Medicare Part A: Hospital Insurance

Medicare Part A is one of four components of the federal government's health insurance program for older adults and other eligible people. It covers inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. Part A is typically free for those who have paid Medicare taxes during their working years, and it's available to people aged 65 or older, people under 65 with certain disabilities, and people of all ages with End-Stage Renal Disease.

Inpatient hospital care

Medicare Part A, also known as Hospital Insurance, covers inpatient hospital care. This includes care in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and long-term care hospitals. It also includes inpatient care as part of a qualifying clinical research study.

To be eligible for Medicare Part A inpatient hospital care, you must be admitted to the hospital as an inpatient after an official doctor's order, stating that inpatient hospital care is necessary to treat your illness or injury. Additionally, the hospital must accept Medicare.

Medicare Part A covers the costs of inpatient hospital care for the first 60 days of your stay. From days 1 to 60, there is a $1,632 deductible. For days 61 to 90, you will be charged $408 per day. After 90 days, you will be charged $816 per day, and these charges will be applied to your 60 lifetime reserve days. Once you have used up your lifetime reserve days, you will be responsible for all costs.

Medicare-covered inpatient hospital services include drugs, hospital services, and supplies as part of your inpatient treatment. It is important to note that Medicare Part A does not cover private-duty nursing, a private room (unless medically necessary), or personal care items.

Skilled nursing facility care

The costs associated with Original Medicare for skilled nursing facility care vary depending on the number of days. For the first 20 days, there is no cost to the patient. From days 21 to 100, a daily fee of $204 is charged, and after the 100th day, all costs must be covered by the patient. Part A limits SNF coverage to 100 days in each benefit period.

The services covered by Medicare in a skilled nursing facility include a semi-private room, skilled nursing care, physical therapy, occupational therapy, speech-language pathology services, medical social services, medical supplies and equipment, and ambulance transportation if necessary for the patient's health. These services aim to improve or maintain the patient's current condition or prevent it from deteriorating.

Skilled nursing facilities (SNFs) are inpatient rehabilitation and medical treatment centers that provide 24/7 care and assistance with activities of daily living. They are typically temporary residences for patients requiring medically necessary rehabilitation treatment. The staff at SNFs includes licensed nurses, physical and occupational therapists, speech pathologists, and audiologists.

In summary, Medicare Part A covers skilled nursing facility care for a limited time, provided certain conditions are met. The coverage includes various services to aid in the patient's recovery and daily living, with costs varying depending on the length of stay. SNFs offer temporary, specialized care to help patients regain their ability to perform daily activities.

Hospice care

Medicare Part A is one of four components of the federal government's health insurance program for older adults and other eligible people. It is also known as Hospital Insurance and covers inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

If you qualify for hospice care, you and your family will work with a hospice team to set up a plan of care that meets your needs. This can include nursing and medical services, durable medical equipment for pain relief and symptom management, medical supplies, drugs for pain and symptom management, aide and homemaker services, physical therapy services, occupational therapy services, speech-language pathology services, spiritual and grief counselling for you and your family, and short-term inpatient care for pain and symptom management.

If you are enrolled in a Medicare Advantage Plan and want to start hospice care, your plan must help you locate a Medicare-approved hospice provider in your area. If you choose to leave hospice care, your Medicare Advantage Plan won't start again until the first of the following month.

If you have Medicare Part A and meet the hospice eligibility requirements, the government will pay up to 100% of the cost of hospice care. There is no deductible or copayment for the patient. However, you may have to pay a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management. You may also pay 5% of the Medicare-approved amount for inpatient respite care, and you will have to pay for room and board if you live in a facility and choose to receive hospice care.

Home health care

Medicare Part A, also known as Hospital Insurance, is one of four components of the federal government's health insurance program for older adults and other eligible individuals. It covers inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

Covered home health services include medically necessary part-time or intermittent skilled nursing care, occupational therapy, speech-language pathology services, medical social services, and part-time or intermittent home health aide care (only if the patient is also receiving skilled nursing care simultaneously). Additionally, injectable osteoporosis drugs for women, durable medical equipment, and medical supplies for use at home are covered.

Medicare does not cover 24-hour-a-day care, meal deliveries, homemaker services, or custodial or personal care that assists with daily living activities when this is the only type of care required. To be eligible for home health benefits, patients can only require part-time or "intermittent" skilled nursing care. However, patients can still leave home for medical treatment or short, infrequent non-medical reasons, such as attending religious services.

Eligibility

Medicare Part A is one of four components of the federal government's health insurance program for older adults and other eligible people. It is also known as Medicare Hospital Insurance and helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

To be eligible for Medicare Part A, you must meet the following criteria:

• Meet the citizenship and residency requirements.
• Be aged 65 or older.
• Receive disability benefits from Social Security or the Railroad Retirement Board for a minimum of 25 months.
• Receive disability benefits because you have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease.
• Have End-Stage Renal Disease (ESRD) and fulfil certain requirements.

Most people do not pay a premium for Part A because they or their spouse paid for it through payroll taxes while working. If you haven't paid these taxes during your working years, you will need to pay premiums, which can be as high as $505 per month.

If you are not automatically enrolled in Medicare Part A when you turn 65, you should sign up through Social Security during your initial seven-month enrollment period, which starts three months before your 65th birthday and ends three months after it.

Frequently asked questions