This month we begin a four part series on the four main parts of Medicare. Each section will focus on one alphabet part to help clear up the coverage, eligibility, cost, and enrollment for that particular area. This week, we’ll start at the very beginning with Medicare Part A.
What is Part A?
Medicare Part A helps pay for inpatient hospital stays for “medically necessary” care for an illness or medical condition. In addition to covering your stay in the hospital, Part A also helps cover some follow-up care such as an extended stay in a skilled nursing facility, hospice care for the terminally ill and some limited in home care for the homebound.
Medicare Part A covers a multitude of medical expenses, but is it important to understand the specifics of what is covered and what is it does not cover.
Hospital Stays: Part A will cover up to 60 days of inpatient hospital care in a semi-private room after meeting the deductible. This means that the patient is required to meet the deductible, and is not eligible for a private room.
Hospital Amenities: In addition to simply the room stay, Part A will cover hospital meals, prescription drugs, medical supplies, lab testing, operating room and recovery room services, as well as physical rehabilitation where necessary.
The hospital coverage in Part A is designed to cover all of the expenses of the average hospital stay once the deductible is met.
Skilled Care in a Nursing Facility: Medicare Part A covers certain skilled nursing care services needed daily in a skilled nursing facility for up to 100 days. In order to have the nursing facility covered, your doctor must decide that you need daily skilled care given by, or under the direct supervision of, skilled nursing or rehabilitation staff. It is important to note that this is in-home care only. For patients who go to a nursing facility 5 or 6 days a week for rehabilitation services only, the care is considered daily care.
Part-Time In Home Nursing Care: Medicare covers care given in a certified skilled nursing facility (SNF) if it's medically necessary as determined by a doctor for you to have skilled nursing care. For those who need in-home care such as bathing, dressing, and general custodial care, this is not covered by Medicare Part A.
Hospice: Hospice care is given in the home and includes services such as counseling, dietary counseling, medical supplies, and short term symptom relief. Hospice care is covered when your doctor includes them in the plan of care for comfort purposes in cases of terminal illness and related conditions.
Home Health Services: Part A covers eligible home health services such as intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, when the doctor orders these services for you.
Eligibility for Medicare begins three months before the month you turn age 65. It includes the month you turn 65 and ends three months after the month you turn 65. Some individuals with certain disabilities may also qualify.
There is no out of pocket cost to Medicare Part A. It is federally administered health insurance that is of no cost to the participant.
All citizens who turn 65 and are already receiving Social Security are automatically enrolled in Medicare Part A. If you age into Medicare and are not already receiving Social Security, you will need to contact your local Social Security office.