What Is Medicare Part A?

Original Medicare is comprised of two parts: Part A (hospital insurance) and Part B (outpatient insurance). Part A generally provides coverage for hospital inpatient care, skilled nursing facility care, nursing home care (non-custodial), hospice care, and home health care.

Inpatient Hospital Services

In terms of inpatient hospital care, Medicare Part A covers the following:

• Semi-private room accommodation
• Nursing care
• Meals
• Medications administered in the hospital
• Necessary medical supplies and equipment
• Lab tests and X-rays
• Other hospital services and supplies deemed medically necessary by a doctor

Skilled Nursing Facility Care (SNF) / Post Hospitalization Care

The following SNF services may be covered by Part A when you need skilled nursing or post-hospitalization care:

• A semi-private room
• Meals
• Skilled nursing care
• Physical or occupational therapy
• Speech-language pathology services
• Medical social services
• Medications
• Durable medical equipment

Some of these services are only covered if they are required to meet your health goal. For full details, visit medicare.gov's SNF page.

What Is Not Covered by Part A?

While Medicare Part A covers various services and treatments, some important limitations must be remembered. The following is a general list of services that are not covered by Part A:

• Long-term (custodial) care
• Private room accommodation (unless medically necessary)
• Private duty nursing
• Routine eye care
• Most prescription drugs outside of the hospital setting
• Routine dental care and dentures
• Cosmetic procedures

Who Is Eligible for Medicare Part A?

To be eligible for Original Medicare Part A, an individual must meet at least one of the following criteria:

• Be 65 years or older.
• Have a disability and received Social Security benefits for at least 24 months.
• Have end-stage renal disease (ESRD).
• Have ALS (Amyotrophic Lateral Sclerosis, also known as Lou Gehrig’s disease).

What Does Part A Cost?

Most individuals do not have to pay for Medicare Part A once they become eligible, as they have automatically paid into the program through their payroll taxes while employed. However, if you or your spouse did not pay Medicare taxes while working or did not work, you may have to pay a Part A monthly premium. Individuals not eligible for premium-free Part A coverage may be able to purchase it if they meet certain requirements.

Even if they are not required to pay a monthly premium, all Part A beneficiaries still have the same deductibles and copayments.

How Do I Enroll?

If you receive Social Security or Railroad Retirement Board benefits, you will be automatically enrolled in Medicare Part A when you turn 65. If you are not receiving these benefits, you can enroll during your Initial Enrollment Period (IEP), which begins three months before your 65th birthday, includes your birthday month, and ends three months after your 65th birthday. If you have ESRD, you can apply even if you are under 65.

You can apply in person at your local Social Security office, through the Social Security website, or by calling 1-(800)-772-1213.

Bottom Line

Medicare Part A is a critical component of the Medicare program, providing Medicare coverage for inpatient hospital services and post-hospitalization care. Eligibility depends on various factors, and there may be costs associated with this coverage. Understanding the details and enrollment process is important to make informed decisions about your healthcare coverage.

FAQs

Are there any other ways to qualify for premium-free Medicare Part A coverage?

Yes, certain individuals may be able to get premium-free Medicare Part A if they have end-stage renal disease (ESRD) or ALS (Amyotrophic Lateral Sclerosis, also known as Lou Gehrig’s disease). Additionally, some individuals who do not meet these criteria may be able to purchase Part A coverage if they meet specific requirements.

Can I enroll in Medicare Part A at any time?

No, there are specific enrollment periods for Medicare Part A. If you receive Social Security or Railroad Retirement Board benefits, you will be automatically enrolled when you turn 65. Otherwise, you can enroll during your Initial Enrollment Period (IEP), which begins three months before your 65th birthday, includes your birthday month, and ends three months after your 65th birthday.

What happens if I don't sign up for Medicare Part A when I'm first eligible?  

If you don't sign up for Medicare Part A when you're first eligible, you may have to pay a penalty unless you qualify for a Special Enrollment Period (SEP) due to having group health plan coverage from current employment.

Can I have other health insurance along with Medicare Part A?  

Yes, you can have other health insurance in addition to Medicare Part A. This is often referred to as dual coverage. Medicare will coordinate with your other insurance to decide which one pays first.

Is there a deductible for Medicare Part A?  

Yes, there is a deductible for Medicare Part A services. The deductible applies to each benefit period and can change from year to year. The deductible is $1,632 per benefit period in 2024.

Florida Medicare Resources

Medicare.gov - The official U.S. government site for Medicare, where one can find information about coverage options and compare plans in Florida.

Florida Department of Elder Affairs - Provides resources and assistance for seniors in Florida, including long-term care options and financial assistance programs.

Florida SHINE Program - A volunteer-based program that provides free, unbiased health insurance counseling for Florida Medicare beneficiaries.

MyBenefitsFlorida - A website that provides information and resources for Florida residents on Medicare Advantage and prescription drug plans.