Last updated: July 20th, 2022
Reviewed by
Grant Desselle
Licensed Insurance Agent
Table of Contents
Medicare Part A is the hospital/inpatient coverage portion of the traditional Medicare program provided by the federal government. Medicare Part A covers inpatient services and supplies during hospital and skilled nursing facility (SNF) with a small amount of coverage for home health in rare circumstances.
Medicare Part A typically allows for:
Certain restrictions may apply based on your eligibility status with the Medicare program.
As long as you have completed 10 years of employment with Medicare payroll taxes deducted, your enrollment eligibility for premium-free Medicare Part A will start at age 65 as long as you are a US citizen collecting Social Security/ Railroad Retirement benefits or a legal resident in the United States for five continuous years. While 65 is the qualifying age for most people, in the event you have a diagnosis of end-stage renal disease or ALS you will be eligible to receive Medicare benefits prior to age 65.
In the event you do not have 10 years (40 quarters) of employment with Medicare payroll taxes taken out, you can still qualify after 65 for Medicare; however, Medicare Part A will carry a premium based on the amount of time you paid in. Those who choose to enroll in Medicare after the enrollment period may be subject to a late enrollment penalty.
If you are currently receiving disability benefits from Social Security or Railroad Retirement and are under the age of 65, you are eligible to receive Medicare Part A coverage.
Medicare Part A covers your costs for inpatient hospital Medicare approved charges for physician and nursing services, room, meals, supplies, and medications for your treatment during a stay at a hospital.
Treatment will be covered through facilities like:
Note that in most cases, the following is not covered:
If you have a qualified injury or illness and require extra time for recovery in an inpatient setting, Medicare Part A will cover your stay in a skilled nursing facility (SNF). These facilities are similar to hospitals, but are cheaper and provide more recovery focused care instead of acute care administered at an inpatient hospital. In order to be qualified for skilled nursing care, your stay as inpatient in a hospital must be at least 3 days. Discharge or outpatient observation days does not count toward this minimum. In most cases the hospital administration will assist in locating a Medicare-approved facility for your transfer.
It is important to note that you doctor must certify medical necessity for these services and you are unable to receive these services at home. Medicare Part A does not cover long-term care (LTC) or personal care charges.
Skilled nursing generally covers:
Hospice coverage under Medicare Part A works a little different than other inpatient types of coverage in that Part A covers the typical medical costs for inpatient care, but also occasionally allows for some non-medical related charges and covers at-home hospice services.
Once in hospice status, Medicare Part A will only cover additional inpatient hospital charges for treatment of symptoms and pain that cannot be managed at the hospice setting itself and no longer covers additional treatments to cure the condition.
Hospice care under Medicare Part A generally covers:
In order to qualify for hospice coverage, you must:
Note: You have the right to stop hospice care at any given time. Consult with your doctor on best options available that are covered under your Medicare coverage.
If deemed medically necessary, Medicare Part A will cover the ordered home health service; however, it will not cover 24 hour care, meals, personal care (bathing, dressing, etc…) and other services that are in direct relation to medical treatment. Medical equipment (durable medical equipment) ordered by the physician for your care will be covered under your Medicare Part B benefits and subject to a 80/20 coinsurance.
***Durable Medical Equipment is medical equipment that can be reused like CPAPs for sleep apnea, oxygen regulators, IV infusion equipment, etc…***
In order to qualify for coverage, the home health services selected must be a Medicare-approved provider with orders from your physician that you are classified as home-bound and home health care is required.
To be homebound means:
You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services.
Home Health care covers:
To enroll:
| Are you turning 65 AND receiving Social Security/ Railroad Retirement benefits? | Medicare Part A enrollment should be automatic on the first day of the month you turn 65. You will receive your Medicare card about 3 months prior. |
| Are you under 65 and on disability from Social Security/ Railroad Retirement? | After 24 months of disability coverage from Social Security/ Railroad Retirement, Medicare Part B enrollment is automatic starting the 25th |
| Have you been diagnosed with end-stage renal disease? | Medicare coverage will begin the first day of the fourth month of dialysis treatment. NOTE: you must manually enroll if under 65. |
| Have you been diagnosed with ALS (Lou Gehrig’s disease? | Automatic coverage when you start receiving Social Security disability benefits.You should receive card about 30 days after Social Security begins. |
| Are you 65, but not taking retirement benefits? | Requires manual enrollment during the Initial Enrollment Period (starts 3 months before your 65th birthday for 7 months total). If enrollment is missed during this time, penalties will apply or you must wait until General Enrollment begins (Jan 1- Mar 31) |
Brian is the founder and CEO of Insurist and carries Life, Health, and Property & Casualty licenses in all 50 U.S. states. Since 2013, Brian has been a member of Million Dollar Round Table, a designation for the top 1% of financial advisors worldwide. Brian has been featured in Yahoo! Finance, Money.com, Entrepreneur.com, Life Happens, Forbes, MSN, and Good Financial Cents. Brian’s goal is to show customers the best products, the quickest answers to their questions, and provide expert advice.
Grant's past experience includes work as a licensed sales agent for Hagerty Insurance. He has reviewed thousands of existing auto policies across the nation and issued hundreds of new ones on everything ranging from classic cars undergoing restoration to modern exotics and motorcycles.
