Medicare Part A: What It Does And Does Not Cover

The two parts of Medicare are Medicare Parts A and B, also known as Original Medicare.

Original Medicare is the basic Medicare available to you when you turn 65.

Medicare Part A plays a crucial role in covering care that is received in inpatient settings. These settings can include hospitals and skilled nursing facilities. Another coverage area included in Medicare Part A is a home setting where home health care or hospice care is required.

What is Covered by Medicare Part A?

• Skilled nursing facility care (not including long-term or custodial)

• Inpatient care in a hospital setting

• Home health care

• Hospice care

• Nursing home care (inpatient care in a skilled nursing facility that's not custodial or long-term care)

There are many healthcare costs that Medicare Part A does not cover. For this reason, you may want to consider a supplement plan to help cover these costs.

What is Not Covered by Medicare Part A?

• Costs related to long-term residence in an assisted living facility or nursing home

• Personal items provided by an assisted living facility or hospital, such as razors, socks, etc.

• A private room inside an assisted living facility or hospital (this may be covered if considered medically necessary)

• A stay in a long-term skilled nursing facility if you were previously staying in the hospital under observation. In order for this cost to be covered, you must have stayed in the hospital as an admitted inpatient for longer than three days.

• Services rendered by physicians. These particular costs are covered by Medicare Part B, the other half of original Medicare.

• Care received in the hospital under observation, which is also covered by Medicare Part B.

• Hearing aids and exams for fitting them

• Routine foot care

Who is Eligible for Medicare Part A?

1. If you are already receiving retirement benefits from Social Security, you become automatically eligible at the age of 65 for Medicare Part A.

2. Before you reach the age of 65, if you are disabled or have amyotrophic lateral sclerosis, also known as ALS or end-stage renal disease (ESRD), you may qualify for Medicare Part A.

Are You Eligible for Medicare Automatic Enrollment?

There are certain circumstances where you will be automatically enrolled in Medicare Part A. These include:

• If you have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), also known as motor neuron disease (MND), the month your disability benefits begin, you will be automatically enrolled in Original Medicare coverage.

• If you receive disability benefits from the Railroad Retirement Board, or if you receive Social Security and are under the age of 65.

If you qualify under one of these scenarios, automatic enrollment in Original Medicare will take place two years after you initially started receiving your disability benefits.

When Will My Medicare Part A Coverage Start?

The specific time when your Medicare coverage begins is dependent upon when you enroll in Medicare.

Scenario 1: Your birthday falls on the first day of the month.

• Example: If your birthday is May 1 and you sign up for Medicare in January, February, or March, your coverage will begin on April 1.

Scenario 2: If you sign up for Medicare within the three months before your birthday, your coverage will begin the 1 day of your birthday month.

• Example: If your birthday is May 15th and you sign up for Medicare in February, March, or April, your coverage will begin on May 1.

How Much Does Medicare Part A Cost?

There is usually no monthly premium associated with Medicare Part A. This is due to the fact that you or your spouse, while working, paid taxes into Medicare.

If you are not eligible for premium-free Medicare Part A, you can still purchase Part A by paying a monthly premium.

The amount of this premium is dependent upon how much you or your spouse paid in taxes, as well as where you are located.

When Should You Apply for Medicare Part A?

You can apply for Original Medicare during the Initial Enrollment Period (IEP), the General Enrollment Period (GEP), or special enrollment periods.

The Initial Enrollment Period is the period of time when you will first become eligible to enroll in Medicare.

The Initial Enrollment Period normally begins three months before you turn 65. If over a two-year period, you have received Social Security Disability Insurance before the age of 65, you may also qualify for this enrollment period.

The General Enrollment Period

If you did not enroll during the IEP, you may enroll during the General Enrollment Period. This period runs from January 1 to March 31.

The General Enrollment Period allows you to sign up for Original Medicare (Part A and/or B) if you did not enroll when you were first eligible.

It is important to note that enrolling during the General Enrollment Period may result in penalties, including an increase in premiums. For this reason, it is preferable to sign up during your Initial Enrollment Period. If you do find yourself having to sign up during General Enrollment, your coverage will begin on July 1.

Special Enrollment Periods

If you experience a life-changing event, such as moving or marriage, you may take advantage of a special enrollment period. This period of time allows you to view and, if necessary, change your Medicare coverage without incurring a penalty. Special enrollment periods have no specific time frame. Instead, they are open to anyone who experiences a qualifying life event.

You May Qualify for the Special Enrollment Period if You:

• Move to a new place of residence

• Get married

• Experience a loss of health insurance

• Have a child born

• Adopt a child

If you have any further questions regarding Medicare Part A, what it covers and the best time for you to enroll, you can chat with a licensed professional. These experts can help empower you during the enrollment process and guide you to make the best decision for your health and budget needs.

Serah Gallo is a healthcare and finance writer with almost 10 years of professional writing experience.