Medicare Part A coverage is provided by the federal government and covers the types of care below:
- Inpatient hospital care
- Skilled nursing care following a hospital stay
- Hospice care
- Home health care
Please note: Some of these benefits are only covered in limited situations under certain conditions.
Part A Eligibility
When you turn 65, you are eligible for Medicare Part A if you meet the following criteria:
- You are age 65 or older and a U.S. citizen or legal resident
- You have paid Medicare taxes while working at least 10 years or 40 quarters
- You are already receiving retirement benefits
- You are receiving disability benefits
- You have ALS or ESRD
You most likely will not have to pay a premium for Medicare Part A if you meet the criteria above. If you don’t meet the criteria above, you may still be able to enroll in Part A coverage. You will just have to pay a premium. If you are eligible for Part A coverage but delay enrollment, you may have to pay a late enrollment penalty.
Medicare Part A covers hospital expenses that are critical to your inpatient care, including nursing services, a semi-private room, meals, medications and any other hospital services and supplies. This coverage applies to care you receive at:
- Acute care hospitals
- Long-term care facilities
- Inpatient rehabilitation centers
- Critical access hospitals
- Mental health care facilities
- Participation in qualifying clinical research studies
Medicare Part A does not cover:
- Costs for a private room (unless medically necessary)
- Private-duty nursing
- Personal care items (shampoo, razors, etc.)
- Any extra charges for television or telephone access
- The cost of blood purchased for you.*
*You would have to pay for the first three units of blood you receive each calendar year. There is no charge if the hospital receives blood from a blood bank or if it is donated by you or someone you know.
Nursing Home Benefits
After a qualifying inpatient hospital stay of at least three days, Medicare Part A covers a skilled nursing facility stay for a related illness or injury. Your discharge day and any time spent under observation as an outpatient do not count towards your qualifying stay.
You must use a Medicare-certified facility for services to be covered. These services may include:
- Rehabilitation services
- Medical social services
- Semi-private room
- Medications while under care
- Medical supplies and equipment used while under care
- Dietary counseling
- Ambulance transportation to the nearest provider (if the necessary services aren’t offered at your current provider)
Home Health Care Benefits
Medically necessary home health care services ordered by a doctor are covered by Medicare Part A (as long as it is provided by a Medicare-certified home health agency). A doctor must also certify that you are “homebound.” This means you meet both of the following criteria:
- Your doctor believes your health or illness could get worse if you leave home OR you need help from another person or medical equipment (crutches, walker or wheelchair) to leave your home
- It requires substantial effort for you to leave your home under normal circumstances
Home health care services may include:
- Part-time or intermittent skilled nursing care
- Part-time or intermittent home health aide services
- Speech-language pathology services
- Medical social services
- Physical therapy
- Occupational therapy
- Durable medical equipment
Medicare Part A will only cover 24-hour home care, homemaker services and personal care services (bathing, dressing, etc.) if it is related to your treatment.
Hospice Care Benefits
Hospice care services may be covered if your doctor has certified that you have a terminal illness with an estimated six months or less to live. You must also receive services at a Medicare-approved facility. The goal of hospice care is to help relieve pain and make patients as comfortable as possible. You must meet the following conditions to qualify for covered hospice care:
- Your doctor has certified that you have a terminal illness with six months or less to live
- You agree to give up medical treatments for your terminal illness (palliative, or comfort-focused, treatment will still be provided)
Hospice care services covered by Medicare Part A may include:
- Doctor services and nursing care
- Social services
- Hospice aide services
- Homemaker services
- Physical and occupational therapy
- Pain relief medications
- Dietary counseling
- Medical supplies
- Durable medical equipment
- Short-term inpatient care (if necessary to manage pain or symptoms)
- Short-term respite care
- Spiritual and grief counseling in some cases
You may stop hospice care at any time if you decide you would like to receive medical treatments. You can discuss your options with your doctor.
Medicare Part A Enrollment
Enrollment in Medicare Part A is usually automatic if you are already receiving Social Security retirement benefits or benefits from the Railroad Retirement Board (RRB) when you turn 65. Benefits begin the first day of the month you turn 65 (unless your birthday is the first day of the month). In that case, your benefits begin the month before your 65th birthday. You will receive your red, white and blue Medicare ID card approximately three months before you turn 65.
In cases where your enrollment is not automatic, you have three periods to manually enroll. These periods include:
- Initial Enrollment Period when you turn 65
- General Enrollment Period if you decide to wait
- Special Enrollment Period for special cases, like losing your employer-sponsored coverage
Initial Enrollment Period
If you do not qualify for Social Security or RRB retirement benefits, then you must enroll for Medicare Part A manually during the Initial Enrollment Period. This period lasts seven months and includes
- Three months before your 65th birthday
- The month you turn 65
- The three months after your birthday
If you do not enroll during this time, you will have to wait until the next General Enrollment Period unless you qualify for a Special Enrollment Period.
To get started, you can visit the Social Security website, visit your local Social Security office or call 1.800.772.1213 (TTY users dial 1.800.0778), Monday through Friday, from 7:00 a.m. to 7:00 p.m.
If you are disabled, your enrollment period will begin 24 months after you start receiving Social Security disability benefits. You should receive your Medicare card approximately three months before your enrollment.
ALS and ESRD
Your Medicare Part A benefits and Medicare Part B benefits will begin at the same time as your Social Security disability benefits if you have ALS or ESRD. You should receive your Medicare card about one month after you sign up for Social Security disability benefits. If you have ALS and require dialysis, the Social Security Administration will determine your Medicare enrollment date.
General Enrollment Period
You may also enroll for Medicare Part A during the General Enrollment Period, which runs from January 1 to March 31 each year. Your coverage will begin on July 1 of that year, and you will receive your Medicare card approximately three months beforehand.
Please note: You may be subject to a penalty if you are not eligible for premium-free Medicare Part A and did not enroll during the Initial Enrollment Period.
Special Enrollment Period
You can enroll in Medicare Part A outside of the General Enrollment Period in some cases. For example, if you or your spouse were to lose employer- or union-sponsored hospital insurance, or if you were a volunteer serving in a foreign nation between April 1 and December 31, you could enroll during the Special Enrollment Period.
Your eight-month period begins the month after you or your spouse’s employment or group coverage ends. You will receive your Medicare card within 30 days of your enrollment and your coverage will begin the first of the month after you enroll.
If you are required to pay a Medicare Part A premium, you usually don’t have to pay a premium penalty when enrolling during this period.
Page last updated on 3/26/2018
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H4497_H6723_WS_2016_Jun15 CMS Approved