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COLUMN: What does Medicare Part A cover?

William C. Lane, Ph.D., Courtesy Oneida County Office for the Aging
Posted 5/6/23

Our March article examined Medicare Part B, which covers outpatient health services. In this article, we will look at Medicare Part A, the hospital insurance portion of Medicare coverage.

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COLUMN: What does Medicare Part A cover?


Our March article examined Medicare Part B, which covers outpatient health services. In this article, we will look at Medicare Part A, the hospital insurance portion of Medicare coverage. In future articles, we will examine Medicare Part C (Advantage Plans), Medicare Part D drug plans, and Medicare supplemental insurance (Medigap plans).

Signing up for Medicare Part A

If you are receiving Social Security or Railroad Retirement Board benefits when you turn 65, you will automatically be enrolled in both Medicare Parts A and B starting on the first day of the month after you turn 65. Three months before you turn 65, you will receive your Medicare card. You do not need to pay a premium for Part A.

If you are not employed and are not yet receiving Social Security benefits when you approach age 65, you will need to apply for Medicare. You are eligible to sign up for Medicare 3 months before you turn 65, through the period that runs 3 months after your birth month. This seven-month period is known as the Initial Enrollment Period. If you do not apply during this period, you may be required to pay additional premium penalties. To apply, you need to contact Social Security (or the Railroad Retirement Board) to start the application process. Many find that it is most convenient for them to apply online. After you sign up, you will receive your Medicare number.

If you are still employed and covered by an employee health plan, you will need to speak to your human resources department about what they want you to do. In most cases, your employer will require you to enroll in Medicare. Medicare becomes your primary insurance provider, and your employee plan will become your secondary or supplemental provider. If you will be covered by your employer’s plan in retirement, this primary/secondary pattern will continue.

What does Medicare Part A cover?

Medicare Part A helps you pay for:

Inpatient hospital care. Part A covers a semi-private room, general nursing, meals, drugs and other services and supplies that are part of your hospital treatment plan. You will be charged a deductible but no coinsurance for days 1-60. Part A does not cover a private room, unless medically necessary, private-duty nursing, a television or phone in your room, or personal care items. Your Part B plan will generally cover 80% of your Medicare-approved doctors’ services while you are in the hospital.

Inpatient care in a skilled nursing facility. This benefit is for rehabilitation following a hospital stay but not custodial or long-term care. In order to be covered for this care following discharge, you must have completed three consecutive days on inpatient status. It is possible to be in the hospital on what is termed observational status. Observational status means that you have never been considered a fully admitted inpatient, so your rehabilitation care following discharge will not be covered.

Hospice care. Hospice care is generally delivered in the home but can also be delivered in a specialized hospice facility. Fully covered, with no co-payment, services include pain management, medical, nursing, and social services, durable medical equipment, and home health aide and homemaker services. There is a $5 per prescription charge for outpatient pain management drugs.

Home health care following a hospital stay. This benefit may include physical, occupational, and speech therapy, as well as medical social services. You pay nothing out-of-pocket for these services. Durable medical equipment requires a 20% co-payment.

Inpatient care in a religious, non-medical health care institution. Care in these types of facilities will be discussed in a future article. In general, Part A will cover services that are related to patient health care but not those that are religious in nature.

COVID emergency ending

On April 10, President Biden signed a bill passed by Congress ending the COVID-19 national emergency, first implemented in 2020 under the Trump Administration.

However, the public health emergency does not end until May 11. This means that you will still be able to order free COVID-19 test kits until that time. Will mask requirements in health care facilities and other locations remain in effect? Barring some guidance from New York state, when the public health emergency ends, it appears that mask requirements and other measures currently in place will be up to individual institutions.

William Lane is the owner of William Lane Associates, a gerontological consulting firm located in Homer, NY. He writes a monthly column on HIICAP related issues for the OFA. Dr. Lane does not sell insurance, work for any insurance company or recommend any insurance products.


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