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What You Need To Know About Medicare Part A

Medicare Part A likely presents questions and confusion regarding eligibility, costs and what Medicare Part A covers. This is true for seniors living in an independent or active senior communities as well as individuals currently receiving services at a nursing facility or considering their senior living options.

Learn detailed information about Medicare Part A benefits.

What Is Medicare Part A?

Medicare Part A is different from other types of Medicare coverage. Part A is commonly referred to as “hospital insurance,” because it pays for your care when you are in the hospital. Some individuals receiving Medicare have Medicare Part A, while others are not yet eligible or do not receive benefits because of other individual reasons.

It meets requirements for “Qualifying Health Care Coverage” under the Affordable Care Act, whether you have traditional Medicare or a Medicare Advantage Plan. If you do have a Medicare Advantage Plan or another type of plan, you need to contact your plan provider for specific details regarding your coverage.

The Official U.S. Government Site for Medicare lists other benefits potentially available to you or your loved one under Part A. Your family doctor or another healthcare provider can help you determine what supplies or services you need and can help determine whether Medicare Part A pays for those services, including senior living options.

What Is The Cost Of Medicare Part A?

If you or your spouse worked and paid Medicare taxes for a time during the years you worked, you do not pay a monthly fee or premium for Medicare Part A. Medicare refers to this as “Premium-free Part A.” If you are under age 65 and receiving Social Security Disability or Railroad Retirement Board benefits, you are also likely eligible for premium-free Part A benefits. Individuals with certain medical conditions such as End-Stage Renal Disease or Lou Gehrig's disease likely qualify to receive Part A premium-free benefits.

The cost of Medicare Part A premiums potentially varies from one year to another year. You should always make sure you pay the correct premium for all your Medicare-eligible services.

Another factor affecting the cost of your Medicare Part A has to do with the number of work quarters for which you paid Medicare taxes. This is not something you or your loved one has to calculate. Medicare determines whether you paid Medicare taxes for 30 to 39 quarters or more, in which case you pay a smaller Medicare Part A premium than individuals who paid Medicare taxes for less than 30 quarters.

What Does Medicare Part A Cover?

Medicare Part A does not cover your prescriptions, visits to your doctor, general laboratory tests or immunizations such as your annual flu shot. Although Part A generally provides hospital coverage, other benefits that eligible recipients often receive includes care in a skilled nursing facility, home health services, and care at a hospice facility.

Residing in a senior living facility does not have to result in exorbitant out-of-pocket costs. You potentially do have coverage for senior care outside a hospital setting.

The U.S. Government Long-Term Care site explains that Medicare helps pay for a short stay in a skilled nursing facility if you need skilled nursing services such as physical therapy, skilled nursing services or certain other types of therapy. You must also meet the requirements of having an inpatient hospital stay of at least three days and be admitted to the skilled nursing facility within 30 days of that same hospital admission. Skilled nursing facilities provide outstanding senior living options for people needing specialized care and services beyond a short hospital admission.

Part A benefits also help pay for hospice care if you or your Medicare Part A-eligible loved one needs hospice care. It also pays for some home health care services.

If you are not sure whether Medicare Part A pays for your senior living or senior care services, talk to a senior living specialist, even if you or your loved one already resides in a skilled nursing facility, receives in-home health care or resides in another type of senior care facility. Discuss Part A coverage benefits and how they apply to your specific needs with a hospital social worker, the skilled nursing care facility social worker, the care coordinator or appropriate representative at other types of senior living facilities.

How Do I Enroll In Medicare Part A?

Enrolling in Medicare Part A requires specific action on your part. You have to enroll to receive Part A benefits. You also have to meet all qualifications for receiving Medicare Part A benefits. The primary qualifications require that you are age 65 or older, be a U.S. resident and a U.S. citizen or an individual admitted to the United States for permanent residency and lived in the U.S. for at least five continuous years prior to the month that you enroll in Medicare Part A.

There are some exceptions to the requirement that you take action to enroll to receive Medicare Part A benefits. If you are a disabled individual receiving Social Security benefits or you receive Railroad Benefits, you are automatically enrolled in both Medicare premium-free Part A and Part B. If you live in Puerto Rico, you have to enroll to receive the premium-free Part B benefits.

If you do not already receive these benefits, you must contact the Social Security Administration (SSA) to enroll. Your Medicare Part A coverage begins the month that you turn 65 years old. However, you need to enroll to receive Part A within six months of the month that you reach 65 years of age.

You must pay all your premiums to keep your Medicare Part A coverage. You also have to pay your Medicare Part B premiums in a timely manner.

Medicare Part A, although usually referred to as “Hospital insurance,” does potentially pay for other types of senior care options, based on eligibility and program coverage rules.

Learn more about senior living resources as you discover whether your Part A benefits may pay for part of the costs of your stay.

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