So, What’s Covered? Basics of Medicare Part A

If you’re thinking about signing up for Medicare, navigating how it works might feel confusing. A good place to start is familiarizing yourself with the ABC’s of Medicare. Below, we’ll cover the basics of Medicare Part A.

What is Medicare Part A?

Medicare Part A is often referred to as hospital insurance, and together with Part B forms Original Medicare. Original Medicare is a government-sponsored health insurance program that United States citizens and permanent legal residents of at least five consecutive years can sign up for. You must be at least 65 years of age or receive disability benefits to enroll.

Most people don’t have to pay a premium for Part A. However, if you don’t qualify for premium free Part A, you will have to pay a monthly premium.

What does Part A cover?

Here is a list of services covered by Medicare Part A:

Inpatient hospital care

Part A covers care you receive after being formally admitted to a hospital by a doctor. Each benefit period covers you for up to 90 days, plus 60 lifetime reserve days. Medicare will also cover up to 190 lifetime days in a Medicare-certified psychiatric hospital. There are certain conditions that need to be met in order for Part A to cover inpatient care at a facility.

Skilled nursing facility care

Part A will also cover a range of services provided at a skilled nursing facility when deemed medically necessary by a provider for ongoing treatment. These services include room and board, administration of medications, wound care, and tube feedings.

Like inpatient care, you need to meet specific criteria for Part A to cover your stay at a skilled nursing facility. Part A covers up to 100 days per benefit period once you qualify, with the first 20 days paid in full. However, the remaining 80 days require copayment.

Medicare won’t cover long-term care, daily living, or custodial care. Nursing home care may not covered. This is because it is usually custodial care, which is activities of daily living like bathing, dressing, and eating.

Home health care

Medicare Part A will cover care administered in your home if you’re homebound and need skilled care. To qualify for coverage, you will have to spend at least three consecutive days as a hospital inpatient within 14 days of getting home health care. Eligible services may include physical therapy, occupational therapy, speech language pathology, and more.

Hospice care

You can receive hospice care when a provider determines you’re terminally ill. Part A covers this for as long as your provider decides you need care. Coverage includes: symptom control prescriptions, medical support, grief counseling, and other services. Patients usually receive hospice care at their residence or an inpatient hospice facility.

How can you enroll in Part A?

People who already receive Social Security benefits or Railroad Retirement benefits are automatically enrolled in Medicare. If you’re eligible for Medicare and weren’t automatically enrolled, you can sign up by doing any of the following:

  • Apply online at www.ssa.gov
  • Call the Social Security number at 800-772-121
  • Visit your local Social Security office. Click here for a locator tool
  • Mail a signed and dated letter to Social Security that includes: your name, Social Security number, and the date you wish to be enrolled in Medicare

Here’s additional information on signing up for Medicare when you turn 65.

There’s a lot to know about Medicare, which is why it’s important for you to have a clear understanding of all the options. If you need help navigating the ins and outs of the Medicare landscape, contact the Guided team today.

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Leave the insurance to us.

Resources

All health insurance sold is processed through the licensed entity of Baldwin Risk Partners.

Guided Solutions is not affiliated with or endorsed by Medicare or any government agency. Guided Solutions does not discriminate based on race, color, national origin, age, disability, or sex.