Medicare Part A helps cover costs of the following services:
- Inpatient care in hospitals (includes critical access hospitals and inpatient rehabilitation facilities)
- Inpatient stays in a skilled nursing facility (not custodial or long‑-term care)
- Hospice care services
- Home health care services
- Inpatient care in a Religious Nonmedical Health Care Institution (facility that provides non-medical, non-religious health care items and services to people who need hospital or skilled nursing facility care but for whom that care wouldn’t be in agreement with their religious beliefs)
Medicare members typically don’t pay a monthly premium for Part A coverage if they or their spouse paid Medicare taxes while working. If you’re not eligible for free Part A, you may be able to buy Part A if you meet the citizenship or residency requirements and you are age 65 or older or you are under age 65, disabled, and your premium-free Part A coverage ended because you returned to work. The 2009 premium amount for people who buy Part A is up to $443 each month.
In most cases, if you choose to buy Part A, you must also buy Part B and pay monthly premiums for both. If you have limited income and resources, your state may help you pay for Part A and/or Part B. See ElderGuru’s Resources by State page and contact your Area Agency on Aging.
Your Medicare card will indicate whether you have Part A or not. If you have Original Medicare, you will use this card to get your Medicare-covered services. If you join a Medicare plan, you must use the card from the plan to get your Medicare-covered services.
When Can You Sign Up for Part A?
Most Medicare Beneficiaries get Part A automatically. If you get benefits from Social Security, you automatically get 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. You will get your Medicare card in the mail 3 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.
Some People Need to Sign up for Part A. If you aren’t getting Social Security benefits (for instance, because you are still working), you will need to sign up for Part A. You will need to sign up even if you are eligible for premium-free Part A. You should contact Social Security 3 months before you turn age 65.
If you have End-Stage Renal Disease (ESRD), you can sign up for Part A by visiting your local Social Security office or by calling Social Security at 1-800-772-1213.
If you aren’t eligible for premium-free Part A, you can buy it during the following times:
- Initial Enrollment Period – When you first become eligible for Medicare (3 months before you turn age 65 to 3 months after the month you turn age 65).
- General Enrollment Period – Between January 1–March 31 each year.
- Special Enrollment Period – If you or your spouse (or family member if you are disabled) is working and has group health plan coverage through the employer or union.
- Special Enrollment Period for International Volunteers – If you are serving as a volunteer in a foreign country.
If you don’t buy Part A when you are first eligible, the monthly premium may go up 10% unless you are eligible for a special enrollment period. For more information on Part A, call Social Security, or visit www.socialsecurity.gov.
Part A-Covered Services:
- Blood – If the hospital has to buy blood for you, you must either pay the hospital costs for the first 3 pints of blood you get in a calendar year or have the blood donated. In most cases, the hospital gets blood from a blood bank at no charge, and you won’t have to pay for it or replace it.
- Home Health Services – Services are limited to medically-necessary part-time or intermittent skilled nursing care or physical therapy, speech-language pathology, or a continuing need for occupational therapy. Care must be ordered by a doctor and provided by a Medicare-certified home health agency. Home health services may also include medical social services, part-time or intermittent home health aide services, durable medical equipment, and medical supplies for use at home. You must be homebound, which means that leaving home takes a lot of effort. Part A covers the cost of the first 100 home health visits following a hospital stay.
- Hospice Care – For people with a terminal illness who are expected to live 6 months or less (as certified by a doctor). Coverage may include drugs (for pain relief and symptom management), medical, nursing, social services, and other covered services as well as services not usually covered by Medicare (like grief counseling). Hospice care is usually given in your home (or other facility like a nursing home) by a Medicare-approved hospice. Medicare covers some short-term inpatient stays (for pain and symptom management that requires an inpatient stay) in a Medicare-approved facility, such as a hospice facility, hospital, or skilled nursing facility. Medicare also covers inpatient respite care (care given to a hospice patient so that the usual caregiver can rest). You can stay in a Medicare-approved facility up to 5 days each time you get respite care. Medicare may pay for covered services for health problems that aren’t related to your terminal illness. You can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies that you are terminally ill.
- Hospital Stays (Inpatient) – Includes semi-private room, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. Examples include inpatient care you get in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, inpatient care as part of a qualifying clinical research study and mental health care. This does not include private-duty nursing, a television or telephone in your room, or personal care items like razors or slipper socks. It also doesn’t include a private room, unless medically necessary. The doctor services you get while you are in a hospital are covered under Part B.
- Skilled Nursing Facility Care – Includes semi-private room, meals, skilled nursing and rehabilitative services, and other services and supplies (only after a 3-day minimum inpatient hospital stay for a related illness or injury) for up to 100 days in a benefit period. To get care in a skilled nursing facility, your doctor must certify that you need daily skilled care like intravenous injections or physical therapy. Medicare doesn’t cover long-term care or custodial care in this setting.
