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No one plans to end up in the hospital, but it's reassuring for millions of enrollees to know that Part A covers so much of hospitalization expenses. It's also comforting to know that most folks who are eligible for Medicare do not have to pay a Part A premium.
Part A coverage – or "hospital insurance" – pays for a broad range of inpatient care in hospitals, skilled nursing facilities and critical access hospitals. And, while it does not include long-term care, Part A may cover some hospice or home health care.
More specifically, the list of expenses covered by Part A includes:
If you are receiving Social Security or Railroad Retirement Board benefits and live in one of the 50 states, the government automatically enrolls you in Medicare Part A at no cost when you reach 65. Look for your Medicare card to automatically arrive in the mail three months prior to your 65th birthday (or the 25th month of a disability).
Individuals not eligible for automatic and free Part A enrollment have a seven-month window of time to enroll, beginning three months prior to the month they turn 65. Enrolling beyond that window triggers higher premiums. Those suffering from ALS receive their Medicare Part A card through the mail the month their disability benefits begin.
How much you pay for Medicare Part A coverage depends on your work history. If both you and your spouse worked and paid into Medicare through taxes for 10 or more years, you pay nothing each month for Part A. If you worked and paid into Medicare less than 10 years, you'll pay $254 a month – and $461 a month if you've paid into Medicare less than 7½ years.
Medicare recipients generally pay 20 percent of the Medicare-approved amount for health care services. For example, if your doctor's visit costs $75, you pay $15. Medicare pays the remainder. However, you must reach a deductible (of $1,024 in 2008) before coverage kicks in.
Also called "traditional" Medicare, it's the fee-for-service program in which the government pays your health care costs. The coverage includes Medicare Part A and Medicare Part B and allows you to see any doctor anywhere (who accepts Medicare patients).
Medicare Part A helps cover inpatient hospital visit expenses, including a semi-private room, medical tests and doctors' fees. It may pay a portion of skilled nursing expenses and home health services, if ordered by a physician, and often 100 percent of hospice care.
Medicare Advantage plans replace your government coverage with private insurance. These plans cost more but offer more benefits than traditional medicare.
Medicare Part D is prescription drug coverage available only through private companies, but any individual who receives Medicare health insurance is eligible. Part D covers both brand name and generic drugs with a short list of exceptions.
Medigap plans offer supplemental benefits sold by private companies to extend traditional medicare. Fourteen plans offer varying combinations of benefits, covering copayments and deductibles and foreign travel emergency expenses, at-home care and preventive care.