How Medicare Part A Works

medicare part a

Original Medicare is made up of two parts, Medicare Part A and Part B. This article will talk about Part A.

After reading this article you will have a solid understanding on the following:

  • What is Medicare Part A
  • Who qualifies
  • What are the costs
  • When you need to enroll
  • The late penalty if you miss your first enrollment window
  • 3 ways to enroll in Medicare Part A

Let’s begin.

What is Medicare Part A?

Simply put, Medicare Part A is hospital insurance coverage for those who are 65 years or older. If you are ever hospitalized and then need a service like an inpatient skilled nursing to recover your Medicare Part A will help you pay for these costs.

Medicare Part A will generally cover things like:

  • Inpatient care in a hospital (medical or mental)
  • Hospice care
  • Home health care
  • Skilled nursing facility care
  • Inpatient care in a skilled nursing facility (no custodial or long-term care)

It does not cover:

  • Doctor services inside the hospital
  • Personal care items like razors, toothpaste, and socks
  • Private room unless it is medically necessary
  • Custodial care like help eating, bathing or getting dressed

Who qualifies for Part A?

If you fall into any of these categories you likely qualify for Medicare Part A.

  • You are 65 years old
  • Have been disabled for at least 2 years and now receiving disability benefits
  • Have a diagnosis of end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALC)
  • Free Medicare Part A if: you’ve worked at least 10 years (40 quarters) and you’ve paid Medicare taxes during this time
  • You will pay a premium for Part A if: you have not worked at least 10 years
  • You are a US citizen or a legal resident for at least 5 straight years

Do I Have To Pay A Premium For Part A?

The short answer is, it depends.

As I mentioned above, if you have worked at least 10 years or 40 quarters then you will not pay a premium for Part A. Most people qualify for the premium-free Part A.

Here are other ways to qualify for Premium-free Medicare Part A.

If you have not worked a total of 10 years/40 quarters then you will likely have to pay a premium.

  • Individuals who have worked less than 30 quarters will pay $437 per month for Medicare Part A.
  • If you’ve worked anywhere from 30 to 39 quarters you are looking at a monthly premium of $252.

Medicare Part A Deductible

If you are hospitalized you will have to pay the Part A deductible. The 2020 cost of the deductible is $1,408.

You will pay this deductible for each benefit period. A  benefit period will start on the first day you are inpatient hospitalized. This benefit period will last until you have been discharged from the hospital/skilled nursing for at least 60 consecutive days. It’s entirely possible that you can have multiple benefit periods (or owe deductibles of $1,408) in one year.

Note: Two ways to get help with deductible costs are choosing a Medicare Advantage Plan or a Medicare Supplement. These two programs will help you pay for enormous costs like this.

When Do You Enroll In Medicare Part A?

Medicare Part A has 3 different enrollment periods.

Initial Enrollment Period

Your first chance to enroll in Part A is during the Initial Enrollment Period (IEP). You are encouraged to enroll during this time because if you miss it you could potentially pay a lifetime penalty.

This enrollment window is available to you for a period of 7 months. This includes the 3 months prior to your 65th birthday. It includes the month of your birthday.  It also includes 3 months after your birthday month.

When your Medicare Part A benefits take effect will depend on your birthday. If your birthday is on the 1st of the month, say March 1st, then your benefits will begin one month before you turn 65 on February 1st. If you are born on any day ranging from March 2nd to 31st, your benefits will begin that same month on March 1st.

General Enrollment Period

The General Enrollment Period is the next way to enroll in Medicare Part A.

This enrollment window runs from January 1st to March 31st each year. If you sign up during the General Enrollment your benefits will begin on July 1st of that same year.

Your Medicare card will arrive 3 months prior to your coverage beginning.

Special Enrollment Period

The best way to describe a Special Enrollment Period (SEP) is if your income, employment status, insurance coverage or family size somehow changes you can potentially qualify to enroll A during this time.

Here are situations that could qualify you for the Special Enrollment Period:

  • You or your spouse lose their employment
  • A loss of your current insurance coverage
  • The insurance you have changed their plan with Medicare
  • You move outside of your current insurance plan’s network
  • Getting released from jail or a skilled nursing facility back into the community

You will find lots more reasons to qualify for the Special Enrollment Period at Medicare’s Special circumstances page.

Late Enrollment Penalty for Medicare Part A

Most individuals qualify for the premium-free Medicare Part A, however, others have to pay each month.

The individuals who do not qualify for the free Medicare Part A and also fail to enroll when they were first eligible must pay a late enrollment penalty.

The penalty is 10% for each 12-month period that you were eligible for Part A but did not enroll.  This penalty will follow you for twice the number of years that you went without Part A.

For example…

If you missed your Initial Enrollment Period by 3 years, then you would pay the penalty for 6 years. For this reason, is extremely important to sign up for Medicare during your Initial Enrollment Period.

How To Enroll In Medicare Part A

There are 3 options for enrolling in Part A. No matter which option you choose you will deal directly with the Social Security Administration because they manage this program.

  1. Visiting the Social Security website to complete an online application. This process takes less than 10 minutes.
  2. Visit a local Social Security office. You will find a map of the Houston area offices below.
  3. Contact Social Security at 800.772.1213 anytime Monday through Friday from 7 am to 7 pm.


For even more information see this guide titled How to Apply For Medicare In Houston.

Conclusion

As you get older, so does the likelihood of hospitalization.

According to Statista, 15% of seniors 65 and older were hospitalized at some point during 2017. Compare that to only 7% of individuals 45 to 64 being hospitalized the same year. This is one reason you should consider signing up for Part A the first chance you get because those hospital stays can become expensive.

The second reason is the penalties you will incur if you do not sign up for Medicare during your Initial Enrollment Period.

The bottom line is it could cost you money or result in limited medical treatment options if you fail to apply for Part A at the right time.

This IS serious stuff, but nothing to be afraid of if you’re prepared.

Should there be any confusion about Medicare Part A or any related issues you can reach out to me for answers. I live in the Houston area, I’m patient and always happy to help.

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