Most individuals automatically get premium-free Part A coverage if they or a spouse paid Medicare taxes (one of the two parts of the FICA taxes withheld from their paychecks) while working for a specified duration of time (last 10 years of work).
Most people should enroll in Part A when they turn 65, even if they have health insurance from an employer.
For those individuals who do not automatically qualify for premium-free Part A coverage, the monthly Part A premium depends on an individual’s duration of Medicare-taxed employment.
You can get premium-free Part A at 65 if:
- You already get retirement benefits from Social Security or the Railroad Retirement Board.
- You're eligible to get Social Security or Railroad benefits but haven't filed for them yet.
- You or your spouse had Medicare-covered government employment.
If you're under 65, you can get premium-free Part A if:
- You got Social Security or Railroad Retirement Board disability benefits for 24 months.
- You have End-Stage Renal Disease (ESRD) and meet certain requirements.
Individuals with qualifying disabilities who are under age 65 are automatically enrolled in Part A after they have received Social Security or Railroad Retirement disability benefits for 24 months.
If you're automatically enrolled, you'll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or your 25th month of disability. If you don't get Medicare automatically, you’ll need to apply for Medicare online.
Part A helps cover medically necessary inpatient care in hospitals. In 2017 (these amounts usually chenge from year to year) , for each benefit period (as defined by Medicare) in a year, you pay:
- $1316 deductible and no coinsurance for a stay of up to 60 days
- $329 coinsurance per day for days 61-90 of a hospital stay
- $658 coinsurance per “lifetime reserve day” after the 90th day each benefit period (up to 60 days over a beneficiary’s (your) lifetime)
- All costs for each inpatient day beyond 150 days
- There is a maximum of 60 lifetime benefit days which can be used up a few days at a time on each benefit period or all 60 used during one benefit period.
Medicare defines a benefit period as the way that Original Medicare measures your use of hospital and skilled nursing facility (SNF) services.
- A benefit period begins the day you're admitted as an inpatient in a hospital or SNF.
- The benefit period ends when you haven't gotten any inpatient hospital care (or skilled care in a SNF) for 60 days in a row.
- If you go into a hospital or a SNF after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period.
- There's no limit to the number of benefit periods
Example of hospital costs:
Using 2017 rates
Part A does not cover custodial or long-term care.
Other coverages include:
- Blood - In most cases, the hospital gets blood from a blood bank at no charge, and you won't have to pay for it or replace it. If the hospital has to buy blood for you, you must take on of these actions:
- Pay the hospital costs for the first 3 units of blood you get in a calendar year
- Have the blood donated
- Hospice care
- Home health care
- Skilled nursing and rehabilitative care (as long as custodial care isn't the only care you need) only after a three day hospital stay, up to 100 days in a benefit period. ($164.50 coinsurance / day)
- Inpatient psychiatric care (up to 190 lifetime days)
Talk to your doctor or other health care provider about why you need certain services or supplies, and ask if Medicare will cover them. If you need something that's usually covered and your provider thinks that Medicare won't cover it in your situation, you'll have to read and sign a notice saying that you may have to pay for the item, service, or supply.
If you don't qualify for premium free Part A and decide to buy Part A, you'll pay up to $413 each month in 2017.
- If you paid Medicare taxes for 30-39 quarters, the standard monthly Part A premium is $227.
- If you paid Medicare taxes for less than 30 quarters, the standard monthly Part A premium is $413.
In most cases, if you choose to buy Part A, you must also have Medicare Part B (Medical Insurance) and pay monthly premiums for both. Contact Social Security for more information about the Part A premium.