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Kat Casna

Medicare Part A is part of Original (traditional) Medicare and constitutes the federal government’s “hospital insurance.” In short, Part A covers costs for inpatient services in the following situations:

While that sounds pretty straightforward, this part of the Medicare program causes plenty of confusion. Most folks aren’t sure exactly what services Part A covers, and some people get an unexpected bill in the mail as a result.

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Hospital care

As a Medicare Part A beneficiary, you have coverage for inpatient care in the hospital, which may be one of the following facilities:

  • Acute care hospitals
  • Critical access hospitals
  • Inpatient rehab facilities
  • Long-term care hospitals

In short, if you’re in the hospital for things like injuries, hip replacements, or heart attacks and strokes, you’ll be covered under Part A’s hospital care rules.

What’s covered for hospital care

When Part A coverage begins, you can expect coverage for the following services:

  • Semi-private rooms
  • Meals
  • Regular nursing services
  • Special care units (e.g., intensive care)
  • Drugs while in the hospital
  • Medical supplies (e.g., casts, splints, wheelchairs)
  • Lab tests, X-rays, and radiation treatments
  • Operating and recovery room expenses
  • Rehabilitation services while in the hospital

What’s not covered for hospital care

  • Private rooms (unless medically necessary)
  • Private nurses
  • TV and phone in your room (if charged separately)
  • Personal items, such as razors or socks

If your doctor recommends services Medicare won’t cover, you may have to pay some or all of the costs. To learn more about costs, visit our Guide to Part A.

What Part A pays for hospital care

You’ll have to meet your deductible and pay any coinsurance or copayments before coverage kicks in. Once it does, Part A covers 100% of approved hospital services.1

Coverage requirements for hospital care

Part A covers much of your care if you’re admitted to a hospital for at least “two midnights.” In other words, you’re covered if your hospital stay runs for at least two nights in a row.

Once you meet that threshold, Part A generally covers your expenses, provided all of the following occur:

  • A doctor officially determines you need to be admitted into the hospital for two or more nights.
  • The hospital accepts Medicare health insurance.
  • You need the kind of care that can be given only in a hospital.

Skilled nursing facility care

Part A covers many of your medical costs at skilled nursing facilities (where folks go after the hospital if they need continued care). These facilities provide recovery and rehabilitation services. You might enter one while you recover from hip replacement surgery or regain your strength after a heart attack, for example.

What’s covered for skilled nursing care

  • Semi-private rooms
  • Meals
  • Skilled nursing care
  • Physical and occupational therapy
  • Medications while in the hospital
  • Medical equipment and supplies
  • Ambulance transportation, if necessary
  • Dietary counseling

What’s not covered for skilled nursing care

  • Private rooms (unless medically necessary)
  • Private nurses
  • TV and phone in your room (if charged separately)
  • Personal items, such as razors or socks

What Part A pays for skilled nursing care

You must meet your deductible and pay any coinsurance or copayments before coverage kicks in. Once it does, Part A covers 100% of approved services at a skilled nursing facility.2

Coverage requirements for skilled nursing care

For Part A to cover your skilled nursing costs, you must spend a minimum of three days as an inpatient (not under “observation”) in the hospital first. While you’re there, your doctor must determine that you require follow-up care that you cannot receive at home.

Finally, you must be in a Medicare-certified skilled nursing facility.

Home health services

Let’s say you can recover from a hospital stay at home, or you require regular medical care at home. Part A may cover some of those costs as well.

What’s covered for home health services

  • Skilled nursing care, such as tube feeding and injections
  • Physical therapy
  • Speech-language pathology
  • Occupational services
  • Some medical supplies such as wound dressings and catheters

What’s not covered for home health services

  • 24-hour at-home care
  • Meal delivery
  • Homemaker services (housekeeping)
  • Personal (custodial) care

What Part A pays for home health services

Generally, you pay $0 for home health care services and 20% of the Medicare-approved amount for medical equipment.

Your home health agency should be able to tell you exactly how much Medicare will cover. Alternatively, the agency should give you a notice called the “Home Health Advance Beneficiary Notice of Noncoverage” before providing noncovered services or supplies. This notice includes your estimate and the reason Medicare won’t pay.

Coverage requirements for home health services

To get coverage for home health care expenses, you must be homebound and a Medicare-certified home health agency must provide all covered services.

Additionally, your doctor must care for you regularly and certify that you need one or more of the following services:

  • Intermittent skilled nursing care
  • Physical therapy
  • Speech-language pathology
  • Continued occupational therapy

If you need more than part-time (eight hours per day) or “intermittent” (less than seven days per week) skilled nursing care, Part A will not cover your home health care expenses. You’ll need to enter a skilled nursing facility instead.

Hospice care

Hospice provides specialized support for you and your loved ones during advanced terminal illness. Instead of centering on a cure, hospice care focuses on comfort and quality of life.

Hospice care works a bit differently than other types of care covered under Part A. Once you choose this type of care, you and your family may have access to services not usually covered, such as grief counseling and certain kinds of social work.

Unfortunately, choosing hospice also means Part A won’t cover costs for services aimed at curing you.

But don’t worry. You can exit hospice care whenever you wish, and enter again later if you change your mind.

What’s covered for hospice care

Depending on your illness, your hospice care could include the following expenses:

  • Doctor services
  • Nursing care
  • Medical equipment
  • Prescription drugs for pain management or symptom control
  • Dietary counseling
  • Grief and loss counseling for you and your family
  • Short-term respite care
  • Social work services
  • Any other service deemed necessary by your hospice team

What’s not covered for hospice care

Once you choose hospice care, Part A will not cover certain expenses:

  • Treatment intended to cure your terminal illness (Talk to your doctor if you wish to stop your hospice care.)
  • Prescription drugs meant to cure your illness
  • Care from additional hospice providers that were not part of your original Medicare-approved hospice team
  • Room and board
  • Care you receive at a hospital or during ambulance transportation (unless cleared by your hospice team or unrelated to your terminal illness)

Make sure to contact your hospice team before getting any of the above services, or you may have to pay the full costs.

What Part A pays for hospice care

Generally, you’ll pay nothing for hospice care services. There are two cases, however, in which you will share care costs.

Let’s say your primary caregiver—your spouse, adult child, or whoever helps care for you—needs a break. So you spend an afternoon at an adult day center or a few days at a healthcare facility.

In this case, you’ll pay 5% of the Medicare-approved amount for inpatient respite care.

The second case in which you’ll share costs is when getting medications You may pay a $5 copayment for drugs intended for pain relief or symptom control. For help with other medication costs, you’ll need a Medicare Part D prescription drug plan.

Coverage requirements for hospice care

You can receive hospice care coverage if you meet all of the following conditions:

  • Your hospice doctor and regular doctor certify you have a terminal illness with a life expectancy of six months or less.
  • You accept care for comfort purposes instead of a cure for your illness.
  • You sign a statement saying you choose hospice care instead of other Medicare-covered treatments for your illness.

The takeaway

Whether Medicare Part A coverage pays for certain health care costs largely depends on your inpatient status. That is, whether you’re admitted into certain types of medical facilities or receiving care at home.

The services Part A covers change a bit, depending on how you’re getting your care.

You can avoid an unpleasant surprise at billing time by understanding precisely what Part A covers and what you’ll pay for. Also, check out our Medicare 101 Guide to find out which other parts of Medicare might pick up the tab for specific expenses.

Medicare Part A coverage FAQ

Am I eligible for Part A coverage?

Most folks become eligible for Part A coverage when they’re 65 years old or after two years on disability. People with amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD) can become eligible shortly after diagnosis.

Additional Medicare Part A eligibility requirements include citizenship status.

How do I get Part A coverage?

Some folks get automatically enrolled in Part A, and their Medicare card simply shows up in the mail. Most people need to enroll themselves.

Enrolling in Medicare means applying through the Social Security Administration, not the Centers for Medicare and Medicaid Services (CMS).

The best time to sign up is as soon as you’re eligible, during your Initial Enrollment Period (IEP). You can also enroll in Part A during the Medicare Open Enrollment Period.

Is Part A Coverage free?

Most people don’t pay Part A premiums because they’ve paid enough into Medicare taxes during their working life to get premium-free coverage. Whether you pay premiums or not, you’ll still need to cover the Part A deductible and coinsurance.

To help cover costs of your Original Medicare plan (Parts A and B), you can get a Medicare Supplement (Medigap) plan. This insurance will help you cover deductibles and coinsurance.

Will Part A cover kidney dialysis?

Part A typically covers only inpatient care. If you receive dialysis while you’re an inpatient at a Medicare-approved hospital, Part A will cover it.

If you receive dialysis as an outpatient—or certain kinds of training and support for self-dialysis—you’ll need to enroll in Medicare Part B to get coverage.

Is Medicare Part A better than Medicare Advantage?

Medicare Advantage includes Part A and B coverage. Many Medicare Advantage plans also include Medicare Part D prescription drug coverage.

If you want only hospital coverage, Part A could be the logical choice. If not, consider switching to Medicare Advantage during Medicare Open Enrollment.

Is Part A coverage right for me?

Which Medicare plans are right for you depends on your unique situation. Luckily, our licensed sales agents can answer all your Medicare questions and help you choose a plan that works for you. Give us a call today!

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