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, or 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. You can qualify for Part A before this time if:
- you have medical conditions such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS)
- a doctor declares a disability that keeps you from working
The creators of Medicare envisioned the parts like a buffet-type option.
A person would always receive Part A so they’d have coverage if they needed a hospital stay. If they didn’t have private insurance or wanted more coverage, they could choose from Medicare’s other parts. Parts B and D are for doctor’s visits and prescriptions, respectively.
Medicare Part C is a bundle of insurance benefits, including those in Medicare Part A, provided through private insurance companies.
You don’t have to be retired to sign up for Medicare Part A — it’s just a benefit you can start receiving when you’re 65. Many people opt to have private insurance (such as from an employer) and Medicare.
With some exceptions, Medicare Part A covers the following services:
- home healthcare
- hospice care
- inpatient hospital care
- short-term inpatient care in a skilled nursing facility
- long-term skilled nursing facility care
Inpatient care in a hospital includes services like getting a semi-private room as well as receiving meals, nursing services, physical therapy, and medications that a doctor says are important for care.
Medicare Part A usually only covers the cost of an emergency room visit 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 the costs of receiving a blood transfusion. 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 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 when you’re 65.
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 2020, this is $1,364 for each benefit period.
A benefit period is basically from day one when you go into a hospital until 60 days after.
If you go to the hospital on day one of your benefit period and get discharged, but have to go back because of complications two weeks after, you’re still in your benefit period and only have to pay one deductible. You can have multiple benefit periods in the same calendar year.
Medicare also usually only covers a hospital stay up to your benefit period of 60 days. If you have to stay more than this, you may have to pay a certain amount based on how much longer you stay.
If you don’t automatically qualify for Part A, you can still buy Part A. For 2020, the cost of Part A is $458 per month, according to Medicare.gov. The costs are a little less if you paid some Medicare taxes. For 2020, you would pay $252 if you paid Medicare taxes for at least 30 to 39 quarters.
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: This part covers some expenses for doctors’ visits, medical equipment, diagnostic screenings, and some other services that don’t take place in a hospital stay. If you make less than $85,000, the monthly premium for Part B is $135.50 in 2019.
- Part C: Medicare Part C (also known as Medicare Advantage) is a bundled insurance plan. You can shop for these plans at Medicare.gov. At a minimum, a Medicare Advantage plan will include services of parts A and B. It may also cover prescription drugs, dental, or vision depending upon what plan you choose. Most of these plans work through “in-network” doctors or securing a referral from a primary care doctor that manages your care.
- Part D: Medicare Part D is Medicare’s prescription drug coverage. 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
- eye exams that are specifically for an eyeglasses prescription
- 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 (1-800-633-4227) 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.
There are three ways you or a loved one can 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 age 65 (this includes the month you turn 65) 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.
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.