Medicare Part A – Hospital Insurance
This article was updated on: 11/16/2016
What is Medicare Part A coverage?
Medicare Part A is health insurance offered by the federal government to United States citizens and legal immigrants who have permanently resided in the U.S. without a break for at least five years. You’re eligible if you’re 65 and older or under age 65 with certain disabilities. You may also qualify at any age if you have end-stage renal disease or amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease). Together with Medicare Part B, it makes up what is known as Original Medicare, the federally administered health-care program. Medicare Part A helps pay for the cost of inpatient hospital care, while Part B covers outpatient medical services.
What does Medicare Part A cover?
Medicare Part A (hospital insurance) helps cover a variety of services, including the following:
- Inpatient hospital care: Includes semi-private rooms, meals, nursing services, and prescription drugs needed for your treatment. Medicare Part A hospital coverage includes inpatient care you receive in long-term care hospitals, inpatient mental health hospitals, acute care hospitals, and critical access hospitals.
- Skilled nursing facility care: Includes semi-private room, meals, skilled nursing care, prescription medications, medical supplies and equipment, and ambulance transportation (if medically necessary). You may be covered if your doctor has decided that daily skilled nursing care is medically necessary.
- Nursing home care: Covered for a limited time if deemed medically necessary and given in a skilled nursing facility. Medicare Part A only covers nursing care if skilled care is needed for your condition. You must require more than just custodial care (help with daily living tasks, such as bathing, dressing, etc.).
- Hospice care: Includes doctor services, nursing care, durable medical equipment, medical supplies, and more if you are terminally ill and your doctor has determined that you have six months or less to live.
- Home health services: Includes at-home skilled nursing care, physical therapy, occupational therapy, and more when intermittent skilled nursing care or therapeutic services are medically necessary. Medicare Part A covers part-time home health care if you’re homebound and you get these services through a Medicare-certified home health agency.
What are my Medicare Part A costs?
Many people get Medicare Part A without a premium if they’ve worked the required amount of time under Medicare-covered employment, generally 10 years or 40 quarters and paid Medicare taxes while working (see below for more information). However, your Part A coverage may still include other costs, even after Medicare has paid its share. This may include deductibles, copayments, and/or coinsurance, which can all change from year to year. Your costs may depend on the type of service you’re getting and how often.
Medicare Part A cost-sharing amounts (for 2016) are listed below.
Inpatient hospital care:
- Medicare Part A deductible: $1,288
- Medicare Part A coinsurance:
- $0 coinsurance for the first 60 days of each benefit period
- $322 a day for the 61st to 90th days of each benefit period
- $644 a day for days 91 and beyond per each lifetime reserve day of each benefit period (you get up to 60 lifetime reserve days)
- After lifetime reserve days are used up: You pay all costs
Skilled nursing facility care:
- $0 for days 1 to 20
- $161 a day for the 21st to 100th days (skilled nursing facility coinsurance)
When do I sign up for Medicare Part A?
Some people are automatically enrolled in Medicare Part A, while you may need to manually sign up for it in other cases.
Automatic enrollment in Medicare Part A
If you’re currently receiving retirement benefits from Social Security or the Railroad Retirement Board (RRB), you’re automatically enrolled in both Medicare Part A and Part B starting the first day of the month you turn age 65. If your birthday happens to fall on the first day of the month, then you’ll be automatically enrolled in Medicare on the first day of the month before your birthday. You should get your Medicare card in the mail three months before your 65th birthday.
Most people don’t pay a monthly premium for Medicare Part A as long as you or your spouse paid Medicare taxes for a minimum of 10 years (40 quarters) while working. If you haven’t worked long enough but your spouse has, you may be able to qualify for premium-free Part A based on your spouse’s work history.
If you are under age 65 and disabled, you automatically get Part A and Part B after you have received disability benefits from Social Security or certain disability benefits from the Railroad Retirement Board for 24 months. You will receive your Medicare card in the mail three months before the 25th month of disability. If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig’s disease), you automatically get Part A the first month that your disability benefits begin.
Manual enrollment in Medicare Part A
In some cases, you may need to manually sign up for Medicare Part A. For example, if you have end-stage renal disease (ESRD), you may be eligible for Medicare Part A, but you’ll need to sign up for it. For more information on eligibility and how to enroll, contact Medicare in any of the following ways:
- Go to Medicare.gov.
- Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Medicare representatives are available 24 hours a day, seven days a week.
You may also need to manually enroll in Part A if you haven’t worked long enough to get this coverage without a premium.
If you are not eligible for premium-free Medicare Part A, you may voluntarily enroll in Part A if any of the following situations applies:
- You are 65 or older and meet the citizenship or residency requirements.
- You are under age 65, disabled, and your premium-free Medicare Part A coverage ended because you returned to work.
- You have not paid Medicare taxes through your employment or have not worked the required time to qualify for premium-free Part A.
If you or your spouse worked and paid Medicare taxes for less than 10 years, the length of time that you worked will be taken into consideration when Social Security determines the amount you owe for your Medicare Part A premium. Your premium amount may be reduced the longer you or your spouse worked and paid taxes. Visit this page for more information on your Medicare Part A premiums and other costs.
How do I sign up for Medicare Part A?
If you need to manually enroll in Medicare Part A, you can do so through Social Security or the Railroad Retirement Board (RRB). You can sign up in a few different ways:
- Online: Visit the Social Security website to apply for Medicare Part A and/or Part B.
- By phone: Call Social Security at 1-800-772-1213 (TTY users, call 1-800-325-0778). Representatives are available Monday through Friday, from 7AM to 7PM.
- In-person: Visit your local Social Security office to apply.
- If you worked for a railroad, contact the RRB to apply at 1-877-772-5772. (TTY users, call 1-312-751-4701). You can call Monday through Friday, 9AM to 3:30PM, to speak to an RRB representative.
You may be subject to a late-enrollment penalty if you do not enroll in Medicare Part A when you are first eligible to do so. If you do not automatically qualify for Medicare Part A, you can do so during your Initial Enrollment Period, which starts three months before you turn 65, includes the month you turn 65, and lasts for three additional months after you turn 65.
If you don’t sign up during your Initial Enrollment Period, you may be able to sign up during the General Enrollment Period that takes place every year from January 1 to March 31; your coverage would start on July 1.
Keep in mind that if you wait to enroll in Part A after you’re first eligible, you may owe a late-enrollment penalty in the form of a higher premium. Your Part A premium could go up 10%, and you’ll have to pay this higher premium for twice the number of years that you could have enrolled in Part A but went without it. In some cases, you may not owe a late-enrollment penalty if you’re eligible to enroll with a Special Enrollment Period; see this article on Medicare enrollment periods for more information.
Of course, this is just the start of the types of Medicare coverage that may be available. Once you’re enrolled in Medicare Part A and Part B, you may be eligible for other types of coverage, including Medicare Advantage plans, Medicare Supplement plans, or Medicare prescription drug coverage. The Medicare plan that may work for your situation often depends on your medical needs, budget, and other factors. I can tell you more. Learn more about me and why I enjoy helping Medicare beneficiaries by clicking the “View profile” link below. There are also links below that let you schedule a phone appointment or have me email you more information. You may just want to explore plan options on your own; if so, click on the Compare Plans buttons on this page. Or, for personalized assistance, call me or another licensed insurance agent at the number below.
Call Medicare.com’s licensed insurance agents at 1-844-847-2660, TTY users 711; Monday through Friday, 8AM to 8PM ET.
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