Who Qualifies For Medicare Part A and What Does Medicare Part A Cover?

Posted by Elliot Marks

Medicare is a nationally funded insurance for elderly individuals who are over sixty-five years of age. It also applies for individuals who are younger than sixty-five with terminal illnesses such as amyotrophic lateral sclerosis (ALS) or kidney failure. It is important to note that Medicare will not cover every medical expense, but will assist with costs. You can submit an application for Medicare Part A through your local Social Security office. They will process it along with thee Centers for Medicare and Medicaid Services. You will get a Medicare card once you are approved. You can learn how to apply here.

Overview of Medicare Part A

Medicare Part A is also known as hospital insurance. It pays for temporary stays in a hospital or nursing facility primarily. It's important to know that it will only pay for stays in a nursing facility when the stay was followed by a hospital stay. Medicare part A will also assist in paying for basic health and hospice care.

As aforementioned, Medicare Part A can be signed up for by visiting your local social security office. You can also fill in the application that is found on Social Security's website.

Medicare Part A hospital insurance

Who Qualifies for Medicare Part A?

As previously mentioned, Medicare Part A is for individuals over the age of sixty-five. Individuals who are under the age of sixty-five but who have a terminal illness or disability may also qualify. Anyone who qualifies must be a citizen of the United States at the time of submitting the application.

There are individuals who may qualify for Medicare Part A for free. These individuals meeting the qualifications below must be at least sixty-five years of age. To ensure you get the benefits quickly, it is also important to sign up at least three months before you turn sixty-five at their website.

If you or your spouse already could or do receive Social Security or Railroad Retirement benefits, Medicare Part A will be free. Spouses are included if they have already passed or if you are divorced. If you or a spouse worked in a government job with Medicare taxes, you will also qualify for free coverage. Finally, if you are a parent of a child who has since passed that was covered, you will qualify for free Medicare Part A coverage. Are you eligible for Medicare? Find out here!

Social Security Benefit Eligibility

It's important to make sure that you're eligible for Social Security retirement benefits. The following guide will help you determine whether you qualify.

Social Security Eligibility

Don't Qualify For Any Of The Above?

If none of the above qualifications apply to you, you can still get Medicare Part A. You will get this benefit through paying a monthly premium just as with any other insurance policy. You must apply during open enrollment if you have to pay, however.

It is possible to get Medicare Part A for free if you are not of sixty-five years of age by meeting one of the following conditions. You've had to receive benefits from either the Railroad Retirement Board or the Social Security office for at least two years. You could also qualify if you received benefits for amyotrophic lateral sclerosis or have a diagnosis of kidney failure and have received dialysis. You can also qualify by working in a government job with Medicare taxes and being eligible for benefits for at least two years, or are the child or widow of a worker in this situation.

Specific Medicare Part A Coverage

Hospital Coverage

Medicare Part A, as mentioned, is considered hospital coverage. Your policy will cover or assist with expenses such as room, food, nursing care and medications. This coverage is for acute care, critical care, rehabilitation, long-term care, psychiatric care and even research study hospital stays.

It does not cover a private room, private nursing and personal hygiene items and personal amenities. Blood transfusion purchases are also not covered. It is possible that the hospital could get blood from a donation, however.

Home Health Coverage

When necessary, Medicare Part A will cover or assist with home health care. It will provide assistance or coverage when the home health care is noted as necessary by a doctor. Services included are skilled nursing, physical therapy, speech-language pathology, occupational therapy, social care, home health aides and equipment prescribed by the doctor.

It is important to note that Medicare Part A does not cover home health that is constant, delivered meals or home maid services. Personal care services by themselves are also not covered. It is also important to note that any equipment that is covered or assisted with will not be covered if it not provided by an agency that is Medicare-certified. It will also be not covered if you are not homebound.

Nursing Home Coverage

As previously mentioned, Medicare Part A will cover nursing home stays that occur after a hospital stay. The hospital stay has to have had been at least three days. The nursing home must be Medicare-certified to qualify as well. Coverages include rooms, food, skilled nursing, rehabilitation when needed, social care, prescriptions, equipment, transportation and nutrition if needed. Medicare Part A will not cover or assist with long-term nursing facility stays.

Hospice Coverage

Hospice is end of life care that Medicare Part A will cover. It will assist with when you have less than six months to live. You also must be in agreement that you are not looking to cure your illness but to manage it until death, though hospice care can be stopped. The hospice care must be Medicare-certified as well, whether in home or residential. The specific items covered include doctors, nurses, prescriptions, social care, equipment and supplies, hospice aides, maid services, therapeutic services, nutritional services, short-term inpatient in a hospital and short-term respite if necessary. Counseling may also be provided.

Medicare Part A hospital insurance

Final Thoughts

Medicare Part A is an insurance option for those who are over the age of sixty-five or who have a terminal illness with benefits. It is called hospital coverage as it does cover hospital stays and nursing home stays after the hospital. It's important to note, however, that Medicare Part A will also cover home health or hospice care when necessary for a terminal illness. It is important to fully understand Medicare Part A in order to best understand the benefits you will receive. You can learn more information about Medicare Part A on their website.

Elliot Marks

Elliot Marks

Author & Social Security Advisor

Elliot Marks has spent over 10 years providing clear and concise information to help Americans navigate the complex nuances of social security and many other government services in the United States. Elliot has a passion for helping those in need of these services to be able to find timely access to news and information that is relevant and helpful to their daily lives.