What is Medicare Part A and What Does it Cover?
June 16, 2019 | Tom Peterson
Did you know that Medicare Part A covers inpatient care, skilled nursing facility care, inpatient care in a skilled nursing facility (not custodial or long-term care), hospice care, and home health care? Here are the details about Medicare Part A coverage that you need to know.
What is Medicare Part A?
Medicare Part A is the first portion of the Federal program known as Original Medicare. Depending on the circumstances, Part A may or may not have a monthly premium. For instance, Part A has a free premium if you or your spouse have worked 10 or more years in the United States. If you or your spouse do not meet these requirements, a premium is established by the Centers of Medicare & Medicaid Services every year. For Medicare Part A, the deductible per benefit period is $1364.
What Does Part A Cover?
Inpatient Care
The annual deductible for Medicare Part A covers inpatient care in a hospital when you are admitted to the hospital as an inpatient after an official doctor’s order, the hospital accepts Medicare, and in certain cases, the Utilization Review Committee of the hospital approves your stay while you are in the hospital. Medicare inpatient hospital care will cover your doctor care, tests, procedures, semi-private room, medication, and anything deemed as medically necessary. Once you have been admitted into a hospital for Medicare-approved inpatient hospital care, you’ll pay:
- $1364 Deductible (2019)
- $0 for the first 60 days
- $341/day for days 61-90
- $682/day for days 91-150 (this set of days are lifetime reserve days, meaning they can only be used once under your Medicare claim number)
Skilled Nursing Facility Care
Medicare Part A covers skilled nursing facility (SNF) care for a short-term basis if you have Part A and days left in your benefit period to use, you have a qualifying hospital stay, and meet other requirements. Beginning on your first day at a skilled nursing facility, you will start a health assessment that is covered by Medicare Part A. Once your health condition is assessed, SNF staff work on preparing or updating your care plan.
Hospice Care
If you meet all of the conditions to qualify for hospice care, you will work with the hospice team to set up a care plan that’s specific for you.
Home Health Care
Medicare Part A and/or Medicare Part B covers home health services like physical therapy, occupational therapy, part-time or intermittent skilled nursing care, medical social services, speech-language pathology services, and part-time or intermittent home health aide services.
Keep in mind that if you’re in a Medicare Advantage Plan or other Medicare plan, you may have different rules. However, your plan must give you at least the same coverage as Original Medicare and some of these services may only be covered in certain settings or for patients with certain conditions.
Do you have additional questions about Medicare Part A and what it covers? We have answers! Come to one of our free Medicare workshops or meet one-on-one with one of our Medicare agents to get your questions answered! Contact us today to get started.
References:
https://www.medicare.gov/what-medicare-covers/what-part-a-cover