Medicare Part A (Hospital Insurance)

Many people become overwhelmed and frustrated by the different Medicare parts and all the red tape that seems to accompany them. However, understanding the different types of Medicare coverage is fairly simple when it is broken down into smaller sections. Let's concentrate for a moment on Medicare Part A. Part A coverage is focused solely on insurance for hospital (or similar facilities) stays. It is often referred to as hospital insurance, but it can cover stays in skilled nursing facilities, hospice services, and home health care as well as inpatient hospital time.

Medicare Part A Coverage

Generally, when you have Part A coverage, you are insured for the following experiences:

  • Hospital Inpatient Care
    Hospital inpatient care is defined as starting when a doctor admits you to the hospital with a formal order. This means that you could spend the day or overnight in a hospital (such as when you go to the emergency room and are undergoing tests) without actually having inpatient status. Hospital inpatient care coverage in Part A also applies to inpatient rehabilitation facilities, critical access hospitals, and long-term care hospitals.
  • Skilled Nursing Facility Inpatient Care
    These facilities are places where they have the skilled nursing staff, equipment, and services to offer medical or rehabilitative services. This is not referencing long-term care or custodial care, such as caring for personal hygiene such as bathing and dressing.
  • Hospice Care Services
    Hospice involves a team of people to provide for a variety of the needs (medical, physical, social, emotional, and spiritual) of terminally ill patients.
  • Home Health Care Services
    Medicare Part A only covers a portion of home health care services and only when they are specifically ordered by your doctor.
  • Religious Nonmedical Healthcare Institution Inpatient Care
    Some people need medical care services, but their religious beliefs prevent them being admitted to hospitals or being treated with traditional medicines. Part A coverage can be used at some religious nonmedical facilities that provide nonmedical healthcare items.

No matter what facility is providing your care, it is very important that you ascertain whether or not you are labeled as inpatient or outpatient status. This label will determine what you have to pay and what is covered by Part A insurance.

Medicare Part A Costs

The good news is that for most people, Part A benefits are free once you turn 65 years of age. This is because most people have been working during their adult lives and paying into the Medicare system. Paying Medicare taxes throughout your career makes you eligible for "premium free Part A." Essentially, you have already paid the premiums prior to taking advantage of the benefits. In order to receive premium-free Part A, you must still enroll in the program once eligible.

However, there are some people who are not eligible for premium free Part A. These individuals may be able to get the coverage by paying a monthly premium, just like paying for insurance. There are certain conditions you must meet in order to purchase Part A coverage.

These conditions include citizenship and residency requirements. In addition, you should be enrolled (or in the process of enrolling) in Medicare Part B coverage if you are 65 or older. You can also buy Part A coverage when you are not yet 65 if you are disabled and have lost your premium-free Part A as a result of returning to work. This should not happen until eight and a half years after returning to work, as you are eligible for the premium-free coverage during this period.

For people who are restricted to a limited income or have fewer financial resources, your state of residency may help you pay Medicare Part A and B premiums if you need to buy this coverage. Medicare savings programs are available by state to help with Medicare premiums, deductibles, coinsurance, and copayments if you meet the conditions.

In 2012, the monthly premium for Medicare Part A coverage is $451, but most people receive either premium-free coverage or help from state programs with the cost.

Medicare Part A Enrollment

Most people will want to enroll in Medicare Part A as soon as they become eligible. For people who are not disabled, eligibility begins at age 65. You may sign up for Part A coverage during the initial enrollment period, which is a seven month period where your 65th birthday month falls in the middle. This means that you can enroll in Part A during the three months prior to the month of your 65th birthday, the month of your birthday, and the three months following the month of your birthday.

If you have missed your initial enrollment period, you can enroll in Medicare Part A between January 1 and March 31 each year (General Enrollment Period).

Note: If you are not eligible for premium-free coverage and you do not enroll until after your initial enrollment period, your premiums may be ten percent more expensive than if you had enrolled when first eligible. This higher premium amount will apply to the number of years between your eligibility and the time when you actually signed up times two. For instance, if you wait five years after you become eligible, you will have to pay a 10% higher premium for ten years.