Medicare Part A in Detail (Enrollment, Eligibility, Coverage Specifics)
The first step to securing your Medicare benefits is to enroll in Medicare Part A and Part B through Social Security. These two parts include the basic coverage offered to all eligible beneficiaries through Original Medicare. You may decide to enroll in a Medigap or Advantage plan, but the first step is always Parts A and B.
Medicare Part A is the portion of Original Medicare that covers inpatient care at a hospital or skilled nursing facility plus hospice and home healthcare. Everything you need to know before signing up is included right here.
When to Enroll in Part A
Every Medicare beneficiary has an Initial Enrollment Period (IEP) that starts three months prior to their 65th birthday. The period remains open for seven months, and that is the ideal time to enroll in Medicare Part A.
There are two things to consider when timing an entrance into the Part A program—late enrollment fees and delayed start dates.
Medicare Part A Late Enrollment Penalty
Failing to enroll in Part A during the IEP means potentially facing a late enrollment penalty when signing up later. This penalty only applies to beneficiaries who don’t qualify for premium-free Part A. If a beneficiary buys Part A, and they don’t buy it when they’re first eligible for Medicare, their monthly premium may go up. The penalty requires the beneficiary to pay a higher premium for two times the number of years they failed to enroll in the program. For example, if they were eligible for Part A for 3 years before signing up, they’ll pay the higher premium for 6 years.
Medicare Part A Delayed Start Date
Enrolling in Part A prior to one’s 65th birthday month means their coverage will start the first day of the month they turn 65. Enrolling during the birthday month results in coverage that starts the following month. These are the best options to avoid lapses in health insurance coverage.
Enrolling in Part A the month after turning 65 will delay coverage by two months. Enrolling two or three months after the 65th birthday month means waiting three months after signup for coverage to begin. There are no financial penalties for enrolling later in the open enrollment period, but the start date delay is something to consider.
Who Qualifies for Part A?
A person is qualified to enroll in Medicare Part A when they meet one or more of the following criteria:
- They are at least 65 years old or will turn 65 soon.
- They have received Social Security or Railroad Board disability benefits for at least four months.
- They have end-stage renal disease.
Those who receive disability benefits long enough and live in the United States will automatically be enrolled in Original Medicare one eligible.
Do Beneficiaries Have to Pay to Enroll in Medicare Part A?
If you or your spouse paid into Medicare for at least 10 years prior to enrolling in Medicare, you will receive premium-free Part A. If you and your spouse worked or paid into Medicare fewer than 40 quarters, you may have a monthly premium once you enroll in Part A.
The premium for Part A varies. It depends on the number of quarters you did pay into the system and rates for the current year.
What Does Medicare Part A Cover?
Medicare Part A is only used for the following care options:
- Inpatient hospital stays
- Skilled nursing facility stays
- Home healthcare
For routine visits to your primary care doctor or specialist appointments, you will use Medicare Part B coverage.
The Cost of Medicare Part A
Recipients of premium-free Medicare Part A still have out-of-pocket costs to consider, including:
- An annual deductible
- An inpatient hospital deductible
- Inpatient hospital coinsurance (starts after day 60).
- Skilled nursing facility coinsurance (starts after day 20).
- Durable home medical equipment coinsurance (20% of cost).
- Inpatient respite care coinsurance (5% of Medicare-approved cost).
What is the Medicare Part A Deductible?
The deductible for Medicare Part A resets on January 1 every year. For 2022, the deductible was $1,556 per benefit period. A benefit period begins the day you’re admitted into the hospital or a skilled nursing facility. The period ends six months after your release.
Medicare Part A FAQ
Does Medicare Part A cover inpatient mental health services?
Medicare Part A does cover inpatient mental health services. Psychiatric hospitals are treated the same as general hospitals with one exception. While there is no limit on the number of days you can spend in a general hospital, coverage is limited to 190 days of psychiatric hospital inpatient care for your lifetime.
If you need psychiatric inpatient care beyond 190 days, you may receive it at a general hospital to ensure coverage.
When will Medicare Part A start covering home healthcare costs?
Part A coverage for home health services is limited to 100 days of daily care. You can receive unlimited days of intermittent home health care. The rule is that you must spend at least three consecutive days as a hospital inpatient and then begin home health care within 14 days of release from the hospital. If you can’t meet that criterion, you may qualify for coverage under Medicare Part B.
Will Medicare Part A cover a private hospital room?
Medicare Part A will not cover a private hospital room. The hospital may choose to give you a private room due to availability, but you cannot upgrade to a single room over a shared room for your personal comfort.
Original Medicare coverage is designed to meet your basic medical needs. That means your coverage won’t extend to private rooms or added in-room luxuries. If your hospital charges extra for televisions or other features, you won’t receive coverage for those items through Medicare Part A.
What are the qualifications to receive skilled nursing facility coverage under Medicare Part A?
You need to spend at least three consecutive days as a hospital inpatient prior to qualifying for Part A skilled nursing facility coverage. That hospital stay must take place within 30 days of entering the skilled nursing facility.
Who is eligible for Part A hospice care?
All Medicare beneficiaries are entitled to unlimited hospice care after a medical provider determines they are terminally ill. Coverage will last as long as the provider deems the service necessary.
What if I need to stay in the hospital more than 90 consecutive days?
Medicare Part A is limited to 90 consecutive days for inpatient hospital care, but you do have a reserve of 60 additional days. There is a coinsurance for those reserve days, and the reserve is for your lifetime.
Medicare Help You Can Trust
Do you need more information about Medicare Part A enrollment? What about guidance in getting the most out of your Original Medicare benefits or selecting an Advantage or Medigap policy? Our experienced and well-trained experts are here to guide you through all aspects of Medicare enrollment and usage.
Contact us today to learn more about Medicare Part A. We’re happy to answer all of your questions to ensure you fully understand your Medicare benefits.