What is Medicare Part A Coverage?
Part A
Medicare Part A helps cover care in hospitals as an inpatient, critical access hospitals, skilled nursing facilities (not custodial or long-term care), hospice care, and some home health care.
Most people will not have to pay a monthly premium for Part A because they or their spouse paid Medicare taxes while they were working. As long as you or your spouse worked 40 quarters (10 years) and contributed to Medicare during that time, you will qualify for premium-free Part A. If you are not eligible for premium-free Part A, you may be able to buy Part A if you meet one of the following conditions:
- You are age 65 or older, and you are entitled to (or enrolling in) Part B and meet the citizenship or residency requirements.
- You are under age 65, disabled and your premium-free Part A coverage ended because you returned to work.
The hospital insurance covered under Part A includes inpatient care in acute care hospitals, nursing homes, skilled nursing facilities, critical access hospitals and long-term care hospitals, inpatient care as part of a qualifying clinical research study and mental health care. It also covers medically necessary home health care as well as hospice care. Part A does not cover long term or custodial care. It is important to know that Medicare does not cover the total cost for many of the covered services and medical supplies. Your out of pocket expenses will be based on which Medicare plan you have.
Part A helps cover the following:
Hospital Stays – Inpatient stays are covered and includes a semi-private room, meals, general nursing, certain hospital services and supplies. The Part A deductible for 2010 is $1,100. Medicare Part A pays the remainder of all covered services for the 1st 60 days. If your stay exceeds 60 days, you will need to pay coinsurance per day. If your stay exceeds 150 days in the same benefit period, your Medicare Part A coverage will be exhausted.
Benefit Period – A benefit period begins the day you go into a hospital or skilled nursing facility. The benefit period ends when you haven’t received any inpatient hospital care or skilled nursing care in a skilled nursing facility for 60 consecutive days.
Skilled Nursing Facility Care – You are covered up to 100 days in a skilled nursing facility per benefit period (as described above). In order to be covered in a skilled nursing facility, you must be an inpatient in an acute care hospital for three days. A nursing home or skilled nursing stay includes a semi-private room, meals and rehabilitative and skilled nursing services and care. The first 20 days are covered in full and the remaining 80 days will require a copayment.
Home Health Care – You are covered for limited, reasonable, and medically necessary part-time care and services such as: skilled nursing care, physical or occupational therapy and speech-language pathology. The agency providing the care must be Medicare-certified and your physician must request the care for you. Home Health Care might also include certain durable medical equipment and/or medical supplies you might need at home, home health aide services and medical social services.
Hospice Care – This coverage is for the terminally ill who have six months or less to live. It includes pain relief and symptom control drugs, medical and support services, grief counseling and other services.
Blood – Medicare does not cover the first 3 units of blood you are given in the hospital. Many times, the hospital gets blood from a blood bank at no charge or the blood can be donated.
Medicare 101 Home>>
Medicare Part A>>
Medicare Part B>>
Medicare Part C>>
Medicare Part D>>