Orlando Harmon
Medicare is a federal health insurance program for anyone aged 65 and older, as well as some people under 65 with certain disabilities or conditions. There are four parts to Medicare: Part A, Part B, Part C, and Part D. Part A, also known as Hospital Insurance, helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. It is free if you have worked and paid Medicare taxes for at least ten years, but some people may also pay a premium for it.
| Characteristics | Values |
|---|---|
| Type | Hospital Insurance |
| Eligibility | Anyone 65 and older, and some people under 65 with certain disabilities or conditions |
| Coverage | Inpatient hospital care, skilled nursing facility care, hospice care, home health care, behavioral and mental health |
| Medicare Advantage | Part C is an alternative to Parts A and B that bundles several coverage types, including Parts A, B, and usually D |
| Enrollment | You must sign up for Part A or Part B before enrolling in a Medicare Advantage plan |
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What You'll Learn
Inpatient hospital care
Medicare Part A is also known as hospital insurance. This part of Original Medicare covers inpatient services, including hospital stays and care at a Skilled Nursing Facility (SNF).
If you are admitted to the hospital as an inpatient after an official doctor's order, Medicare Part A will cover you for up to 90 days in your benefit period. This period begins the day you are admitted and ends once you have been out of the hospital for 60 days in a row. For the first 60 days, you will need to meet your Part A deductible ($1,676), after which Medicare will cover your inpatient care at no additional cost. For days 61-90, you will pay a coinsurance fee of $419 per day. If your hospital stay exceeds 90 days, you can use up to 60 lifetime reserve days, for which you will be charged $838 per day.
Medicare Part A also covers inpatient mental health care in a freestanding psychiatric hospital, limited to 190 days during your lifetime. However, this limit does not apply to care received in a Medicare-certified psychiatric unit within an acute care or critical access hospital.
In addition to inpatient hospital care, Medicare Part A also helps cover skilled nursing facility care, hospice care, and some home health care services. To be eligible for Medicare Part A coverage, you must either be 65 or older or have certain qualifying conditions, such as receiving Social Security disability benefits for 24 consecutive months or having specific medical conditions like Lou Gehrig's disease or end-stage kidney disease.
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Skilled nursing facility care
Medicare Part A covers inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. If you worked and paid Medicare taxes for a minimum of 10 years, Part A is free. Otherwise, you may still be eligible due to your spouse's work.
Skilled nursing facility (SNF) care is a type of healthcare that requires skilled nursing or skilled therapy to treat, manage, observe, and evaluate your care. It can only be safely and effectively administered by professionals or technical personnel. Medicare Part A covers SNF care for up to 100 days in each benefit period. This includes semi-private rooms, meals, and therapy.
To be eligible for SNF care under Medicare Part A, you typically need to have had a minimum of 3 days of inpatient hospital stay. However, this requirement may be waived if your doctor participates in an Accountable Care Organization or another type of Medicare initiative approved for a "Skilled Nursing Facility 3-Day Rule Waiver". Alternatively, if your status was changed to "outpatient getting observation services" during your inpatient hospital stay, you can appeal the denial of Part A coverage. If your appeal is approved, Part A may cover your SNF services.
It is important to note that Medicare Advantage Plans may have different rules and costs associated with SNF care. For example, you may be charged copayments during the first 20 days of SNF care under a Medicare Advantage Plan. Additionally, Medicare Supplement Insurance (Medigap) is an option to help cover your share of costs in Original Medicare, but it generally does not cover long-term care in a nursing home.
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Hospice care
Medicare Part A is federal health insurance for anyone aged 65 or older and some people under 65 with certain disabilities or conditions. Part A helps cover inpatient care in hospitals, skilled nursing facility care, and hospice care.
To qualify for hospice care, you must have Medicare Part A and meet the following conditions:
- Your hospice doctor and your regular doctor certify that you are terminally ill with a life expectancy of six months or less.
- You accept comfort care (palliative care) instead of care to cure your illness.
- You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness.
If you qualify, you can receive hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods. You can receive hospice care in your home or another facility, such as a nursing home or inpatient hospice facility.
Medicare pays hospice agencies a daily rate for each day a patient is enrolled in the hospice benefit. This daily payment covers the costs of providing services included in the patient's care plan, such as services from a hospice-employed physician, nurse practitioner, or other chosen physicians. Medicare may also pay for other reasonable and necessary hospice services in the patient's plan of care.
You pay nothing for hospice care if you receive it from a Medicare-approved provider. However, you may pay a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management. In some cases, you may also pay 5% of the Medicare-approved amount for inpatient respite care.
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Home health care
Medicare Part A is federal health insurance for anyone aged 65 and older, as well as some people under 65 with certain disabilities. Part A is free if you have worked and paid Medicare taxes for a minimum of 10 years. It helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and some home health care services.
Medicare Part A covers intermittent skilled nursing care, skilled therapy services, and care provided by a home health aide. This can include medical care such as medication education, vital sign monitoring, wound care, and infusions. Before starting home health care, the home health agency should inform you how much Medicare will pay and whether there are any items or services that Medicare will not cover.
If you receive your Medicare benefits through a Medicare Advantage Plan (Part C) or another Medicare health plan, you should check with your plan for specific information about your home health benefits. You can also call 1-800-MEDICARE for more information about your home health benefits.
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Critical access hospitals
Medicare Part A helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. Medicare Supplement Insurance (Medigap) is extra insurance that can be purchased from a private company to help pay your share of costs in Original Medicare. Generally, you need Part A and Part B to buy a Medigap policy.
CAHs are required to furnish 24-hour emergency care services 7 days a week. They may also be granted "swing-bed" approval to provide post-hospital skilled nursing facility-level care in their inpatient beds. CAHs can benefit from collaboration and network agreements with other healthcare facilities. For example, a CAH can contract with a hospice to provide the Medicare hospice hospital benefit, with reimbursement from Medicare.
The Medicare Rural Hospital Flexibility Program (Flex Program), administered through the Federal Office of Rural Health Policy (FORHP), was created by the Balanced Budget Act of 1997. The Flex Program encourages states to strengthen rural healthcare with a focus on CAHs and their Rural Health Clinics, rural emergency medical services (EMS), and rural communities. FORHP expects CAHs to collect and report quality data as a fundamental part of healthcare operations and to use quality data to make decisions.
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Frequently asked questions
Medicare Part A covers inpatient care in hospitals, skilled nursing facility care, hospice care, and some home health care.
Medicare Part A is hospital insurance. It is one of the two parts of Original Medicare, the other being Part B (Medical Insurance).
Medicare Part A covers inpatient hospital care, while Part B covers medical care received from doctors and other healthcare providers, outpatient care, and certain drugs administered in a physician's office.
