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Medicare Part A

This article was updated on: 01/01/2018

Medicare Part A is health insurance offered by the federal government to United States citizens, and legal immigrants who have permanently resided in the U.S. without a break for the 5-year period, who are age 65 and older and to some people under age 65 with certain disabilities. Together with Medicare Part B, it makes up what is known as Original Medicare. Part A helps pay for the cost of inpatient hospital care.

Medicare Part A (hospital insurance) helps cover the following:

  • Inpatient hospital care: Includes semi-private rooms, meals, and nursing services for patients who were transferred from an acute-care hospital or were admitted to a long-term care hospital within 60 days of being discharged from an inpatient hospital stay.
  • Skilled nursing facility care: Includes semi-private room, meals, skilled nursing care, medications, medical supplies and equipment, and transportation for those whose doctor has decided that daily skilled care is medically necessary.
  • Nursing home care: Included if deemed medically necessary, provided the beneficiary requires more than custodial care (help with daily living tasks, such as bathing, dressing, etc.).
  • Hospice care: Includes doctor services, nursing care, medical equipment, medical supplies, and more for those who are terminally ill and are expected to have six months or less to live.
  • Home health services: Includes at-home skilled nursing care, physical therapy, occupational therapy, and more when intermittent skilled nursing care or therapeutic services are medically necessary.

Medicare Part A cost-sharing amounts (for 2016) are listed below.

Inpatient hospital:

  • Deductible: $1,340.00
  • Coinsurance:
    - $322.00 a day for the 61st-90th days
    - $644.00 a day for the 91st-150th days (lifetime reserve days)

Skilled nursing:

  • $0 for days 1-20
  • $157.50 a day for the 21st-100th days (Skilled Nursing Facility coinsurance)

If you get benefits from Social Security or the Railroad Retirement Board, you automatically get Medicare Part A starting the first day of the month you turn age 65. If you are under age 65 and disabled, you automatically get Part A after you get disability benefits from Social Security or certain disability benefits from the Railroad Retirement Board for 24 months. You will receive your Medicare card in the mail three months before your 65th birthday or your 25th month of disability. If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig’s disease), you automatically get Part A the month your disability benefits begin.

If you have end-stage renal disease (ESRD), you may be eligible for Medicare Part A. For details, contact Medicare in any of the following ways:

  • Go to medicare.gov.
  • Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Medicare representatives are available 24 hours a day, seven days a week.

Most people will not have to pay a monthly premium for Medicare Part A, provided you or your spouse paid Medicare taxes for a minimum of ten years while working. If you are not eligible for premium-free Medicare Part A, you may voluntarily enroll in Part A if you meet the following conditions:

  • You are 65 or older, and you are entitled to (or enrolling in) Medicare Part B, and meet the citizenship or residency requirements.
  • You are under age 65, disabled, and your premium-free Medicare Part A coverage ended because you returned to work.
  • You have not paid Medicare taxes through your employment.

If you or your spouse worked and paid Medicare taxes for less than ten years, it will still be taken into consideration by the Social Security Administration when the Medicare Part A premium amount is assessed; therefore the premium amount may be reduced the longer you or your spouse worked and paid taxes. You may be subject to a late enrollment penalty if you do not enroll in Medicare Part A when you are first eligible to do so. If you do not automatically qualify for Medicare Part A, you will be given an Initial Enrollment Period that starts three months before you turn 65, includes the month you turn 65, and lasts for three additional months after you turn 65. When voluntary enrollment takes place more than 12 months after a person’s initial enrollment period, a 10 percent penalty is assessed for 2 years for every year he or she could have enrolled and failed to enroll in Part A.

Of course, this is just the start of what Medicare benefits are available. The plan that may work for you depends on your medical needs, budget, and other factors.

If you’re enrolled in, or will soon be eligible for Medicare, and are considering whether one of the Medicare plans could be a good option for you, we can help you compare your options. We're happy to walk you through your options by phone or email you information; you can request that using the links below. If you’d like to get personalized assistance, you can talk to a licensed insurance agent today.

Call US Medicare Brokers licensed insurance agents at 1-888-408-6913, Monday through Friday, 10AM to 8PM EST.