Medicare Part A Explained

Basics of Medicare A

Medicare A helps cover inpatient care in a hospital or skilled nursing facility (following a hospital stay), home health care services, and hospice care services. Co-payments, coinsurance, and deductibles may apply for each service. You usually do not pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working.

Medicare Part A Helps Cover:

  • Inpatient care in hospitals (such as critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals)

  • Inpatient care in a skilled nursing facility (not custodial or long-term care)

  • Hospice care services

  • Home health care services

  • Inpatient care in a religious non-medical health care institution (RNHCI).

You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working.

If you aren’t eligible for premium-free Part A, you may be able to buy Part A if you meet one of the following conditions:

  • You are age 65 or older, and you are entitled to (or enrolling in) Part B and meet the citizenship or residency requirements.

  • You are disabled and your premium-free Part A coverage ended because you returned to work.

Call Social Security at 1-800-772-1213 for more information about the Part A premium. TTY users should call 1-800-325-0778.

In most cases, if you choose to buy Part A, you must also have Part B and pay monthly premiums for both. If you have limited income and resources, your state may help you pay for Part A and/or Part B.

You can find out if you have Part A by looking at your Medicare card.

medicare card.jpg

Note: Keep this card safe. If you have Original Medicare, you will use this card to get your Medicare-covered services. If you join a Medicare plan, you must use the card from the plan to get your Medicare-covered services.

More Facts

.Signing Up for Part A: Many People Automatically Get Part A

If you get benefits from Social Security or the Railroad Retirement Board (RRB), in most cases you automatically get Part A starting the first day of the month you turn age 65. If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month. If you are under age 65 and disabled, you automatically get Part A after you get disability benefits from Social Security or certain disability benefits from the RRB for 24 months.

You will get your Medicare card in the mail three months before your 65th birthday or your 25th month of disability.

If you have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s disease), you automatically get Part A and Part B the month your disability benefits begin.

Some People Need to Sign up for Part A

If you aren’t getting Social Security or RRB benefits (for instance, because you are still working), you will need to sign up for Part A (even if you are eligible to get it premium-free). You should contact Social Security three months before you turn age 65. If you worked for a railroad, contact the RRB to sign up. If you have coverage through a current or former employer, it’s important to understand how your current coverage works with Medicare before making any decisions.

If you need to sign up for Part A, you may be able to sign up during the following times:

  • Initial Enrollment Period—When you are first eligible for Medicare. (This is a 7-month period that begins three months before the month you turn age 65, includes the month you turn age 65, and ends three months after the month you turn age 65.)

  • General Enrollment Period—Between January 1 – March 31 each year. Your coverage will begin July 1. You may have to pay a higher premium for late enrollment. See below.

  • Special Enrollment Period—If you or your spouse (or family member if you are disabled) is currently working, and you are covered by a group health plan through the employer or union.

  • Special Enrollment Period for International Volunteers—If you are serving as a volunteer in a foreign country.

If you aren’t eligible for premium-free Part A, you may be able to buy it. However, if you don’t buy Part A when you are first eligible, your monthly premium may go up 10%. You will have to pay the higher premium for twice the number of years you could have had Part A, but didn’t join. For example, if you were eligible for Part A, but didn’t join for two years, you will have to pay the higher premium for four years.

For more information on Part A, call Social Security, or visit www.socialsecurity.gov. If you get benefits from the RRB, call 1-877-772-5772