Medicare is the national health insurance program in the United States. If a person is age 65 or older or has certain medical conditions, they can receive Medicare coverage.
The Centers for Medicare and Medicaid Services run Medicare, and they divide services into parts A, B, C, and D.
Medicare Part A helps pay if a person requires hospital services. If you or your spouse worked and paid Medicare taxes for at least 10 years, you can qualify for Medicare Part A free of charge.
Medicare Part A is the hospital coverage plan for people age 65 and older. The creators of Medicare envisioned the parts like a buffet.
You would always receive Part A, so you’d have coverage for a hospital stay. If you don’t have private insurance and want more coverage, you could choose from Medicare’s other parts.
You don’t have to be retired to sign up for Medicare Part A – it’s a benefit you can start receiving as soon as you turn age 65. Many people choose to have private insurance (such as from an employer) and Medicare.
With some exceptions, Medicare Part A covers the following services:
- Inpatient hospital care. This covers any tests or treatments you need when you’ve been admitted to the hospital.
- Limited home healthcare. If you need care from a home health aide after you’ve been released from an inpatient hospital stay, Medicare will cover medically necessary care while you recover.
- Hospice care. Once you’ve made the choice to seek hospice care instead of treatment for a terminal illness, Medicare will cover most of your healthcare costs.
- Short-term skilled nursing facility stays. If you need skilled nursing facility care, Medicare will cover your stay and services for a certain amount of time.
Inpatient care in a hospital includes services like meals, nursing services, physical therapy, and medications that a doctor says are important for care.
Medicare Part A usually only covers emergency room visit costs if a doctor admits you to the hospital. If a doctor doesn’t admit you and you return home, Medicare Part B or your private insurance may pay for the costs.
It’s also important to know that Medicare Part A doesn’t cover all hospital costs. Here are a few things that Part A won’t cover:
- Your first 3 pints of blood. If a hospital receives blood from a blood bank, you may not have to pay anything. However, if a hospital has to get special blood for you, it’s possible you may have to pay for it out of pocket.
- Private rooms. While inpatient care includes a stay in a semiprivate room, you are not entitled to a private room during your care.
- Long-term care. Part A is only intended to provide care during an acute illness or injury. If you have long-term care needs, such as a nursing home, you will have to pay for your own residential care out of pocket.
When you work, your employer (or you, if you’re self-employed) takes out money for Medicare taxes. As long as you or your spouse works for 10 years paying Medicare taxes, you get Medicare Part A without a premium when you’re 65 years old.
That’s not to say that you or a loved one can walk into a hospital and receive free care. Medical Part A requires you pay a deductible toward your inpatient care. For 2021, this is $1,484 for each benefit period.
If you don’t automatically qualify for free Part A, you can still buy Part A. For 2021, the monthly premium for Part A is $471 if you’ve worked less than 30 quarters. If you paid Medicare taxes for 30 to 39 quarters, you would pay $259.
There’s more to Medicare than Part A – there are also parts B, C, and D. You or a loved one don’t have to utilize any other parts. They do each have a monthly premium. Examples of services covered under each include:
- Part B. Medicare Part B covers some expenses for doctors’ visits, medical equipment, diagnostic screenings, and some other outpatient services that you may need.
- Part C. Medicare Part C (Medicare Advantage) covers the services of parts A and B. It may also cover prescription drugs, dental, and vision, depending on the plan you choose. Most of these plans work through “in-network” doctors or securing a referral from a primary care doctor who manages your care.
- Part D. Medicare Part D covers prescription drugs. Like Medicare parts B and C, you have to pay a premium for this coverage. There are several Part D plan types, and you buy them from a private insurer.
Of course, there are some services that original Medicare doesn’t usually cover. Sometimes, a person has private insurance that may pay for these services, or they pay for them out-of-pocket. Examples include:
- cosmetic surgery
- eyeglasses or contact lenses
- fittings or examinations for hearing aids
- long-term care
- most dental care services
- routine foot care
If you aren’t sure if a service is covered under different Medicare types, you can call 800-MEDICARE (800-633-4227) to ask.
If you or a loved one is in the hospital, you’ll usually have a case worker assigned to you who can help answer questions about Medicare coverage.
If you’re currently receiving Social Security benefits and are under age 65, you’ll be automatically enrolled in Medicare parts A and B when you turn 65 years old. However, if you’re not currently getting Social Security, you’ll have to actively enroll in Medicare.
The section below on initial enrollment explains when you can begin the enrollment process based on your age.
However, you can qualify for Part A before this time if:
There are three ways to enroll in Medicare Part A:
- Go online to SocialSecurity.gov and click on “Medicare Enrollment“.
- Call the Social Security office at 800-772-1213. If you need TTY, call 800-325-0778. This service is open Monday through Friday from 7 a.m. to 7 p.m.
- Apply in person at your local Social Security Office. Click here to find your local office by ZIP code.
You can start enrolling in Medicare 3 months before you turn 65 years old (this includes the month you turn 65 years old) and up to 3 months after your 65th birthday. As a general rule, your coverage will start on July 1 of the year you enroll.
Under certain conditions, you may be able to apply late for Medicare. This period of time is known as the special enrollment period.
You may qualify to enroll during this period if you were employed by a company that had more than 20 employees when you turned 65 years old and had health insurance through your job, union, or spouse.
In this case, you can apply for Medicare Part A within the 8 months after your previous coverage ended.
Navigating the world of Medicare can be confusing – if you just turned or are nearing age 65, it’s a new world for you.
Fortunately, there are many resources available to you, from the internet to the phone to your local Social Security office. If you have a specific question, these sources are a great place to start.