Medicare Part A: Do I Need to Enroll and Pay for It?

Generally speaking, Medicare covers services like laboratory testing, surgery and doctor visits, as well as the supplies necessary for your treatment and care, including wheelchairs and walkers, provided that all of this is considered medically necessary to treat an illness or condition. 

However, Medicare part A is basically hospital insurance, meaning it covers everything related to the care you receive through a hospital.

The Details: What Does Part A Cover?

• Hospital care: Whether this is inpatient care, at an institution under the care of nurses, or for long-term hospitalization. In these cases Part A will cover semi-private rooms, food, general nursing services, inpatient treatment, rehabilitation, and other more serious situations. Ask exactly what the coverage details are when choosing this Medicare plan. All these services are covered if your doctor issues an order stating that you require inpatient treatment and care. The hospital must also accept Medicare in order for your coverage to work. Even if you have chose Original Medicare, you might be responsible for some costs. Ask ahead of time to avoid surprises.

• Skilled Nursing Facilities (SNF): in these cases, the coverage applies for the following services, and for a limited duration: semi-private rooms, food, skilled nursing care, physical and occupational therapy, speech therapy, medication, medical equipment and supplies, transport in ambulance, nutrition services.

• Long-Term Hospital Care: or long-term care hospitals (LTCH). Medicare covers inpatient care for individuals who have a more serious condition but can improve through treatment and are able to return to their homes. Some deductible costs apply in certain cases. But you will never pay more for this type of hospital than you will for intensive care. Medicare’s website states that you will not have to pay a second deductible at an LTCH if you are transferred from an intensive care unit or if you are admitted to the hospital within 60 days of having been released from another hospital.

• Nursing home care: provided that the care is more than just custodial care. This means that you need help with needs other than taking a bath or getting dressed. Medicare covers this service when the help you need is more than custodial care, which can include things like changing bandages or medical devices. This service may have a cost. The first twenty days will not have a cost, but will start on the twenty-first day.

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• Hospices

• Home Health Care Services

Do I have to pay for Medicare Part A?

In general, you and your spouse will not have to pay a monthly premium for Part A if you paid Medicare taxes while you were working for at least 10 years. This is what is known as Premium-Free Part A. 

There are also other cases where you can have this hospital insurance coverage before or after turning 65 without having to pay a premium (monthly fee).

If you are under 65, you can still be covered by Medicare Part A only if:

• You received Social Security disability or Railroad Retirement Board benefits during 24 months.

• You have end-stage renal disease and meet certain requirements. 

If you are 65 or over you won’t have to pay premiums if:

• You are already receiving Social Security retirement or Railroad Retirement Board benefits.

• You are eligible to receive Social Security or railroad benefits but have not yet applied. 

• You or your spouse have a government job that provides Medicare coverage.

Many people, depending on their circumstances, pay a monthly premium for Medicare Part A from $259 to $471 (according to 2021 rates). 

The official Medicare site states that, in many cases, if you purchase Part A (hospital insurance) you will also have to pay for Medicare Part B, which is medical insurance. 

How Can I Know for Sure if I am Eligible?

Medicare has a telephone help line. If you would like to check your eligibility, call Social Security at 1-800-772-1213 or visit your local Social Security office. TTY users should call 1-800-325-0778.

You can also visit Medicare’s official website and use the eligibility calculator.

Here you can also find out if the health services you need are covered

Do I Have to Enroll or is It Automatic?

Enrollment in both Medicare Part A and Part B is automatic if:

• You receive Social Security or Railroad Retirement Board (RBR) benefits.

• If you are under the age of 65 and have a disability.

• If you have Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.

• If you live in Puerto Rico and receive Social Security or RBR benefits

In all of these cases, you will receive your red, white, and blue Medicare card 3 months before your 65th birthday or 25th month of disability.

You should enroll (meaning you don’t meet the requirements for automatic enrollment) if:

• You do not receive Social Security retirement or Railroad Retirement Board benefits (for example, if you are still working).

• You are eligible for Medicare because you have end-stage renal disease (ESRD).

• You live in Puerto Rico and want to enroll in Part B.

How Do I Enroll in Medicare Part A and B?

• Send your request online to Social Security

• Visit a local Social Security office.

• Call Social Security at 1-800-772-1213.

• If you worked for a railroad company, contact the RRB at 1-877-772-5772.

Government warnings: Medicare is managed by the Medicare Services Centers and Medicaid (CMS). Social Security works in collaboration with the CMS to enroll in Medicare.