Medicare Part A: Your Comprehensive Guide 2020
Understand Part A eligibility, enrollment, coverage, costs, and more.
What Is Medicare Part A?
For Medicare recipients, Part A is known as your hospital insurance. It is one of two parts that make up Original Medicare, which is the basic coverage provided through enrollment.
Part A helps to cover your costs for in-patient care in a hospital and skilled nursing facility, as well as home health care and hospice care services.
In this guide, we’ll help you develop a solid understanding of Medicare Part A and how it applies to your healthcare needs. If you are looking for a particular topic related to Part A, feel free to jump ahead. Here are the topics we will cover throughout.
Guide to Medicare Part A Topics:
Am I Eligible for Medicare Part A?
How Do I Enroll in Part A?
When Does My Part A Coverage Begin?
What Does Medicare Part A Cover?
How Much Does Medicare Part A Cost?
How to Pay Your Part A Premium
Am I Eligible for Medicare Part A?
Generally, if you are the age of 65 or older, a U.S. Citizen or Permanent Legal Resident of at least 5 consecutive years, you are eligible for Medicare Part A.
If you are an individual with a disability, you might be eligible for Medicare before you turn 65. For example, if you are already receiving retirement or disability benefits, you are likely eligible for Medicare Part A.
The same is true if you have the following medical conditions:
End-Stage Renal Disease (ESRD)
Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease, ALS)
How Do I Enroll in Medicare Part A?
Some individuals don’t need to enroll in Medicare to start receiving Medicare Part A coverage. If you are already collecting benefits from Social Security or the Railroad Retirement Board at age 65, then you will be automatically enrolled in Medicare Part A at no additional cost.
If this applies to you, then roughly 3 months prior to your 65th birthday, you will receive your Medicare card in the mail. Then, your Part A benefits will begin on the 1st day of the month in which you turn 65.
Note: If your birthday falls on the 1st of the month, then your Part A benefits will begin the month before your 65th birthday month.
Also, it is important to note that when you receive your Medicare card in the mail, you have the option of opting out of this Medicare coverage. Instructions are provided with your card on how to do so if you wish. For example, some people choose to postpone Medicare enrollment if they are working past 65 and still receive healthcare coverage through their employer.
If you aren’t already collecting benefits from Social Security or the Railroad Retirement Board, then you can enroll in Medicare during your Initial Enrollment Period. This period begins three months prior to your 65th birthday. While this period extends for seven months, it is best to enroll in the months prior to your 65th birthday. This helps to ensure there are no gaps in your coverage.
To enroll in Medicare, you must sign up through Social Security. There are three options for signing up:
Sign up online at the Social Security website.
Phone call: 1-800-772-1213 (TTY: 1-800-325-0778)
Local Office Visit: Find your local office using the Social Security Office Locator. It is best to first call and make an appointment before visiting.
When Does My Part A Coverage Begin?
The start date of your coverage will depend on when you enrolled during your Initial Enrollment Period. This is the seven month long period that begins 3 months prior to your 65th birthday month, includes your birthday month, then extends 3 more additional months.
If you sign up in the 3 months leading up to your birthday, your coverage will start the 1st of your birthday month. (Unless if your birthday is on the 1st of the month, then it starts a month early).
If you sign up the month of your 65th birthday, your coverage will start in 1 month.
If you sign up 1 month after your birthday month, your coverage will start in 2 months.
If you sign up 2 to 3 months after your birthday month, your coverage will start in 3 months.
Note: If you miss enrollment during your Initial Enrollment Period, you won’t be able to sign up for Medicare until the General Enrollment Period. General Enrollment runs from January 1 – March 31. In this case, your coverage will start on July 1st.
Additional Part A Enrollment Scenarios:
If you are disabled –
Your Part A coverage begins once you have received Social Security disability benefits for 24 months, at the start of the 25th month. Your Medicare card will arrive in the mail around 3 months prior to your coverage starting.
If you have ALS –
Your Part A coverage automatically begins the same month that your Social Security disability benefits do. Your Medicare card will arrive in the mail around one month after you have signed up for your Social Security disability benefits.
If you have End-Stage Renal Disease –
And you require dialysis, your Part A effective date typically begins on the fourth month of your dialysis treatments. If you are younger than 65, you will need to apply for Medicare Part A benefits.
What Does Medicare Part A Cover?
When you sign up for Medicare Part A, you receive coverage for:
Inpatient Hospital Care
Skilled Nursing Facility Care
Hospice Care
Home Health Care
Inpatient Hospital Care –
This care applies to people admitted to a hospital by a physician. In this case, Part A covers certain services during your stay. The coverage extends for up to 90 days during each benefit period. You also have an additional 60 lifetime reserve days. For inpatient care at a psychiatric hospital, Part A covers up to 190 lifetime reserve days.
Covered Inpatient Hospital Care Services Include:
Semi-private rooms
General nursing
Drug treatment
Meals
Hospital services and supplies
Also included: inpatient care you receive in acute care hospitals, critical access hospitals, rehabilitation facilities, long-term care hospitals, qualifying clinical research studies, and psychiatric hospitals.
How to Qualify for Inpatient Hospital Care:
Inpatient stay must be in a Medicare-covered hospital or psychiatric hospital.
A doctor must determine that hospital care is necessary for treatment.
Important Note About Part A Inpatient Hospital Care:
During your stay, your doctor might suggest services for your treatment that are not covered by Medicare. In this case, you will be responsible for paying the additional costs. Also to note, options like a private room or private-duty nurse may be covered, but only if medically necessary.
Long-Term Care Hospital Services:
Part A also covers the cost of care in a long-term care hospital. These are hospitals that specialize in treating patients hospitalized for 25+ days. This might apply to a patient using a ventilator for an extended period or a patient with a severe wound or injury. After discharge from a long-term care hospital, many patients move onto care in a Skilled Nursing Facility or custodial care in a long-term facility.
Skilled Nursing Facility Care –
Part A covers a wide-range of the services offered in a Skilled Nursing Facility by a skilled nurse of therapist. This coverage extends for up to 100 days each benefit period and also covers your room and board in the facility. It does not, however, include custodial or long-term care.
Covered Skilled Nursing Facility Services:
Tube feedings
Wound care
Medication administration
How to Qualify for Skilled Nursing Care:
You have spent 3 consecutive days as an inpatient at a hospital.
You receive your skilled nursing care within 30 days of your inpatient stay.
A doctor has determined you require skilled care on a daily basis.
Hospice Care –
For those that are terminally ill, Part A covers any necessary care used to manage symptoms and control your pain. Part A also covers respite care and some medical equipment that is intended for use at your home. This coverage is extended for as long as your healthcare provider determines you need the care.
Covered Hospice Care:
Any items or services needed for pain relief and symptom management
Any medical, nursing, and social services
Durable medical equipment
Aide and homemaker services
Important Hospice Care Note:
Your Part A hospice care does not pay for your stay in a facility unless a short-term stay is determined necessary for pain or symptom management. If such a stay is determined necessary, the facility must be Medicare-approved.
Home Health Care –
For those that are homebound and in need of skilled care, Part A covers part-time skilled care in your home. For daily care, this coverage lasts for up to 100 days. For intermittent care, your coverage is unlimited.
How to Qualify for Home Health Care:
You have spent 3 consecutive days as an inpatient at a hospital.
You receive your home health care within 14 days of your inpatient stay.
Important Note About Part A Home Health Care Coverage:
If you find that your circumstance does not meet the Part A qualifications for coverage, you might want to look at Medicare Part B. Part B offers additional home health care coverage.
How to Tell If Part A Covers What You Need:
1. Consult with your doctor or health care provider to find out if Medicare covers your needed services or supplies.
In some cases, you may require something that is typically covered by Medicare but your provider isn’t sure if coverage will extend in your specific situation. If this happens, you can sign a notice that says you may be required to pay for the test, item, or service.
2. You can also always search your Medicare coverage by test, item, or service at this Medicare.gov page.
Remember: Your Medicare coverage will be based on federal and state laws, national coverage decisions by Medicare, and local coverage decisions made by Medicare claims processors in each state.
Parting Thoughts on Part A Coverage:
Be mindful of the fact that Medicare rarely pays the entire cost of your care. So, even when dealing with Medicare-covered services, you will often times be responsible for a portion of the cost. This cost will come in the form of a deductible, coinsurance, or copayment.
Next, we’ll go over the costs associated with Medicare Part A and when they apply to you.
How Much Does Medicare Part A Cost?
Most commonly, people that are eligible for Medicare Part A do not have to pay a monthly premium. That’s because the average Part A enrollee usually meets the criteria for premium-free coverage.
If any of the following criteria apply to you, then you qualify for premium-free Part A coverage:
You are 65 years old and you (or a spouse) have paid Medicare taxes (FICA) for 10 years.
You already receive benefits from Social Security or the Railroad Retirement Board.
You are eligible for benefits from Social Security or the Railroad Retirement Board but have not yet filed for them.
You are disabled and you (or a spouse) have paid FICA taxes for 10 years. In this case, you are eligible for Medicare once you have received Social Security benefits for 2 years.
Even if you find that none of the above criteria apply to you, there is still the option to purchase Part A coverage. When you purchase Part A, however, you will need to pay a monthly premium. The amount your premium costs is based on how long you (or your spouse) have been paying Medicare taxes.
Purchasing Part A Coverage:
If you are purchasing Part A, your coverage will come with a monthly premium. The cost of your premium is based on the amount of time you paid Medicare taxes. Here is how to determine the cost of your Part A premium:
Paid Medicare taxes for 40 quarters or more (10 years) = No Premium
Paid Medicare taxes for 30 – 39 quarters (7.5 – 9.75 years) = Standard Premium is $252
Paid Medicare taxes for less than 30 quarters (less than 7.5 years) = Standard Premium is $458
Also, keep in mind that if you are purchasing Part A coverage:
You will likely also need to purchase Medicare Part B.
You will need to pay two premiums each month, Part A and Part B.
How to Pay Your Part A Premium
As we covered above, there is no monthly premium for most Part A enrollees. If you are a Part A purchaser, however, you will need to pay a monthly premium. Your Medicare premium bill will arrive every month. Here are the different ways you can pay your Medicare premium:
Pay online with your credit or debit card.
You can do this at your MyMedicare.gov account. If you don’t already have an account, you can create one by following the guide on the homepage. When you pay at MyMedicare.gov, you will need your card information and a copy of your premium bill to reference the correct payment amount.
On your card statement, the payment will show as “CMS Medicare”. Unfortunately, there is not an option to set up recurring monthly payments through MyMedicare.gov. You will have to visit the site to pay each month.
Pay online with your savings or checking account.
You may be able to set a direct payment from your savings or checking account if your bank offers an online bill payment service. Check your account options or with your bank to determine what information you will need to set up a monthly automatic bill payment.
Pay online with Medicare Easy Pay.
Medicare Easy Pay is a free payment service for your Medicare premium payments. Once you sign up, the service automatically deducts your premium payment each month from the savings or checking account that you designated. This payment usually takes place on the 20th of the month.
If you want to sign up for Medicare Easy Pay:
Complete this Authorization Agreement for Pre-authorized Payments Form from the CMS website.
Mail the form to:
Medicare Premium Collection Center
PO Box 979098
St. Louis, MO 63197-9000
This form can take about 6 – 8 weeks to process. Once it is complete, you will receive notifications when the deductions take place. Medicare Easy Pay will always take out the correct and current premium amount that you owe, even if this amount changes over time.
Important Note: If your bill comes from the Railroad Retirement Board (RRB), then you cannot use Medicare Easy Pay for payment. Your premium payments must be sent to:
RRB, Medicare Premium Payments
PO Box 979024
St. Louis, MO 63197-9000
Mail in your payment.
When you receive your premium bill in the mail, a payment coupon will accompany it. Fill out all the necessary information on the coupon. You can make your payment by check, money order, credit or debit card.
Make sure to include the coupon along with your payment. Payments that are received without the coupon might not be processed. Mail your premium payment and coupon to:
Medicare Premium Collection Center
PO Box 790355
St. Louis, MO 63179-0355
What If My Part A Premium Payment Is Late?
If you are late on your Part A premium payment, you will receive a second bill that includes the past due amount and the next month’s premium amount. If the total amount presented on this second bill is not paid by the 25th of the month, you will receive a delinquent bill. If you fail to pay the total amount presented on this delinquent bill by the 25th of the month, you will lose your Medicare Part A coverage.
If you have questions about your bill or the status of your coverage:
Call Social Security: 1-800-772-1213 (TTY: 1-800-325-0778)
If you have questions about your premium bill amount or Part A status:
Call Medicare: 1-800-633-4227
Up Next: Medicare Part B Guide
Helpful Resources:
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