Medicare Part A
Medicare Part A focuses on inpatient coverage for services such as hospitalizations, rehabilitation, and hospice care. For most beneficiaries, Part A has a $0 premium. Learn more about the benefits of Part A below.
What Part A Covers
Part A covers hospital and inpatient visits. Covered services include inpatient hospital stays, hospice and home health care, skilled nursing facility care, inpatient rehabilitation and more. Part A covers a percentage of these services and beneficiaries are subjected to out-of-pocket expenses such as coinsurance, copays and deductibles.
Inpatient Hospital Visits
Part A will cover a semi-private room, meals, medications administered in the facility, and nursing care as a part of an inpatient hospital stay. Part A may also cover blood transfusions depending on the circumstances and medical necessity.
In order to qualify for coverage, your hospital visit must qualify as an inpatient stay. The doctor must admit you to the facility as an inpatient and some hospitals have individual requirements which must be met for the hospital visit to qualify as an inpatient stay.
Keep in mind that Part A does not cover everything a beneficiary might consider necessary to their inpatient stay. Services such as private-duty nursing, personal care items (such as socks, tooth brushes, or combs), a phone, or a television may not be covered if the hospital charges separately for these items or services.
While Part A covers some parts of an inpatient hospital stay, this coverage is not unlimited. An annual deductible applies per benefit period and is subject to repeat within a calendar year. The first 60 days of an inpatient hospital stay have a $0 coinsurance per day. For days 61-90, a daily coinsurance begins to apply to the stay. For days 91-150, the coinsurance increases again. Part A limits coverage to 150 days including lifetime reserve days. Any time spent beyond the beneficiary’s allowance becomes the beneficiary’s financial responsibility.
Skilled Nursing Facility Visits
Medicare Part A covers Skilled Nursing Facility (SNF) visits. In order to qualify for SNF coverage, your treating doctor must document that you have met the SNF requirements after a qualifying hospital stay. The hospital visit needs to be a minimum of 3 days in duration to qualify beneficiaries for SNF coverage. Part A covers shared rooms, meals, skilled nursing and rehabilitation services, and other supplies that are relevant and considered necessary for your stay.
Like inpatient services, SNF costs also depend on the length of the stay. The first 20 days of the stay have a $0 copay. For days 21-100, there is a coinsurance per day. For Days 101 and after, the beneficiary assumes all costs.
Home Health Services
Medicare Part A also covers home healthcare. These services are slightly unique because they are technically covered by both Part A and Part B. Coverage includes skilled nursing care, physical and occupational therapies, and speech language pathology. Beneficiaries have to meet certain criteria to qualify for home health coverage under Medicare. A treating doctor must order the home health services and document that the beneficiary is homebound due to their condition. Each service received must be considered medically necessary, and the home health agency must be approved my medicare.
The patient is responsible for 20% of the durable medical equipment and the Part B deductible applies to home health services.
Hospice Care
Part A hospice covers hospice care services such as palliative care for comfort, doctor’s services, medications for pain relief and symptom management, nursing, physical and occupational therapy services, homemaker and aide services, and durable medical equipment. The coverage also includes spiritual and grief counseling for beneficiaries and their families.
Once a beneficiary elects hospice care, Medicare will not cover treatment to cure their illness or prescription drugs to cure the illness. Medicare will also no longer cover care from any hospice provider that is not set up by the hospice medical team. Keep in mind that beneficiaries will be required to sign a statement that they will be electing care for comfort instead of curing their illness, and their doctor will need to certify that they have 6 months or less to live.
Hospice care is administered at no cost to the beneficiary, however for inpatient respite care there may be a 5% charge for using the facility, and each prescription used for pain relief and symptom control may have a copay of up to $5.
