Medicare Part A: Easy to Understand Guide to Medicare Part A
Medicare Part A is a government-funded hospital insurance intended to benefit certain individuals. Qualifying Medicare Part A recipients receive insurance for many hospital inpatient services with only a 20% co-payment or coinsurance payment required for some services.
If you or your spouse paid Medicare taxes while you were working, you typically won’t have to pay a premium for Part A. However, if you qualify for Part A, but didn’t pay enough taxes to avoid a premium, you can still purchase coverage for up to $443 a month.
Video: Medicare in Simple Terms (HCFA)
Taxes Paid to Qualify for Medicare
To qualify for Medicare, you must have paid a certain amount of taxes and earned a certain number of “credits.” The amount of earnings needed to earn one credit changes each year. In 2009, the amount you need to earn to get one credit is $1,090. You can earn a maximum of four credits in one calendar year. If you were born after 1929, you need 40 credits to qualify for Medicare. That’s 10 years of work. If you were born before 1929, subtract one credit for every year before 1929 you were born. For example, you would need 38 credits if you were born in 1927.
What is Covered By Medicare Part A?
The following is a list of services that are covered by Medicare Part A. If you have additional questions about covered services, you can visit the Medicare website or call 1-800-633-4227.
Blood
- Part A covers blood after the first 3 pints
- You pay for the first 3 pints received during a calendar year
- If the blood is donated from the blood pay, there is no charge
Home Health Services
- If your doctor orders it, you can receive part-time skilled nursing care, physical therapy, occupational therapy, or speech-language pathology.
- Medical social services, home aide services, medical supplies, and medical equipment may be included.
- The first 100 visits after a hospital stay are covered by Medicare Part A
- To qualify, you must be homebound, that is, it takes a great deal of effort for you to leave the home.
Video: What is Medicare and How Do I Use It?
Hospice Care
- Part A covers hospice care for individuals who have a terminal illness and have been doctor-certified to live only 6 months or less
- Hospice care can be given in the home by a Medicare-approved hospice
- A short stay in an approved facility may be covered
- Inpatient respite care is provided, including up to 5 days each time
- Drugs, medical services, and nursing services are covered
- Unrelated health problems may be covered
Hospital Stays
A hospital stay in a semi-private room including means, nursing, drugs, hospital services, and medical supplies - A private room may be covered if the doctor deems it medically-necessary
- Part A only covers the hospital stay. The cost of the doctor’s services are covered under Medicare Part B
Skilled Nursing Facility Care
- Up to 100 days in a benefit are covered after a minimum 3-day inpatient hospital stay
- The hospital stay must have been for a related illness
- Part A covers a semi-private room, including meals, nursing, rehabilitative services, and medical supplies
- Your doctor must state that you need skilled care on a daily basis
Part A Primary Insurance
You may have multiple insurance policies, especially if you are still covered under an employer’s group health insurance plan. In that type of situation, you typically have to select a primary insurance, which is the insurance that gets billed first. Once your primary insurance pays its share, the secondary insurance typically kicks in and pays the difference.