When you first enroll in Medicare and at certain times of the year, you can choose from one of two main ways to get your Medicare coverage – through Original Medicare (Part A and Part B) or through a Medicare Advantage Plan (Medicare Part C).
The first part of Original Medicare, Medicare Part A, is often referred to as “Hospital Insurance.” Part A helps to cover costs related to hospital stays, hospice care and some skilled nursing facility care (more details on what Part A covers below).
There is typically no monthly premium cost for Part A, as long as you have paid in a certain amount of Medicare taxes (more details on the costs for Medicare Part A below).
Overall, Medicare Part A is the first main part of Medicare, because it covers the most vital care for aging adults in the form of hospital, hospice and skilled nursing facility care.
What Does Part A Cover?
Part A helps to cover inpatient hospital care, hospice care, and some skilled nursing facility and in-home care costs.
Part A also helps to cover costs related to your hospital stays and hospice care, such as lab tests, surgeries, in-hospital medications, diagnostics and some rehabilitation.
In comparison, there are some things that are not covered by Part A. Medicare Part A does not help to cover long-term care, which is related to the assistance individuals need when they are no longer able to perform their basic activities of daily living, or ADLs. Also called custodial care, Medicare Part A does not cover services related to long-term care and custodial care.
You can choose to purchase separate long-term care insurance to help cover the costs associated with long-term custodial care. You can also look into Medigap Supplement plans or independent Medicare Advantage plans (Part C) that might help to cover additional benefits.
How Much Does Part A Cost?
Medicare Part A typically does not have a monthly premium, as long as you or your spouse paid Medicare taxes for a certain amount of time while working.
Sometimes called “premium-free Part A,” you can get Part A for no monthly premium if you are already receiving or are eligible to receive retirement benefits from Social Security or the Railroad Retirement Board. Typically, this means you must have worked in the United States for at least 10 years to be eligible for premium-free Part A.
You can also get premium-free Part A if you or your spouse had Medicare-covered government employment.
If you do not qualify for a premium-free Part A, you can purchase Part A for either $259 or $471 each month in 2021, depending on how long you or your spouse paid Medicare taxes. There is also a standard deductible for Part A ($1,484 per benefit period in 2021), and co-pays for hospital stays longer than 60 days.
When Do I Enroll in Part A?
You are typically automatically enrolled in Medicare Part A when you turn 65, as long as you are already receiving Social Security benefits.
If you are still working and have comprehensive health insurance coverage from your employer, or through your spouse, you may not have to enroll in Part A right away. It will depend on your employer and if they require you to enroll in Medicare.
Even if you do have credible coverage through your spouse or your employer, you can still choose to enroll in Medicare Part A. Since most people do not pay a premium for Part A, it helps to make additional enrollment easier once you lose employer coverage, and helps to provide additional coverage for any gaps in your group health plan.
If you have questions about Medicare Part A, you can talk to a local senior health plan consultant. They tend to be experts in their field, and can help you navigate your options when it comes to your Medicare health insurance enrollment. Contact us today to get help finding an advocate in your area. You can also reach out to your local Social Security office.