Medicare Part A

Medicare Part A is a fundamental component of the Medicare program in the United States. Primarily, it covers hospital insurance and is available to individuals who are 65 years of age or older, certain younger people with disabilities, and individuals with End-Stage Renal Disease (ESRD).

Overview

Medicare Part A provides coverage for inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also covers hospice care and some home health care services. Beneficiaries typically do not pay a monthly premium if they or their spouse have paid Medicare taxes while working.

Eligibility

• Age-based eligibility: Individuals who are 65 years or older are eligible for Medicare Part A. They must be U.S. citizens or permanent legal residents for at least five continuous years.
• Disability-based eligibility: People under 65 with certain disabilities may also be eligible for Medicare Part A after receiving Social Security Disability Insurance (SSDI) benefits for 24 months.
• ESRD-based eligibility: Individuals with end-stage renal disease are eligible for Medicare Part A regardless of age, subject to specific conditions.

Enrollment

Automatic enrollment in Medicare Part A occurs for those receiving Social Security benefits at 65. Others must enroll through the Social Security Administration during their initial enrollment period, which starts three months before their 65th birthday and ends three months after.

Coverage Details

• Hospital care: Coverage includes semi-private rooms, meals, general nursing, and medications as part of inpatient treatment.
• Skilled nursing facility care: Coverage includes a semi-private room, meals, skilled nursing and rehabilitative services, and other services and supplies.
• Home health care: Coverage may include part-time or intermittent skilled nursing care, and physical therapy, speech-language pathology services, and occupational therapy.
• Hospice care: Medicare covers a range of services for individuals who are terminally ill.

Costs

While most beneficiaries do not pay a premium for Part A, there are costs associated with coverage. These can include deductibles, copayments, and coinsurance.

Limitations

Medicare Part A does not cover long-term or custodial care. It also does not cover a private room (unless medically necessary), private-duty nursing, or personal care items.

See Also

• Medicare Part B
• Medicare Part C
• Medicare Part D

Medicare Part A Resources
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