Medicare Part A Coverage | Medicare Plan Finder

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What is Medicare Part A Coverage?

Every Medicare beneficiary will begin their Medicare journey with “Original Medicare.” Original Medicare comprises of Medicare Part A and Medicare Part B. Part A is responsible for hospital visit coverage. Most people are automatically enrolled in Part A when they become eligible for Medicare.

What Does Medicare Part A Cover?

Medicare Part A covers:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care
  • Hospice
  • Home health services

In most cases, a doctor, pharmacist, or specialist will have to prescribe a certain treatment or service and provide proof that it is medically necessary before Medicare will cover it.

Inpatient hospital and skilled facility coverage with Part A includes semi-private rooms, meals, nurse and doctor services, and in-hospital drugs. If it is medically necessary, Part A can also cover home care, nursing home and hospice services for a limited time.

Part A does NOT cover non-medically necessary amenities like completely private hospital rooms, private nurses, and personal care items that hospitals may provide (shower supplies, TV, etc.).

What Does Medicare Part A Cost?

If you or your spouse paid Medicare taxes while working or if you are eligible for retirement benefits from either Social Security or the Railroad Retirement Board, you will not have to pay a premium for Medicare Part A (but other premiums may apply). If you worked for anywhere from 30 to 39 quarters of your life and paid Medicare taxes, your premium will be $240 per month in 2019. If you worked and paid Medicare taxes for less than 30 quarters of your life (or did not work at all), your premium will be $437 per month in 2019.*

Most Part A recipients will be responsible for coinsurance for hospital stays. If you stay in a hospital for less than 90 days, you will be charged $341 per day in 2019. Once your stay exceeds 90 days, your coinsurance goes up to $682 per day in 2019.

*If you do not enroll when you first become eligible, you will face up to a 10% premium increase for enrolling late.  

How Do I Enroll in Medicare Part A?

If you receive Social Security or Railroad Retirement benefits, you will be automatically enrolled on the first day of the month that you turn 65. You will receive a red, white, and blue Medicare card about three months before.

If you do not receive Railroad or Social Security benefits, you will need to enroll in Medicare Part A during your Initial Enrollment Period (IEP). Your IEP starts three months before your 65th birthday and ends three months after. If you miss this period, not only will you be charged a late enrollment penalty fee, but you won’t be able to enroll until the General Enrollment Period from January 1 through March 31.

Some people may qualify for an SEP, or Special Enrollment Period. If you move to a new service area, lose employer or union coverage, or have some other life-changing event, you may qualify to enroll or change plans during any time of the year.

To get started on your enrollment process, give us a call! We can answer your questions and help you sort through your options. Set up a free appointment with one of our licensed and experienced agents in your area by calling 1-844-431-1832 or completing this form.

Have questions? Ask a Benefits Advisor!