a decision.
Part A -- What's Covered?
So what is Medicare Part A? In general, Part A is referred to as hospital insurance. Ideal for unexpected situations or accidents, this coverage supports various aspects of hospital and home care. Since this coverage is limited, however, it's recommended that you enroll in Part B as well -- covering your regular doctor visits and healthcare needs.
To clarify, Part A covers hospital stays and nursing care but not doctors' fees.
For those who are automatically enrolled, it's important to understand what's included. That way, you can decide whether or not you want to upgrade your plan. To help you decide, in general, Part A covers:
- Inpatient hospital care -- This includes most aspects of your hospital stay within a semi-private room, including meals, drugs, nursing care and other key services. Patients will not receive a private room unless it has been deemed medically necessary. This is also time-limited based on Medicare deductibles.
- Skilled nursing care -- Although skilled nursing is included, once again, it is limited. For example, when staying at a skilled nursing facility, there will be no charge for the first 20 days within a benefit period. Following this period, there is an expensive co-pay for up to 100 days. In addition, nursing home care is available when deemed medically necessary.
- Hospice care -- If you're living with a terminal illness and are expected to live six months or less, palliative care becomes an option. This level of care is covered under Part A.
- Home healthcare -- Not intended for round-the-clock care, this includes intermittent skilled nursing care, as well as physical therapy and other at-home services.
Am I Eligible?
If you're wondering if you're eligible, know that as long as you're 65 or older and have paid into the Medicare system, or meet at least one of the following criteria, coverage will be available to meet your needs:
- You are already receiving benefits from the Railroad Retirement Board or from Social Security
- You are under 65 but live with a disability
- You currently have ALS or end-stage renal disease
Once you turn 65, you will be automatically enrolled. You should receive your card in the mail three months before you turn 65 or when you have reached your 25th month of disability. Part A is free; however, this does not mean that you receive full coverage. To minimize financial risk, additional coverage is available through Part B, Part C, and Part D.
In order to qualify for free coverage, you or your spouse must have paid Medicare taxes for at least 10 years -- or 40 quarters of work. In this case, once you turn 65, you will automatically be eligible for what's referred to as a "premium-free Part A."
If you are a United States citizen or permanent resident but have not yet worked long enough to qualify, you may be able to purchase Part A coverage. In 2017, if workers paid Medicare taxes for fewer than 30 quarters, their premium was $413 each month. For those who paid Medicare taxes for 30 to 39 quarters, the premium was $227. Additional costs may be required in order to receive coverage, as Part B may not be optional.
Enrollment Period for Part A
As mentioned, when you turn 65, you will automatically be enrolled in Original Medicare. Once enrolled, your benefits will begin on the first day of the month that you become eligible. For example, if your 65th birthday is on March 16, you would become eligible on March 1.
For those whose birthdays fall on the first of the month, their Medicare benefits will begin on the first of the previous month. Meaning, if your birthday is on March 1, your benefits will begin on February 1.
If you have not worked 40 quarters, you will need to enroll manually. In this case, you can sign up during the following times:
- Initial enrollment period -- This seven-month sign-up period begins three months before you turn 65 and includes the month in which you turn 65, as well as the three months after your 65th birthday.
- General enrollment period -- If you missed the initial enrollment period, you can sign-up between January 1 and March 31 each year. Coverage then begins on July 1. In some cases, beneficiaries will need to pay a late-enrollment period, resulting in higher premiums.
- Special enrollment period -- If you are currently working and are covered through your employer, you can enroll when your coverage ends or you stop working -- whichever comes sooner. This period lasts for up to two months after your coverage ends. There are other special circumstances as well, such as international volunteers who work with tax-exempt organizations.
Want to Make Changes?
If you are already enrolled in Medicare and would like to make changes, you are typically limited to specific time periods. The Annual Election Period is generally an ideal time to make changes or update your plan; it runs from October 15 through December 7.