Medicare Part A

Medicare Part A, also known as hospital insurance, typically covers expenses related to inpatient hospital stays, hospice care, skilled nursing care, and some home healthcare services. In addition, there are usually out-of-pocket costs, such as deductibles, coinsurance, and copayments, associated with this coverage.

What is Medicare Part A Insurance?

Medicare Part A is insurance for individuals 65 years or older or those with a disability or end-stage renal disease (ESRD). It is also known as "hospital insurance" and helps cover the costs of inpatient hospital stays, hospice care, and some home health care services.

What does Medicare Part A Insurance cover?

Medicare Part A covers the following services:

  • Inpatient hospital care: This is care received after you are formally admitted into a hospital by a physician. A general hospital stay of up to 90 days throughout each benefit period is covered, in addition to 60 lifetime reserve days. Medicare also includes up to 190 lifetime days in a Medicare-certified psychiatric hospital.
  • Skilled nursing facility (SNF) care: Medicare pays for lodging, food, and various services offered in a skilled nursing facility, such as medication management, tube feedings, and wound care. If you are eligible for coverage, you are protected for up to 100 days throughout each benefit period. You must require skilled nursing or therapy services and have at least three consecutive days as a hospital inpatient within 30 days of admission to the SNF to be eligible.
  • Home health care: Medicare will pay for those services if you are confined to your home and require skilled care. Your insurance covers up to 100 days of daily care or an infinite number of intermittent care sessions. You must have been a hospital inpatient for at least three consecutive days within 14 days of obtaining home health care to be eligible for Part A payment. (Note: If you don't fit the criteria for Part A coverage, you can still receive home health care under Medicare Part B.)
  • Hospice care: This is the care you may elect to receive if a provider determines you are terminally ill. As long as your provider verifies that you require care, you are covered.

Am I eligible for Medicare Part A Insurance?

You may be eligible for Medicare Part A if you are 65 years or older and a citizen or permanent resident of the United States.

Medicare Part A eligibility requirements for people under 65 years of age include those collecting Social Security Insurance (SSI) or Railroad Retirement Board (RRB) for 24 months due to a disability.

Additionally, there are specific guidelines for those under age 65 who suffer from either end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). The first month after becoming eligible for SSI benefits, people with ALS can start receiving Medicare Part A.

Coverage will also kick in during the month of a kidney transplant or earlier if a person requires hospitalization two months before a kidney transplant to prepare for the procedure.

Already have Medicare Part A ? Switching is easy

It might be time to switch insurers whenever the service that your existing insurer provides doesn’t meet your needs. For example, if you have a poor claims experience or an unexplained rate increase, it might be time to consider other options

If you cancel a previous policy before a new policy is effective, you could run into some serious financial problems.

Contact us today to help you with multiple options to choose from.

California Medicare Part A Buy-In Frequently Asked Questions

Background:

The Medicare Premium Payment Program, or Medicare Buy-In, allows Medi-Cal to pay Medicare Part A and/or Part B premiums for Medi-Cal members and others who qualify for Medi-Cal under special programs, allowing Medi-Cal to defer medical costs to Medicare where appropriate.

Q: Where can beneficiaries apply for Part A?

A: Part A Buy-In is an automatic process. Notifications will be mailed from CMS and/or the States of California.

Q: Does a beneficiary need to have a full Medi-Cal (No Share of Cost) to qualify?

A: Yes

Q: Once a beneficiary receives Part A coverage, do they qualify for a Special Enrollment Period (SEP) to enroll in a DSNP?

A: Yes. The beneficiary would be new to Medicare and qualify for both an SEP and an Initial Coverage Enrollment Period (ICEP). Note: ICEP guideline – Individuals who newly enroll in Part A and/or Part B beyond their initial Medicare enrollment period may elect to join an MA plan up to Two months after the date they have Part A or Part B coverage.

Q: Can a member contact the Health Net Medi-Cal support line for assistance with Part A Buy-In?

A: While Health Net call center terms will be provided information about the process, members should contact 1-800-MEDICARE to receive any needed assistance.