Effective: February 1, 2009
04.40.05 - Medicare Part A
Medicare Part A is hospital insurance. For more information on Medicare Part A, see the Medicare website.
Medicare Part A helps cover:
l Inpatient hospital care, including critical access hospitals and skilled nursing facilities.
l Certain medications while hospitalized.
l Some hospice care and some home health care if the beneficiary meets certain conditions.
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Medicare Part A has a monthly premium. However, most people do not pay the premium for Part A. People who have acquired 40 or more SSA or Railroad Retirement Board work credits are considered insured and are entitled to premium-free Medicare Part A. People acquire work credits based on their own or their spouse’s employment. Adult children who are disabled before age 22 acquire work credits from their parents.
The following people qualify for premium-free Medicare Part A:
l People age 65 or older who:
n Receive or would qualify to receive RSDI or Railroad Retirement benefits;
n Would be entitled to RSDI based on a spouse’s (or divorced spouse’s) work record and that spouse is 62 or older; or
n Worked long enough in a federal, state or local government job to be eligible for Medicare. (This is similar to the 40 work credits requirement.)
l People under age 65 who:
n Have received Social Security (RSDI) benefits based on disability for 24 months or more;
n Receive Social Security disability benefits and have amyotrophic lateral sclerosis (ALS), also know as Lou Gehrig’s disease;
n Have worked long enough in a federal, state, or local government job and meet the requirements of the Social Security disability program;
n Receive a disability annuity from the Railroad Retirement Board, after a waiting period; or.
n Are disabled widows or widowers, disabled divorced widows or widowers, or disabled children, usually after a two-year qualifying period. Previous months of eligibility for Supplemental Security Income (SSI) based on disability may count toward the qualifying period for disabled widows or widowers.
l People of any age with End-stage Renal Disease (ESRD) who receive maintenance dialysis or a kidney transplant and would qualify for monthly Social Security (RSDI or SSDI) or railroad retirement benefits through their own, their spouse, or parent’s work records (receipt of benefits is not required to qualify for Medicare due to ESRD).
Certain people age 65 or older are not entitled to premium-free Medicare Part A because they have not attained 40 work credits. They must also enroll in Medicare Part B to get Medicare Part A coverage.
l People who have less than 30 work credits pay the full Part A premium.
l People who have 30 or more work credits pay a reduced Part A premium.
The following people must pay a premium to get Medicare Part A:
l People age 65 or older who do not qualify for monthly RSDI or railroad retirement benefits, but who reside in the United States, whether or not they are U.S. citizens. If a noncitizen, the person must be lawfully admitted to the United States for permanent residence (LPR), and residing continuously in the United States five years or more at the time of application.
Note: This group includes SSI recipients age 65 or older.
l Certain disabled people who lost premium-free Part A due to work. See Qualified Working Disabled (QWD).
See Referrals to Medicare and The Buy-In for more information.
See Medicare Cost-Sharing Amounts for the Part A premium amounts.
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Medicare recipients must pay a deductible for hospital stays that are 60 days or less. See Medicare Cost-Sharing Amounts for the Part A deductible amounts.
The Part A coinsurance amount varies based on how many days the person has been hospitalized and in what type of facility. See Medicare Cost-Sharing Amounts for the Part A coinsurance amounts.
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