Medicare is the federal health insurance program designed for adults age 65 and older and some younger people who have qualifying disabilities. Medicare coverage is split broadly into two major types of coverage:
— Original Medicare, which is administered by the government. This coverage, also sometimes referred to as traditional Medicare, consists of two parts — Part A and Part B.
— Medicare Advantage plans, which are offered by private health insurers who have been approved by the Centers for Medicare & Medicaid Services. These plans are also known as Medicare Part C.
Read on to learn everything you need to know about Medicare Part A.
What Does Medicare Part A Cover?
Medicare Part A, also known as hospital insurance, covers inpatient and intensive care for people enrolled in original Medicare, says Cindy George, a senior personal finance editor at GoodRx, a free website and mobile app that tracks prescription drug prices and provides coupons and discounts on medications.
Specifically, Medicare Part A covers:
— Hospital stays. This includes your room, meals, nursing and medications while you’re in the hospital. So, if you need inpatient heart surgery heart surgery, Part A will cover some or all of those costs, depending on your situation.
— Skilled nursing care. After a hospital stay, Part A helps cover short-term care in a skilled nursing facility.
— Hospice care. For those with terminal illnesses, medical care and family support are covered.
— Some home health care services. This is limited to part-time skilled nursing or therapy, and does not include 24-hour care. Personal assistance is covered only when you’re receiving skilled nursing care.
[READ: Does Medicare Cover Home Health Care?]
What’s excluded from Part A?
George notes that there are several things that Medicare Part A doesn’t usually cover:
— Add-ons or conveniences, such as a private room, personal care items or a TV or phone if those aren’t already included in your hospital room
— Long-term care in a nursing home
— 24-hour home health care
— Most personal assistance services
— Outpatient services
— Prescription medications for use at home
[READ The Parts of Medicare Explained: What They Cover and What They Don’t]
What about visits to the doctor and prescriptions?
Medicare Part A is hospital insurance, so it doesn’t cover the prescriptions you use at home and it doesn’t pay for visits to your primary care provider and most other outpatient services.
Instead, Medicare Part A is designed to work with Medicare Part B, which covers a wide range of outpatient medical services and preventive care, such as vaccines, visits to the doctor and some medical equipment. You will have to pay a monthly premium for Part B, which was $174.70 in 2024 and is projected to increase to $185 per month in 2025.
Even with original Medicare (Part A and Part B) combined, there can still be significant gaps in your coverage, according to Whitney Stidom, vice president of sales and operations with eHealth Inc., a health insurance broker and online resource provider headquartered in Santa Clara, California.
“For example, it doesn’t provide coverage for prescriptions, so you will need to enroll in a separate prescription drug plan offered by a private insurance company, otherwise you could face penalties,” she says.
For prescriptions, you’ll need to purchase a Part D plan, and you’ll pay a monthly premium for it. That premium can vary depending on your income level.
And it’s important to note that if you don’t sign up for Part D when you first become eligible, you may have to pay a Part D late enrollment penalty later. That penalty also varies depending on how long you went without creditable prescription drug coverage, and it can get expensive quickly.
[Related:8 Reasons to Switch Medicare Part D Plans]
How Do I Get Medicare Part A?
When you turn 65 you are, in most cases, entitled to Part A with no premium, explains Scott R. Maibor, a licensed insurance advisor and managing director of Senior Benefits Boston LLC, a Medicare advisory based in Haverhill, Massachusetts.
“It is not required to enroll, unless you work for a company of fewer than 20, but there is no harm in enrolling,” Maibor says.
But, he notes, there is one exception — “if there is a health savings account in your name being actively contributed to, you cannot have Medicare, including Part A, at the same time.”
In short, many people enroll in Medicare Part A when they turn 65 years old.
“You can enroll through the Social Security Administration online during your initial enrollment period, which starts three months before your 65th birthday and ends the third month after your birthday,” Stidom explains.
If you’re still working and have creditable coverage through your employer or a spouse’s employer, you can delay enrolling in Medicare. You can also switch to original Medicare from a Medicare Advantage plan during Medicare open enrollment, which runs from October 15 through December 7, George notes.
If you have a qualifying disability, you may be eligible for Medicare before age 65.
“After receiving Social Security Disability Insurance or Railroad Retirement Board disability benefits for 24 months, regardless of your age, you’ll automatically be enrolled in Medicare Parts A and B,” George explains.
This waiting period is waived if you have certain conditions such as end-stage renal disease or amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), she adds.
How Much Does Medicare Part A Cost?
Most beneficiaries don’t need to pay a monthly premium for Medicare Part A, “as long as you or your spouse worked and paid Medicare taxes for at least 10 years,” Stidom notes.
However, there are other costs, including deductibles and coinsurance that the individual must pay. This means Medicare Part A is not, as many people describe it, “free,” Maibor says.
For example, the Medicare Part A deductible in 2024 is $1,632 for each time you’re admitted to the hospital per benefit period (though this amount may change in 2025).
What’s more, “if neither you nor your spouse meets the work requirements, you’ll need to pay a monthly premium, which ranged from $278 to $505 in 2024, depending on how long you paid Medicare taxes,” George adds.
How Can I Lower Out-Of-Pocket Costs?
In addition to Medicare Part A, Part B and Part D, you may want to add a Medicare supplement plan, also called a Medigap plan, as these “can help cover your out-of-pocket costs with original Medicare,” Stidom explains.
For some people, selecting a Medicare Advantage plan may offer a better mix of coverage options for their particular needs. Many Medicare Advantage plans include prescription drug coverage, and some may include other health care services, such as vision and dental benefits.
It can all seem very complicated, but “working with a licensed insurance agent can help take the confusion out of the process and help you decide which options make the most sense for you,” Stidom says.
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What Is Medicare Part A? originally appeared on usnews.com
