Why You Should Still Review Part A Even If You’re Automatically Enrolled

Key Takeaways

• Being automatically enrolled in Medicare Part A doesn’t mean you can skip reviewing your coverage details—there are still potential costs, limitations, and coordination issues you need to understand.

• Reviewing your Part A enrollment ensures you don’t overlook coverage gaps, penalties, or conflicts with employer or retiree coverage that may impact your long-term financial or healthcare situation.

You Might Be Enrolled Automatically—But That Doesn’t Mean You Understand What You Have

If you’re already receiving Social Security or Railroad Retirement Board benefits when you turn 65, you’re typically enrolled in Medicare Part A automatically. You’ll receive your Medicare card in the mail about three months before your 65th birthday. While this automatic process is helpful, it doesn’t mean your job is done.

Many people assume automatic enrollment means everything is handled perfectly, but that isn’t always the case. Automatic enrollment doesn’t confirm that you know how Part A works, what it covers, or how it coordinates with other forms of insurance.

What Part A Actually Covers

Medicare Part A is known as hospital insurance, and while it covers many critical services, it’s not as complete as many people assume. Here’s what it generally includes:

• Inpatient hospital stays

• Skilled nursing facility care (following a qualifying hospital stay)

• Hospice care

• Limited home health services

However, Part A does not cover:

• Long-term care (also known as custodial care)

• Most outpatient services

• Prescription drugs

• Routine doctor visits

Understanding this helps set realistic expectations, especially when preparing for hospital costs or post-acute care.

You Still Pay for Part A in Some Cases

While most people qualify for premium-free Part A based on work history, that’s not universal. In 2025, you qualify for premium-free Part A if:

• You or your spouse worked and paid Medicare taxes for at least 40 quarters (10 years).

If you have fewer than 30 quarters of Medicare-covered employment, you’ll pay a full monthly premium. If you have 30 to 39 quarters, you’ll pay a reduced premium.

If you’re automatically enrolled but don’t qualify for premium-free Part A, it’s especially important to review whether enrolling is worth the cost or if you want to delay.

How Part A Works with Employer Coverage

Still working at 65? Then your automatic enrollment deserves extra scrutiny. Medicare has coordination rules with employer insurance:

• If your employer has fewer than 20 employees, Medicare is usually the primary payer.

• If your employer has 20 or more employees, your employer coverage typically pays first, and Medicare is secondary.

Why does this matter? Because enrolling in Medicare could affect how your employer coverage works. It might shift how your claims are paid, and in some cases, cause you to lose Health Savings Account (HSA) eligibility.

You Might Not Need It Yet—Or You Might Need More

Depending on your situation, you may want to delay Part A enrollment, especially if it requires a premium. Or you might think automatic enrollment into Part A is all you need, when in reality, it’s just one part of Medicare.

Automatic enrollment includes only Part A and, sometimes, Part B (if you’re collecting benefits). But if you want:

• Prescription drug coverage (Part D), or

• Additional services like dental, hearing, or vision,

…you’ll need to enroll separately. Waiting too long could lead to penalties or coverage gaps.

Check for Errors and Coverage Dates

Automatic enrollment doesn’t guarantee everything is accurate. Mistakes happen, and it’s up to you to verify:

• Your name and Medicare number are correct on your card

• Your effective date is accurate (usually the first day of the month you turn 65)

• Your enrollment status matches your expectations (e.g., Part A only or Part A and B)

Any discrepancies can delay care or cause unexpected billing issues. The sooner you catch an error, the easier it is to fix.

Enrollment Timing Still Matters for the Rest of Medicare

Even if Part A was automatic, other parts of Medicare are not. The Initial Enrollment Period (IEP) spans 7 months:

• Begins 3 months before your 65th birthday

• Includes the month of your birthday

• Ends 3 months after

This window is critical. If you want full Medicare coverage (like Part B or D), you must act within this timeline to avoid lifelong penalties.

Review Your Out-of-Pocket Exposure

Part A isn’t truly free. In 2025, even if you pay no monthly premium, you still face:

• An inpatient hospital deductible of $1,676 per benefit period

• Daily coinsurance starting after 60 days in the hospital

• Coinsurance for skilled nursing facility stays after 20 days

Understanding these costs can help you plan for expenses or decide whether to add supplemental coverage. You can be automatically enrolled but still underprepared financially.

Automatic Enrollment May Affect Your HSA

If you’re still working and contribute to a Health Savings Account (HSA), automatic enrollment in Part A could create a problem. IRS rules prohibit HSA contributions if you’re enrolled in any part of Medicare.

This includes retroactive Part A enrollment—which often goes back up to six months from your start date. If you mistakenly continue contributing to your HSA during this period, you could face tax penalties.

Careful planning around when to claim Social Security and enroll in Medicare helps you avoid this situation.

Review Coverage for Dependents

Medicare does not provide coverage for spouses or dependents. If your employer plan includes family coverage and you transition to Medicare, make sure your dependents remain covered elsewhere.

Automatic enrollment in Part A does not address this. You must coordinate benefits to ensure continuous protection for your family members.

Evaluate Whether You Need Supplemental Coverage

Part A by itself leaves significant gaps. If you’re automatically enrolled, it might create a false sense of being fully protected. But without supplemental coverage, you could be vulnerable to high costs.

Options include:

• Medicare Part B (for outpatient care)

• Standalone Part D (for prescription drugs)

• Medigap plans (to cover deductibles and coinsurance)

You must actively sign up for these during the right enrollment periods.

Look Ahead to Coordination with Other Programs

If you qualify for Medicaid, TRICARE, or other federal/state programs, how Medicare Part A interacts with these benefits matters. Automatic enrollment doesn’t ensure proper coordination.

You may need to:

• Report your Medicare status to the other program

• Submit additional documents to verify coverage

• Understand which payer is primary

Skipping this step could delay benefits or cause claim denials.

Being Proactive Puts You in Control

Automatic enrollment is convenient, but it doesn’t replace the need for strategic planning. Reviewing your Medicare Part A coverage helps you:

• Confirm your eligibility

• Anticipate costs

• Align coverage with your needs and employment status

• Protect your HSA or other insurance benefits

It also ensures your records are accurate and that you’re prepared for what comes next.

Take the Next Step in Understanding Your Medicare Coverage

While automatic enrollment in Part A removes a barrier, it can also create confusion if left unexamined. Reviewing your coverage, timelines, and related decisions gives you confidence and clarity. Don’t assume your coverage is all set just because you received a Medicare card.

If you have questions about what your Medicare options mean for you, or how to make the most of your enrollment window, get in touch with a licensed agent listed on this website for professional advice.