Medicare Part A | What Does It Cover

What Is Medicare Part A?

Original Medicare has two separate parts: Medicare Part A, which covers hospital costs, and Medicare Part B, which is your medical insurance. Typically, most Medicare recipients have both of these parts, your Medicare Supplement Plan can cover the costs that Medicare Part A does not. This post will offer a detailed look at Medicare Part A—what it is, what it covers, and how to enroll. Call us if you have questions, 844-528-8688.

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What Does Medicare Part A Cover

Medicare Part A covers inpatient costs or the costs of care received while in a hospital or certain nursing facilities. In some cases, Medicare Part A will also include the costs of home care and hospice care.

As with all types of coverage under Medicare, these costs are covered only in certain circumstances and only if specific requirements are met.

Medicare Part A and Inpatient Care

Medicare Part A covers inpatient care, meaning your healthcare as well room and board while you’re in a hospital. Coverage includes a semi-private room, meals, and the like.Your drugs and medication that are administered as part of your care while in the hospital are also covered (whereas Part D covers prescriptions filled at a pharmacy). Lab tests performed while admitted also fall under your Part A coverage.

The hospitals covered under Part A include the following:

Long-term care hospitals
Acute care hospitals and medical facilities
Critical access or emergency hospitals
Rehabilitation facilities, when inpatient care is needed
Mental health care hospitals

Medicare Part A also typically covers costs incurred when participating in a quality clinical study or research in such hospitals.

What Is Not Included With Medicare Part A Inpatient Care?

Medicare Part A does not cover the cost of a private room, unless such a room is medically necessary, such as in the case of a patient needing to be quarantined. This plan also does not cover the cost of private-duty nursing during your stay.

Medicare Part A will typically cover the cost of blood transfusions needed as part of your care. In some cases, a hospital may get blood from a blood bank or a private donor at no charge, so there is no cost for your transfusions.

If the hospital does incur costs for providing you with blood, you would be obligated to pay for the first three units received each calendar year (the right Medicare supplement can eliminate these costs). While in the hospital, Medicare Part A does not cover the cost of personal hygiene products, razors, slippers, and the like. This coverage also does not include any charges for television usage and telephone calls, or food and drinks that are not provided by the hospital, such as items purchased from a vending machine.

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Medicare Part A and Home Healthcare Services

Medicare Part A may cover certain costs associated with home health care services if those services are deemed medically necessary by your doctor. This coverage typically includes the following:

Physical therapy
Speech therapy and pathology
Occupational therapy
Skilled nursing care for part-time or intermittent care
Some social services
Some home health aide services

These home health care services are for those that are deemed housebound by their doctors, meaning that the patient cannot leave home under normal circumstances, or that it’s inadvisable for you to leave home because of your medical condition. You may also be considered housebound if you would require special medical devices, transportation, and other such assistance to leave home. Durable medical equipment, if deemed medically necessary by your doctor while receiving home care or for your long-term health, would actually fall under Medicare Part B. And you may also be obligated to pay 20% of the cost of such equipment

What Is Not Covered for Home Healthcare?

Medicare Part A does not cover the cost of meals and personal care items, or 24-hour nursing care. This plan also does not include the cost of household services, such as house cleaning, laundry, and so on. Medicare Part A also doesn’t include the cost of assistance for tasks such as bathing and dressing, if these are the only tasks for which you need help. Note, too, that a Medicare-certified home health agency must provide nursing services

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Medicare Part A Nursing Home and Hospice Coverage

Medicare Part A does not cover costs for a long-term stay in a nursing home but will cover costs associated with what is called a skilled nursing facility. A skilled nursing facility, or SNF, provides rehabilitation services and medical care after an illness or injury that required hospitalization.

For Medicare Part A to cover costs during your stay in an SNF, your hospital stay must have been at least three days long. Time spent as an outpatient but under observation would not count toward this three-day requirement. Medicare Part A also covers the costs of hospice care, under the condition that your doctor has certified that you have a terminal illness with less than six months to live. This care must be received at a Medicare-approved facility.

Medicare Part A Costs

Premium. Most people do not pay a monthly premium for Part A coverage because of Medicare taxes paid by them or their spouse. For those who do have to pay, the costs for 2018 are $422 per month for those who paid less than 30 quarters worth of Medicare taxes. If you paid between 30 and 39 quarters, your premium would be $232.

Deductible. The Part A inpatient deductible for 2018 is $1,340 per benefit period. This is the amount out-of-pocket that you must pay in full before your Part A benefits kick in.

Coinsurance. Part A includes a coinsurance for inpatient services that scales based on the duration of your stay. Up to 60 days in a benefit period are free. Beyond that, you’ll pay $335 per day until you reach 91 days, at which point the daily coinsurance increases to $670.

Who is Eligible for Medicare Part A?

You are generally eligible for Medicare coverage if you are 65 or older, or are already receiving retirement benefits. Persons who are disabled, have end-stage renal disease, and those with amyotrophic lateral sclerosis (ALS) are also typically automatically eligible for Medicare.

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How to Enroll in Medicare Part A

If you are 65 or older and are already receiving Social Security benefits, enrollment in Medicare Part A is often automatic, as part of those SS benefits. Most enrollees will receive their Medicare coverage card in the mail, a few months before their Social Security benefits begin.

However, if you do not qualify for Social Security for any reason, you will need to enroll in Medicare yourself. You can do this through the website for Medicare, SSA.gov, or by calling the Social Security office, Monday through Friday, 7 a.m. to 7 p.m., at 1-800-772-1213. You can also visit a local Social Security office in person to enroll if there is one near you.

Note that you can enroll anytime during what is called an Initial Enrollment Period, or IEP, which begins three months before you turn 65. This IEP then includes the month of your 65th birthday and ends three months after your birthday month.

After this IEP has lapsed, you typically need to wait until what is called a general enrollment period or open enrollment, January 1 through March 31, to enroll.