Medicare is the United States federal health insurance program first presented in 1966 to cover hospital and medical expenses. It was known as Original Medicare – Part A (hospital insurance) and Part B (medical insurance). Over the years, Medicare has expanded its program to offer even wider coverage, with two new parts – referred to as Medicare Part C (Medicare Advantage) and Medicare Part D (Prescription drug coverage). Medicare coverage is delivered not only by the federal government but also by private insurance companies that are contracted by Medicare.
In this blog, we will discuss Part A of the Medicare program, commonly referred to as hospital insurance.
Medicare Part A Coverage in Texas
Medicare Part A is the main part of health insurance, and it is the first half of Original Medicare. It is commonly referred to as hospital insurance because it covers services provided while you are admitted to a hospital. These services usually include but are not limited to: staying in a semi-private room, meals, medications for treatments, and general nursing care. Medicare Part A also covers skilled nursing facility care, hospice care, and limited home health services.
Skilled nursing facility care is covered under Part A of Medicare if you are admitted to the hospital for at least three consecutive days and if it is under a doctor`s orders to better help your treatment. Services included in skilled nursing facility care are, but are not limited to: staying in a semi-private room, meals, skilled nursing care, and occupational and physical therapy if considered needed.
Hospice care is generally always covered under Medicare Part A. It is described as end-of-life care because it is designed for those who are terminally ill. Coverage includes a wide range of supportive care, pain management, pain medications, and everything in its power to make patients more comfortable. Grief and loss counseling for all family members is also covered.
Home health services are covered under Part A if it is described as medically needed and approved by the doctor. Another requirement is to use a Medicare-certified agency. Coverage includes skilled nursing care, occupational and physical therapy, speech-language therapy, and social services.
In addition, Part A includes inpatient care received through acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, mental health care, and participation in qualifying clinical research studies.
What is not Covered Under Medicare Part A?
Be aware that Medicare Part A does not cover all hospital services provided. It does not cover your first 3 pints of blood, but if a hospital receives blood for you from a central blood bank, you may not be charged. Medicare Part A does not cover private rooms, inpatient care in a hospital is meant for you to stay in a semi-private room. If you have long-term care needs, such as a nursing home, you will have to pay for your own care out of pocket, because Part A is intended to provide care during the acute illness or injury.
Medicare Part A Eligibility
To qualify for Medicare in Texas, you must meet specific eligibility requirements. They are the same in Texas, as they are in other states because Medicare is a program on the federal level. First, you must be a U.S. citizen or permanent resident who lives in the U.S. for at least five years. You must also be 65 years old or older, or have a disability and receive Social Security Disability benefits for at least 2 years. You may qualify for Medicare under the exception of age if you have been diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).
Medicare Part A Enrollment in Texas
Most beneficiaries enroll in Medicare automatically. To enroll automatically you need to receive Social Security benefits before you turn 65, and then on your 65th birthday, you will automatically be enrolled in Original Medicare – Part A and Part B. Those who are not enrolled automatically need to apply for Medicare Part A through Social Security during on of three enrollment period: Initial, Special or General enrollment period. You can apply online through the Social Security website or you can visit their office in your city.
The Initial enrollment period happens only once, around your 65th birthday. In general, you are required to enroll in Medicare during this period or you will be exposed to a late enrollment penalty unless you qualify for Special Enrollment. Your initial enrollment period begins three months before your 65th birthday and lasts for seven months.
The General enrollment period occurs every year from January 1st until March 31st. It is intended for those who failed to enroll in Medicare Part A during their Initial enrollment period. However, they are still exposed to late enrollment penalties.
The Special enrollment period is specifically for individuals who are getting coverage through their employer. It starts in the month after your work coverage ends and it lasts for eight months. If you are eligible for special enrollment then a late enrollment penalty will not be applied.
There are many documents you will probably need for a Medicare application, so it is better to be prepared and know what to bring with you. The worst thing that can happen is that you miss one or more of the required documents during the application process. So here is the list of all documents needed to apply for Medicare:
- your Social Security card
- Proof of U.S. citizenship or proof of your legal residency if you are not the U.S. citizen
- Records of your earnings
- Original birth certificate
- A W-2 form or self-employment tax documentation
- Alternate proof of age besides a birth certificate
Medicare Part A Costs in Texas
Most beneficiaries in Texas qualify for premium-free Part A coverage. The only requirement is that you or your spouse have been paying Medicare taxes through your employment for at least 40 quarters, which is approximately 10 years of work. If you are not qualified for premium-free Part A, you will have to pay a monthly premium from $278 up to $506 in 2023.
The costs for hospital stays are the following:
- day 1-60 – $0/per day
- day 61-90 – $389/per day
- day 91+ – $778/per day
There are some options in Medicare supplement plans that can help you with paying hospital costs. For more information, read our blog about the Best Medicare Supplement plans in Texas.