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What to Know When Considering Medicare Part A

Are you thinking about signing up for Medicare Part A? Most people will want to sign up for Part A, but there are of course exceptions to this rule. Plus, there are some things everyone should know before they make the decision to sign up for Part A. You might have heard that it’s “free” but what does this actually mean. Learn more about what you need to know before you sign up for Medicare Part A, in our blog!


What should you think about when considering Medicare Part A?

What to Know When Considering Medicare Part A

What does it cover?

Medicare Part A covers stays in hospitals, as well as medically necessary care in skilled nursing facilities, hospice, and home health care. If you go to the hospital, you have a $1,260 deductible for the period of your stay. However, if you’re in the hospital for more that 60 consecutive days, or 20 in a skilled nursing facility, you will have to start paying coinsurance fees. You are allowed to have multiple hospital visits per year, but they need to be separated by at least 60 days.

Part A does not cover the surgical procedures, testing, or other treatment you receive at the hospital. This is covered by Part B, which covers about 80% of these costs. Think of Part A as room and board for a hospital stay.

Is it “free”?

You may have heard that Part A is free. It is not. What people mean by this is that if you are eligible to collected Social Security benefits, then you don’t have to pay the premium for Part A. If you are not eligible for these benefits, then you do have to pay the premium, which can be up to $407 a month.

If you are not eligible but your spouse is, then you qualify for the no-cost premium under the Medicare spousal benefit.

What if I’m keeping my employer plan?

Some people choose to stay with their employer group health insurance when they turn 65. If you’re doing this, should you sign up for Medicare Part A?

If your employer has 20 or fewer employees, you’ll have to sign up. But if your employer has 20 or more employees, you don’t need to. But should you?

If you don’t have to pay the premium (because you qualify for Social Security benefits) then it’s a good idea to sign up for Part A, because it will help defer the costs of hospital expenses not covered by your employer plan. You will of course need to pay the deductible. In addition, “Part A will only help you with expenses that do no exceed Medicare-approved limits for covered provider procedures,” according to PBS.

When you should not sign up for Part A.

“The exception is when the employee is in a high-deductible health plan that includes a health savings account that is funded with pre-tax dollars,” says PBS. “These plans are not open to anyone taking Medicare, including Part A.

The drug coverage caveat.

In order to sign up for Part A, you need to have prescription drug coverage from your employer that is as good or better than what you could get from Part D. Otherwise you might be forced to enroll in Part D. Or, when your employer coverage ends, you would have to pay premium surcharges that come with late enrollment in Part D. “Realistically, if your drug coverage was this bad, you might well be better off dropping out of your employer plan and moving totally onto Medicare.

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