What is Medicare Part A?
Medicare Part A (along with Medicare Part B) make up what is commonly known as Original or Traditional Medicare. Part A specifically covers hospital care, skilled nursing facility care, hospice care and home health care. While Part B cover such things as doctor services, outpatient care, and preventive services.
The various “parts” can be what makes Medicare confusing at first, but that’s actually what makes Medicare rather smart if you think about it. It was created with these different parts so that you can build a coverage plan that fits your unique needs and lifestyle. No “one-size-fits-all” here, and that’s where Healthpilot cracked the code of being able to show your recommended plan in minutes and where you can also complete your enrollment online, fast, and securely – but more on that later.
Part A and Part B are foundational to your Medicare program. You have to be at least 65 years old (or younger if you have certain medical conditions) to qualify. If you don’t have private insurance, such as an employer, but want more coverage, you can add Medicare’s other parts to support the medical coverage you need.
More Parts of Medicare
To aid in the health and financial security for people who were previously underrepresented in the traditional insurance market, the U.S. federal government created Medicare as a national health insurance program. The Centers for Medicare and Medicaid Services (CMS) are in charge of Medicare, and the services are divided up into four main parts – A, B, C, and D.
Find out more about each of the parts of Medicare:
Medicare Part A
Medicare Part B
Medicare Advantage (Part C)
Prescription Drug Plans (Part D)
Medigap (Medicare Supplement Insurance)
The individual parts listed above in addition to Part A are often called the Medicare Alphabet. These parts can be combined to provide a customized, unique answer for your medical needs. To learn more about the Medicare Alphabet, please visit the Healthpilot Medicare Basics page.
Who is eligible for Medicare Part A?
Eligibility for Parts A and B (Original Medicare) are the same. You don’t have to have Part B to get Part A, so if you do choose to sign up for Medicare A without enrolling in Medicare Part B, know that the eligibility requirements do not change. Just be aware that if you choose to delay Part B coverage because you already have credible coverage, you have 8 months after that credible coverage ends to enroll in Part B before penalties kick in.
Original Medicare Eligibility and Enrollment
There are a few ways to check if you are eligible to receive Medicare Part A and/or Part B coverage, or if you may have already been automatically enrolled.
Want an easier way? When you use Healthpilot to find your Medicare plan, we will verify for you to confirm you’re eligible as one of the first steps to enrolling.
If you are already receiving Social Security benefits or the Railroad Retirement Board (RRB), then you have been or will be auto-enrolled in Medicare Parts A and B upon the first day of your 65th birthday month (unless you live in Puerto Rico, you don’t automatically get Part B and must sign up for it). You will receive your red, white and blue Medicare card in the mail 3 months before your 65th birthday or the 25th month of receiving disability benefits. On the other hand, if you aren’t yet receiving your Social Security benefits, you will have to enroll actively in Medicare.
How do I get in touch with Social Security?
While it is Medicare that covers you, you have to sign up for it through the Social Security Administration (SSA). This is because the SSA manages some eligibility requirements on behalf of Medicare, such as if you’ve paid Medicare taxes long enough to get Part A for free, a.k.a. Premium-Free Part A.
Signing up is easy. You can do it online at Social Security. It’s the easiest and quickest way to sign up and get help if you need it. Or if you prefer the phone, just call 1-800-772-1213 to talk to Social Security. (TTY: 1-800-325-0778).
If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772. (TTY: (312) 751-4701)
Now, here comes the word problem. You may contact the Social Security Administration to file for Medicare enrollment 3 months before you turn 65 and up to 3 months after your 65th birth month. We created a quick visual to simplify everything.
It is also possible to qualify for Medicare Part A before you are 65 if:
- You have a qualifying medical condition
- A doctor has diagnosed you with a condition that qualifies as a disability that prevents you from working
Still here? Good. Knowing when to sign up during your Medicare Initial Enrollment Period (IEP) is one thing you don’t want to be fashionably late to. Mark your calendars, set an alert on your phone, or just avoid the stress altogether and start working with Healthpilot now. You’ve already read most of this page – it’s time to put your newfound knowledge to work.
What Happens If You Miss Your Initial Enrollment Period?
What if you didn’t sign up when you first could and don’t have other creditable coverage (such as health insurance through an employer)? You’ll have to wait until the next General Enrollment Period, which runs from January 1 to March 31 every year.
Your coverage will start July 1 of that year, and you may have to pay a late enrollment penalty on your Medicare Part B premium for as long as you have Part B coverage. Your premium will go up 10% for every year you weren’t enrolled.
What does Medicare Part A cover?
Knowing what each part of Medicare covers will ensure you not only get the best coverage for yourself while making a very informed choice, but also prevent any billing-related surprises in the future.
Hospital stays. Part A helps cover the tests and treatments you may need once you have been admitted to the hospital. This also includes services like nursing services, physical therapy, meals, and most medications that your doctor prescribes for your care.
Short-term skilled nursing facilities. Medicare Part A will help cover your inpatient stay and services in a skilled nursing facility for a certain amount of time if you need it.
Home healthcare. You will have help with coverage if it is deemed that you need medical care from a home health professional while you recover from an inpatient hospital stay.
Hospice care. When yourself and doctor have chosen to seek hospice care for a terminally ill condition, Medicare Part A will help cover most of your healthcare costs for comfort care (palliative care) instead of care to cure your terminal illness.
It is important to note that Medicare Part A will help cover an ER visit if it results in your being admitted to the hospital by a physician. However, if you return home without being admitted to the hospital, Medicare Part B or your private insurance may be able to help pay the costs, but not Medicare Part A.
What does Medicare Part A not cover?
Because Medicare Part A is meant to provide care during a critical injury or illness, it is vital to understand that Medicare Part A doesn’t provide coverage over all hospital costs. Here are the most common incidents that Part A won’t cover:
Private Rooms. While your hospital stay includes a semi-private room, Medicare Part A does not entitle you to a private room during your inpatient care.
Blood. Medicare Part A will not cover it, and you may have to pay out of pocket if the hospital has to get blood for you. The good news is that if the inpatient facility receives blood from a blood bank or is donated by you or someone else, you likely won’t have to pay for it.
Long-term hospital stays. In the event you require long-term care needs (on average more than 25 days), Medicare Part A won’t pay for your care, and you may have to rely on your private insurance or pay out of pocket.
This is why it is important to know exactly what you currently want or will need in the future from your healthcare plan. Make a list of those wants and needs, like medications, and physician information, so you can make sure you know which parts of each Medicare plan cover what you require or what may end up coming out-of-pocket.
What is the cost for Medicare Part A?
Medicare Part A deductibles
Medicare Part A has a deductible to be paid toward your inpatient care (up to the 60th day) should you require it. For 2023, this is $1,600 for each benefit period. An additional daily co-insurance applies for inpatient care (days 61 through 90) of $400.
You can also buy Part A coverage if you don’t automatically qualify for free Part A. The premium for Medicare Part A in 2023 is:
- $278/month if you have worked and paid Medicare taxes for more than 30 quarters
- $506/month if you have worked and paid Medicare taxes less than 30 quarters
Ready to see your recommended Medicare plans?
Phew! We are finally here. We understand it’s very normal to feel a little anxiety about choosing a Medicare plan or modifying your existing Medicare coverage. Decisions involving your health and your finances, especially the future of your healthcare, are important and shouldn’t be taken lightly.
Here at Healthpilot, we understand that interpreting all of the different parts of Medicare can be complex and confounding. Fortunately, after you are completely enrolled in Original Medicare, we can do all of the work for you. You answer a few questions, and we sift through all the data points to recommend the best plan for you with the information you provided. Your doctors, your prescriptions, your pharmacy, your needs. We even made enrolling online easy. Best of all, once you’re a Healthpilot customer, we do this for you every year for the rest of your life.
Let us help you find your Medicare plan.
Tell us a little about how you use healthcare, and then let Healthpilot’s proprietary technology find an unbiased, accurate Medicare plan recommendation tailored to your needs.
We account for changes to insurance plans as well as any updates to your health profile to ensure your plan is providing the best coverage for your needs or saving you money. You won’t have to worry about your Medicare coverage again.
And after reading through this very long article…doesn’t that sound nice. #worksmarternotharder
