Medicare Part A – Medicare Inpatient Care
What is Medicare Part A?
Original Medicare consists of two parts: Medicare hospital insurance (Part A) and Medicare medical insurance (Part B). Part A helps cover Medicare inpatient care, which includes care received while in a hospital, a stay in a skilled nursing facility, and care received through home health care.
Medicare hospital insurance includes those expenses that are critical to your inpatient care, such as a semi-private room, meals, nursing services, medications that are part of your inpatient treatment, and any other services and supplies from the hospital.
Medicare hospital insurance does not cover the costs for a private room, private-duty nursing, personal care items like shampoo or razors, or other extraneous charges like telephone and television. Medicare also does not cover the cost of blood. That's because hospitals usually get blood from a blood bank at no charge. If, however, the hospital does charge you for the blood, you must pay for only the first three units that you receive each calendar year.Medicare hospital insurance does not cover the costs for a private room, private-duty nursing, personal care items like shampoo or razors, or other extraneous charges like telephone and television. Medicare also does not cover the cost of blood. That's because hospitals usually get blood from a blood bank at no charge. If, however, the hospital does charge you for the blood, you must pay for only the first three units that you receive each calendar year.
Covered home health care services by a part-time or intermittent skilled nurse, physical therapist, speech-language pathologist or occupational therapist must be for medically necessary purposes ordered by your doctor.
Skilled nursing facilities are covered after you've been a patient in a hospital no less than three days for a related illness or injury. Coverage includes a semi-private room, meals, nursing services, rehabilitation services and any other supplies or services that are medically necessary. Your doctor must certify that you need daily care that you cannot receive at home, such as intravenous drugs or physical therapy. Medicare Part A does not cover long-term care.
If your doctor has certified that you have a terminal illness with less than six months to live, Medicare Part A coverage includes pain relief medications, nursing and social services, and certain equipment. In this case, Medicare hospital insurance also covers some costs that Medicare normally does not include, such as spiritual and grief counseling. Normally, hospice care is received at home. Medicare only pays for room and board in a hospital if the hospice medical team orders short-term inpatient stays for pain or other symptom management.
Eligibility for Medicare Part A
Medicare hospital insurance is available for age 65 retirees, disabled Americans who are receiving Medicare disability benefits, and those with Lou Gehrig's Disease (or Amyotrophic Lateral Sclerosis (ALS)).
Most people do not pay a premium for Medicare Part A. For those who do, you may be subject to a penalty in the form of a higher premium if you delay enrollment after you were first eligible.
Initial Enrollment in Medicare Part A
When you turn age 65 and are already receiving Social Security retirement benefits or benefits from the Railroad Retirement Board (RRB), enrollment in Medicare Part A is usually automatic. Medicare Part A benefits begin the first day of the month you turn 65. If your birthday is on the first day of the month, your benefits will begin the month before you turn 65. Some people will also get Medicare Part B medical insurance automatically at the same time with their Medicare hospital insurance. Your red, white and blue Medicare ID card will arrive about three months before your 65th birthday.
If you turn 65, but have delayed your Social Security retirement, you must enroll in Medicare hospital insurance manually (call 1-800-772-1213 or visit www.socialsecurity.gov/medicareonly). The seven-month initial enrollment period begins three months before your 65th birthday and ends four months after your birthday. Your coverage will begin in July after you enroll. Be careful not to wait until the last minute to do so. For example, if you were eligible to enroll in May, but you wait until August, your coverage will begin in October instead of July. You will have missed out on three months of coverage. If you haven't enrolled during your seven-month initial enrollment period, you must wait until the next general enrollment period (January 1 through March 31) to enroll. Your red, white and blue Medicare ID card will arrive about one month after you enroll.
If you are disabled, enrollment in Medicare Part A hospital insurance (and Medicare Part B medical insurance) will begin after you have been receiving Social Security disability benefits for 24 months. Your coverage will begin in the 25th month. Your red, white and blue Medicare ID card will arrive about three months before your coverage begins.
If you have Lou Gehrig's Disease, your Medicare Part A hospital insurance (and Medicare Part B medical insurance) will automatically begin the same month that your Social Security disability benefits begin. Your red, white and blue Medicare ID card will arrive about one month after you sign up for Social Security disability benefits.
General Enrollment for Medicare Part A
You may have delayed enrollment in Medicare Part A because you or your spouse is still employed and you already had hospital insurance through a private insurer. In this case, you may enroll during the next available general enrollment period, which is each year from January 1 through March 31. Your coverage will begin July 1 of that year and your red, white and blue Medicare ID card will arrive about three months before your coverage begins.
Special Enrollment Period for Medicare Part A
If you or your spouse (or family member if you're disabled) loses your employer- or union-sponsored group hospital insurance, or if you were a volunteer serving in a foreign country, you may enroll immediately or during the eight-month period that begins the month after your employment or other group coverage ends. You usually do not have to pay the premium penalty (if you pay a premium) if you qualify for the special enrollment period. Your Medicare Part A coverage will begin the first of the month after you enroll and your red, white and blue Medicare ID card should arrive within 30 days of your enrollment. If you are eligible for Medicare Part A because you have End Stage Renal Disease (ESRD), the special enrollment period does not apply. If your employment ends during what would be your initial enrollment period, follow the rules for enrollment in Medicare hospital insurance for that initial period.
