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Medicare Part A: What You Need to Know

What is Medicare Part A coverage?

Original Medicare Part A is the hospital insurance portion of Medicare and is the oldest product in the Medicare program. It is a benefit every U.S. citizen or permanent legal resident (residing for at least five continuous years) is entitled to if they meet eligibility requirements.

To ensure the care you’re receiving or plan to receive is covered by Medicare Part A, talk with your healthcare provider or contact Medicare directly.

Will you have to pay a monthly premium for Medicare Part A?

If you have to pay a monthly premium for Medicare Part A depends on your circumstances. Here’s what you need to consider:

  • If You’ve Worked 10+ years by age 65:
    • You will likely get your Part A coverage without paying a monthly premium. However, if you’ve been working less than 10 years (but more than zero) by age 65, you may qualify for discounted Part A monthly premium.
  • If You Meet the Following Requirements at age 65:
    • You already get retirement benefits from Social Security or the Railroad Retirement Board
    • You’re eligible to get Social Security or RailRoad benefits, but you haven’t filed for them yet
    • You or your spouse had Medicare-covered government employment
  • If You’re Under 65 and Meet the Following:
    • You received Social Security or Railroad Retirement Board disability benefits for 24 months
    • You have End-Stage Renal Disease (ESRD) and meet certain requirements
    • You have Lou Gehrig’s disease (Amyotrophic Lateral Sclerosis or ALS) and meet certain requirements

Who is eligible to receive Medicare Part A coverage?

If you’ve worked for any length of time and you’ve been paying Medicare taxes out of your paycheck, you’re eligible for Part A coverage. Most individuals receive Part A without paying a monthly premium, while some still pay a monthly premium.

See if You’re Eligible Today

Medicare Part A Coverage Gap Costs

Services not covered by Medicare Part A fall into what’s commonly known as the “coverage gap.” As of 2020, you are responsible for paying for the following coverage gaps if you need to be hospitalized:

  • $1,408 deductible for each benefit period
  • Days 61-90: $352 coinsurance per day of each benefit period (first 60 days – zero coinsurance)
  • Days 91 and beyond: $704 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
  • Beyond lifetime reserve days: You are responsible for all costs

Services Medicare Part A Covers

Medicare Part A covers the following:

  • Care received while you’re in the hospital
  • Inpatient care in a skilled nursing facility (but not custodial or long-term care)
  • Hospice care
  • Home health services (within approved limitations)
  • Care received while you’re in the hospital
  • Inpatient care in a skilled nursing facility (but not custodial or long-term care)
  • Hospice care
  • Home health services (within approved limitations)

Medicare part A does not cover:

  • Private hospital rooms (or room TV, room phone, personal care items)
  • Transfusions – first three units (unless donated by you or by donation)
  • Private-duty nursing care
  • Long-term care
  • Care received while you’re in the hospital
  • Inpatient care in a skilled nursing facility (but not custodial or long-term care)
  • Hospice care
  • Home health services (within approved limitations)

What will Part A cost if you don’t qualify for no-cost or discounted coverage?

Individuals who do not qualify for premium-free or discounted Medicare Part A coverage will need to pay a monthly premium.

You will likely pay up to $437 each month for 2020, but the actual amount you’ll pay depends on how many quarters you have worked and paid into the Medicare fund. Here’s how to figure your monthly premium amount:

  • If you paid Medicare taxes for less than 30 quarters, your Part A premium will be $458/month (for 2020)+
  • If you paid Medicare taxes for 30-39 quarters, the standard Part A premium will be $252/month (for 2020)+
  • If you paid Medicare taxes for less than 30 quarters, your Part A premium will be $458/month (for 2020)+
  • If you paid Medicare taxes for 30-39 quarters, the standard Part A premium will be $252/month (for 2020)+

In most cases, if you choose to buy Part A, you must also:

  • Have Medicare Part B (Medical Insurance)
  • Pay monthly premiums for both Part A and Part B
  • Have Medicare Part B (Medical Insurance)
  • Pay monthly premiums for both Part A and Part B

Enrolling in Medicare Part A

If you already collect Social Security benefits, you’ll be automatically enrolled for Medicare Part A. If you’re over 65, or will be turning 65 in the next three months, you need to sign up for Part A (and Part B)—you will not be automatically enrolled.

We can help you figure out if you’re getting the coverage you need. There’s no obligation to enroll.

Enrollment Periods

Keep in mind that if you don’t enroll in Medicare Part A when you’re first eligible, your monthly premium could go up 10%. You’ll have to pay the higher premium for twice the number of years you could have had Part A.

Initial Enrollment Period (IEP)

When you first become eligible for Medicare, you have a seven-month Initial Enrollment Period to sign up for Part A that includes the three months prior to your 65th birthday month, your birthday month and the three months following your birthday month.

It’s important to know that if you wait until the month you turn 65 or the three months following, your Part A coverage will be delayed, causing a gap in your coverage. In many cases, if you don’t sign up for Part A when you’re first eligible, you’ll have to pay a late enrollment penalty.

> Learn More About IEP

General Enrollment Period (GEP)

General enrollment for Medicare Part A (and Medicare Part B) takes place January 1–March 31 each year. During this period, you can sign up if:

  • You didn’t sign up when you were first eligible (you may have to pay a late enrollment penalty resulting in a higher premium)
  • You aren’t eligible for a Special Enrollment period

> Learn More About GEP

Special Enrollment Period (SEP)

After your Initial Enrollment Period ends, you may be able to sign up during a SEP and you typically won’t have to pay a late enrollment penalty if you do. You may be eligible if:

  1. You’re covered under a group health plan based on current employment and have a SEP to sign up for Part A and/or Part B anytime as long as:
    • You or your spouse (or family member if you’re disabled) is working
    • You’re covered by a group health plan through the employer or union based on that work
  2. You have an eight-month SEP to sign up for Part A and/or Part B that starts at one of these times (whichever happens first):
    • The month after the employment ends
    • The month after group health plan insurance based on current employment ends
  3. You may qualify for a Special Enrollment Period for Part A and Part B if you’re a volunteer, serving in a foreign country

> Learn More About Medicare Enrollment

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