Medicare Part A and Part B make up Original Medicare. When you qualify for Medicare, it is usually Medicare Part A and Part B that you are first enrolled in. Medicare Part A generally helps pay your costs as a hospital inpatient. Medicare Part B may help pay for doctor visits, preventive services, lab tests, medical equipment and supplies, and more. Parts A & B are not in competition, but instead they are complementary, meaning that they togehter provide best health coverage in hospital and doctor`s offices as well.
PART A EXPLAINED
Medicare Part A is basically hospital insurance which covers a variety of hospital services. Part A generally covers inpatient hospital stays, skilled nursing care, hospice care, and limited home health-care services. In adition, it includes inpatient care recieved through: Acute care hospitals, Critical access hospitals, Inpatient rehabilitation facilities, Long-term care hospitals, Mental Health care and Participation in qualifying clinical research study.
Medicare Part A covers the entire cost for covered home health care services. If durable medical equipment is needed and it is ordered by doctor – it is covered under Medicare Part B and you are responsible for 20% of the Medicare-approved amount.
MEDICARE PART A COVERAGE
Medicare Part A covers a wide range of inpatient hospital services and other supportive care. Generally, it covers:
- Inpatient hospital care: This covers any tests or treatments you need while admitted to the hospital. It includes services like meals, nursing services, physical therapy, and medications that a doctor says are needed.
- Limited home healthcare: If you need care from a home health aid after you’ve been released from an inpatient hospital stay, Medicare will cover medically necessary care while you recover.
- Hospice care: Once you have made the choice to seek hospice care instead of treatment for a terminal illness, Medicare will cover most of your healthcare costs.
- Short-term skilled nursing facility stays: If you need skilled nursing facility care, Medicare will cover your stay and services for a certain amount of time.
MEDICARE PART A ELIGIBILITY
To be able to enroll in Medicare Part A, you must meet one of the four criteria:
- You are 65 years old or older,
- You have dissability determined by doctor and you recieve Social Security benefits for at least 2 years (24 months) in a row,
- You have been diagnosed with End stage renal disease (ESRD) and
- You have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), known as Lou Gehrig`s disease.
If you are currently receiving Social Security benefits and are under age 65, you will be automatically enrolled in Medicare parts A and B when you turn 65 years old.
MEDICARE PART A ENROLLMENT
Individuals already receiving Social Security benefits at least 4 months before being eligible for Medicare and residing in the United States (except residents of Puerto Rico) are automatically enrolled in both premium-free Part A and Part B when they turn 65th birthday. People living in Puerto Rico who are eligible for automatic enrollment are only enrolled in premium-free Part A.
Individuals who are not receiving a Social Security benefit are not automatically enrolled. These individuals must apply by contacting Social Security. Then there are two types of enrollment: Initial enrollment and Special enrollment.
Initial enrollment period is starting 3 months before your`s 65th birthday (including the month of the birthday) and lasts until 3 months after your 65th birthday. General rule is that your coverage starts on July 1 of the year you enroll.
Special enrollment is for cases when you did not enroll in the Inital enrollment period but you still want to enroll in Part A late. You may qualify to enroll during this period if you were employed by a company that had more than 20 employees when you turned 65 years old and had health insurance through your job, union, or spouse. In this case, you can apply for Medicare Part A within the 8 months after your previous coverage ended.
PART A COSTS
Most people who qualify for Medicare do not pay for Part A. This is the case if you or your spouse worked for at least 40 quarters (10 years) paying Medicare taxes. If you didn’t work for 40 quarters, you can still enroll and pay a monthly premium for Medicare Part A.
For the 2022, if you worked and payed taxes for a 40+ quarters you will have $0 premium. But if you have worked less than 40 quarters, there are some premiums you need to pay. For the period of 30-39 worked quarters you will be paying $274 premium for Part A, and if you have worked less than 30 quarters then your premium will be $499.