Medicare Part A

Medicare Part Explained

In general, Part A covers:

  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Inpatient care in a skilled nursing facility (not custodial or long-term care)
  • Hospice care
  • Home health care

Medicare Part A hospital care coverage

As a Medicare Part A beneficiary, you will receive coverage for hospital expenses that are critical to your inpatient care, such as a semi-private room, meals, nursing services, medications that are part of your inpatient treatment, and any other services and supplies from the hospital. This includes inpatient care that received through:

  • Acute care hospitals
  • Critical access hospitals
  • Inpatient rehabilitation facilities
  • Long-term care hospitals
  • Mental health care
  • Participation in a qualifying clinical research study

Please note that Medicare Part A hospital insurance does not cover the costs for a private room (unless medically necessary), private-duty nursing, personal care items like shampoo or razors, or other extraneous charges like telephone and television.

Medicare Part A also does not cover the cost of blood. You do not need to pay anything if the hospital gets it from a blood bank at no charge. If the hospital does need to purchase blood for you, you must pay for only the first three units that you receive each calendar year, unless you have the blood donated by you or someone else.

Medicare Part A home health care benefits

Medicare Part A benefits for home health care services are covered when deemed medically necessary and ordered by your doctor.

Home health care services may include:

  • Part-time or intermittent skilled nursing care
  • Physical therapy
  • Speech-language pathology services
  • Occupational therapy
  • Medical social services
  • Part-time or intermittent home health aide services
  • Durable medical equipment, when ordered by your doctor*

*If your doctor orders durable medical equipment as part of your care and the equipment meets eligibility requirements, this cost is covered separately under Medicare Part B. If you’re eligible for coverage, Medicare typically covers 80% of the Medicare-approved amount for the durable medical equipment.

Medicare Part A does not cover 24-hour home care, meals, or homemaker services if they are unrelated to your treatment. It also does not cover personal care services, such as help with bathing and dressing, if this is the only care that you need.

Medicare Part A covers the entire cost for covered home health care services. As mentioned, if you need durable medical equipment and it’s ordered by your doctor this is covered under Medicare Part B and you are responsible for 20% of the Medicare-approved amount.

The home health care must be provided by a Medicare-certified home health agency, and a doctor must certify that you are home-bound. According to Medicare, you are “homebound” if both of the following are true:

  • Under normal circumstances, you cannot leave home and doing so would require substantial effort.
  • It is medically inadvisable for you to leave home without the help of another person, transportation, or special equipment.

Medicare Part A nursing home coverage

Skilled nursing facility (SNF) stays are covered under Medicare Part A after a qualifying hospital inpatient stay for a related illness or injury. To qualify for SNF care, the hospital stay must be a minimum of three days, beginning on the day you are formally admitted as an inpatient. The day you are discharged does not count towards this minimum three-day requirement. Time spent under observation as an outpatient also does not count towards your qualifying stay.

The skilled nursing care must be provided at a Medicare-certified facility. Medicare-covered skilled nursing care includes, but is not limited to:

  • Semi-private room
  • Meals
  • Skilled nursing services
  • Rehabilitation services, if they are medically necessary to treat your illness
  • Medical social services
  • Medications received while in SNF care
  • Medical supplies and equipment used in SNF
  • Ambulance transportation to nearest provider if needed services are not provided at the SNF
  • Dietary counseling

Your doctor must certify that you need daily skilled care that you cannot receive at home, such as intravenous drugs or physical therapy. Medicare Part A does not cover long-term care (or personal care, if that is the only care you need).

Medicare Part A hospice coverage

If your doctor has certified that you have a terminal illness with an estimated six months or less to live, you may be eligible for hospice care coverage. In hospice care, the focus is on palliative care, not curing your disease. The goal is to relieve pain and make the patient as comfortable as possible.

To qualify for Medicare-covered hospice care, you must meet all of the following conditions:

  • You must be enrolled in Medicare Part A.
  • Your doctor or health provider must certify that you are terminally ill and have six months or less to live.
  • You must agree to give up curative treatments for your terminal illness, although Medicare will still cover palliative (comfort-focused) treatment for your terminal illness, along with related symptoms or conditions.
  • You must receive hospice care from a Medicare-approved hospice facility.

Medicare Part A hospice care is usually received in the patient’s home. It may include, but is not limited to:

  • Doctor services
  • Nursing care
  • Pain relief medications
  • Social services
  • Durable medical equipment
  • Medical supplies
  • Hospice aide services
  • Homemaker services
  • Physical and occupational therapy
  • Dietary counseling
  • Short-term inpatient care (if necessary for managing pain or symptoms)
  • Short-term respite care

If a patient is under hospice care, Medicare Part A may also cover some costs that Medicare normally does not include, such as spiritual and grief counseling. Medicare Part A only pays for room and board in a hospital if the hospice medical team orders short-term inpatient stays for pain or other symptom management.

Although you must give up any curative treatments for your terminal illness to receive Medicare coverage, you have the right to stop hospice care at any time. If you are thinking about going back to curative treatments, talk to your doctor.

Eligibility for Medicare Part A

In general, you are eligible for Medicare Part A if:

  • You are age 65 or older and a U.S. citizen or permanent legal resident of at least five years in a row.
  • You are already receiving retirement benefits.
  • You are disabled and receiving disability benefits.
  • You have end-stage renal disease (ESRD).
  • You have amyotrophic lateral sclerosis (Lou Gehrig’s disease or ALS).

Most beneficiaries do not pay a premium for Medicare Part A if they have worked at least 10 years (or 40 quarters) and paid Medicare taxes during that time. Individuals who aren’t eligible for premium-free Medicare Part A can still enroll in Part A and pay a premium. Beneficiaries who delay enrollment after they first become eligible for Medicare Part A may be subject to a late enrollment penalty once they sign up.

Call Today To Learn If You Qualify For Medicare Part A 618-806-8519

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