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Does my elderly parent qualify for Medicare Part A?

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If you have questions concerning your elderly parent’s Medicare eligibility, MedicareInsurance.com is here to assist you. Simply contact us online via our live chat feature or give us a call at (800) 950-0608 to learn more.

Just the Essentials…

  • Medicare is a government-managed health insurance program that is composed of four parts: Part A, Part B, Part C, and Part D.

  • Medicare Part A covers costs related to inpatient hospital expenses, such as surgery.

  • Individuals aged 65 or older may qualify for Medicare Part A, as may those diagnosed with certain disabilities and those who have received certain social security benefits.

  • Medicare Part A premiums can vary, but as long as one has worked and paid taxes for at least 10 years over the course of their lifetime, they likely will not need to pay a Medicare Part A premium.

  • There are a few ways that your parent may be able to reduce out-of-pocket costs for Medicare. Contact MedicareInsurance.com today to learn more about whether this possibility applies to your parent.

What is Medicare?

Medicare is a healthcare insurance program that is regulated by the U.S. federal government. It is composed of different parts. When your parents first become eligible to apply for Medicare, they will typically apply for Medicare Part A and Part B, which are known collectively as “Original Medicare.”

Medicare Part A is mostly responsible for hospital-related insurance coverage, such as inpatient surgery, while Medicare Part B is mostly responsible for medical coverage like doctor’s visits.

The first part of Medicare, Part A, works a bit differently than the other parts of Medicare. In certain circumstances, Medicare Part A coverage may vary, and your parents may have to pay a premium for it.

What is Medicare Part A?

Medicare Part A covers inpatient hospital coverage or services related to a hospital stay. Most people choose to receive their hospital benefits through Medicare Part A because it covers services provided by a nationwide network of doctors and hospitals. When doctors and hospitals accept assignment from Original Medicare, the government pays the doctor or hospital for the services provided. This is known as fee-for-service. 

Under fee-for-service, your parent can see an approved doctor or go to the hospital whenever they require care. No prior authorization or permission from Medicare is required. In return, recipients of Medicare Part A are charged coinsurance for the service they receive. This is the cost that your parent is responsible for paying out-of-pocket. There are limits imposed by Medicare for how much doctors or hospitals can charge for the services or care they provide.

Who is Eligible for Medicare Part A?

One typically becomes eligible to enroll in Medicare Part A as soon as they turn 65 or are diagnosed with a qualifying disease or disability. One can also become eligible to receive Medicare Part A if they:

  • Have received Social Security or Railroad Retirement Board (RRB) benefits for four months before turning 65.
  • Are under 65 and have received Social Security or RRB benefits for 24 full months or 2 years due to a disability.
  • Have ALS and are receiving Social Security or RRB benefits.

What does Medicare Part A cover?

Medicare Part A is the hospital insurance portion of Original Medicare. While it does cover stays in the hospital including room, food, and medical care. It also provides coverage for other services as well. These services usually include include:

  • Care received from a skilled nursing facility: The services provided in a skilled nursing facility, a facility that patients stay in after a hospital stay of at least 3 days to continue recovering.
  • Home Health Care: Medical care provided by nurses, therapists, and home health aides at a patient’s home. The care is provided under orders from the patient’s doctor to promote continued recovery.
  • Hospice Care: Care provided by hospice services for the terminally ill. Like Home Health Care, it is ordered by a doctor.

Understanding Medicare Part A premium costs.

Medicare Part A is premium-free for the majority of people. Typically, one will not have to pay a premium for Part A as long as they have worked and paid taxes in a job for at least 10 years. 

If your parent hasn’t filed for Social Security benefits or RRB benefits yet, but they are still qualified to receive them, they can also apply for Medicare Part A without needing to pay a premium. The same is true if your parent has had Medicare-qualified government employment or if their spouse did.

Those who have worked for local, state, or federal government after December 31, 1982, and a state or local government employee after March 31, 1986, may be eligible for premium-free part A as well.

However, if your parent or their spouse has not worked for at least 10 years, and they paid social security taxes, they will need to pay a premium amount that varies depending on how long they have worked during their lifetime. As of 2021, the premium costs are as follows

  • $259 if your parent or their spouse has worked for 7.5 to just under 10 years over their lifetime
  • $471 if your parent or their spouse has worked for less than 7.5 years over their lifetime

Those who qualify as low income individuals may be eligible for the Qualified Medicare Beneficiary program, which helps pay for Medicare Part A and Part B premiums as well as other Medicare costs.

How might I reduce out-of-pocket costs for Medicare Part A?

In most circumstances, your parent is responsible for paying out-of-pocket costs associated with Medicare Part A. To minimize the expense, your parent can sign up for a supplemental insurance plan. These plans, commonly known as Medigap plans, are offered by private insurance companies. 

Medigap plans often require their beneficiaries to keep Original Medicare coverage. However, if your parent has other health insurance, such as that received from an employer, that insurance may act as secondary insurance and reduce out-of-pocket costs. Medicare Advantage Plans (also known as medicare Part C) can also help to reduce out-of-pocket costs but cannot be used in addition to Medigap.

To learn more about how Medicare Part A eligibility works or how your parent may be able to reduce out of pocket costs through Medicare Advantage, visit MedicareInsurance.com. Our team of insurance experts can help walk you through different plan options.

Want to learn more about how Medicare Part A eligibility works or how your parent may be able to reduce out-of-pocket expenses related to Medicare? Just contact MedicareInsurance.com via our online chat feature or by phone at (800) 950-0608 today!

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