Texas Medicare Part A is a government service that provides hospital coverage for seniors. Most seniors receive Medicare Part A at no cost. If you or your spouse paid Medicare taxes through a job for at least ten years, you are eligible for free hospital coverage through Medicare Part A. Some younger people with qualifying disabilities or health concerns can also receive Medicare Part A.
Medicare Part A coverage is only one piece of your Medicare puzzle. Explore your Medicare Part A choices so you can make the most informed decisions for your health.
What does Texas Medicare Part A cover?
Medicare Part A is insurance for hospital services. This portion of Medicare provides for your hospital stays, treatment at a skilled nursing facility, and hospice care. Some home health services are also covered.
Medicare Part A – Hospital Care Coverage
Medicare Part A covers in-patient hospital stays, so long as certain conditions are met.
In order for your hospital stay to be covered by Part A, you must be admitted to the hospital under a doctor’s order. This is when a doctor formally recommends you to stay in a hospital to receive treatment or care. Your hospital must accept Medicare in order for your stay to be covered. In some cases, a hospital board must also approve of your stay.
Medicare Part A – Home Health Care Benefits
Texas Medicare Part A coverage includes home health care under some circumstances. Home health care can include skilled nursing, physical therapy, social services, and other treatments.
Your doctor must order home health services for them to be covered by Medicare Part A. Your doctor must also certify that you are homebound, which means both that you cannot easily leave your home and that it is medically dangerous for you to do so.
Medicare Part A – Nursing Home Coverage
Medicare Part A provides for skilled nursing care in a nursing home or other long-term treatment facility. You are eligible for meals, medicine, social services, physical therapy, nursing care, a shared room, ambulance transport, and other services through Medicare Part A.
Your treatment must meet some requirements in order to be covered. Nursing home coverage typically requires a qualifying hospital stay related to your need for skilled nursing. Your nursing home must also accept Medicare Part A.
Medicare Part A – Hospice Coverage
Texas Medicare Part A coverage also features hospice care. Hospice treatment takes place at the end of a patient’s life and focuses on maintaining comfort and dignity. Hospice care is usually performed in a patient’s own home, which is covered by Medicare.
Hospice treatment has some requirements to be covered by Medicare Part A. Your doctor must certify that you have a terminal illness with less than six months to live, and you must agree to stop any treatments designed to cure this illness. Hospice providers must accept Medicare to receive benefits.
What doesn’t Texas Medicare Part A cover?
Part A does not provide for 24-hour-a-day care at home or meal delivery. Home-keeping services (such as help with shopping, cleaning, and laundry) and personal care (such as using the bathroom or dressing) are also not covered when those are the only services you need.
What’s the difference between Medicare Part A and B?
Texas Medicare Part A is only hospital coverage, and Texas Medicare Part B is medical coverage. Part B covers visits to your doctor’s office, vaccines, preventative services, screening tests, cancer treatment, medical equipment, and many other services.
Most people don’t pay a premium for Part A coverage but do pay a Part B premium. The “standard” premium in 2020 was $144 for the year.
How much does Medicare Part A cost?
Most people over 65 don’t pay anything for Medicare Part A. If you or your spouse worked for more than 10 years and paid Medicare taxes at this job, you receive Medicare Part A coverage with no premium.
If you are under 65, you can still receive Medicare Part A with no premium under certain conditions. You are eligible if you received disability benefits for 24 months, or if you have End-Stage Renal Disease.
If you are over 65 but don’t have ten years of qualifying employment, you can purchase Medicare Part A coverage. Depending on your tax history, you may pay a standard premium of either $252 or $458.
What is the deductible for Medicare Part A?
If Medicare is your primary insurance, you have a deductible of $1,556 that must be paid before Medicare pays for hospital services.
Eligibility for Medicare Part A in Texas
Most people become eligible for Medicare on their 65th birthday. If you or your spouse paid Medicare taxes through a job for at least ten years, you become eligible for Medicare Part A when you turn 65.
Occasionally, younger people are eligible for Medicare before turning 65. Eligible patients have permanent disabilities, serious medical conditions, or End-Stage Renal Disease (permanent liver damage).
Texas Medicare Enrollment Periods for Part A
Initial Enrollment Period for Part A: Your 65th Birthday
Your Initial Enrollment Period is unique to you and covers seven months around your 65th birthday. The Initial Enrollment Period begins three months before your 65th birthday includes your birthday month, and lasts three months after your birthday.
General Enrollment Period for Part A: January 1 to March 31
If you don’t sign up for Medicare in your Initial Enrollment Period, you can sign up later. The General Enrollment Period for Texas Medicare Part A and Part B lasts from January 1 to March 31 each year.
Medicare Advantage Open Enrollment: April 1 to June 30
If you signed up for Medicare Parts A and B during the General Enrollment Period, you can enroll in Medicare Part D from April 1 to June 30. Medicare Part D is prescription drug coverage.
Open Enrollment: October 15 to December 7
During Medicare Open Enrollment, you can change from Medicare Part A and B to a Part C plan. Medicare Part C plans are offered by private insurance companies and may provide additional coverage to standard Medicare options.
Special Enrollment Period for Part A
Seniors who are still working and are covered by their employer’s insurance when they turn 65 can keep their private insurance and sign up for Medicare after this coverage ends. Their Special Enrollment Period lasts as long as they are covered by their employer’s insurance, plus an additional eight months after that coverage ends.
Am I eligible for Medicare Part A if I’m younger than 65 years old?
Some younger people are eligible for Texas Medicare Part A coverage. If you have a permanent disability, serious medical conditions, or permanent liver damage, you may be eligible for Medicare Part A. Contact Coverage2Care to see if you may qualify.
When am I automatically enrolled in Medicare Part A?
In some cases, people are automatically enrolled in Medicare Part A. If you are already receiving Social Security or Railroad Retirement Board benefits before turning 65, you will automatically be enrolled in Medicare Part A. You will also be enrolled if you are under 65 and have a disability or ALS.
Are there penalties for signing up late for Medicare Part A?
If you are not eligible for free Medicare Part A coverage but do not sign up as soon as you’re eligible, you will may a late enrollment penalty. Your premiums will be higher once you do enroll.
Have More Texas Medicare Questions?
There is a lot to learn about your Medicare choices. If you have more questions, contact the experts at Coverage2Care for help exploring your options.