Medicare Part A – Coverage
What does Medicare Part A cover? Below we explain Medicare Part A coverage as well as eligibility, costs, deductible and some examples of the types of health services covered. We even explore what health services are NOT covered by Medicare Part A.
Inpatient Care in Hospitals
Medicare Part A, also known as Hospital Insurance, provides coverage for hosipital semi-private room, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. If you have Medicare Part B, it covers the doctor and services you receive while you are in the hospital.
Inpatient Care in a Skilled Nursing Facility (not custodial or long term care)
Medicare Part A provides coverage for semi-private room, meals, skilled nursing and rehabilitative services, and other services and supplies that are medically necessary after a 3-day minimum inpatient hospital stay for a related illness or injury.
Your doctor must certify that you’re expected to live 6 months or less. Medicare Part A coverage includes drugs for pain relief and symptom management; medical, nursing and social services; certain durable medical equipment and other covered services.
Home Health Care
Home health care services are limited by Medicare Part A to medically-necessary part time or intermittent skilled nursing care, or physical therapy, speech-language pathology, or a continuing need for occupational therapy. A doctor or other health care provider enrolled in Medicare must order your care, and a Medicare-certified home health agency must provide it.
In most cases, the hospital gets blood from a blood bank at no charge, and you won’t have to pay for it. However, if the hospital has to order blood for you, you must pay for the first 3 units you get in a calender year. You can also have the blood donated to you by someone.
Medicare Part A – Eligibility Criteria
Generally, you are eligible for Medicare IF you or your spouse worked for at least 10 years in Medicare-covered employment AND you are 65 or older and a citizen or permanent resident of the United States OR you are under 65 and qualify for Medicare due to a disability AND you are a citizen or permanent resident of the United States.
If you meet the requirements above, you will eligible for Medicare Part A and Part B starting the first day of the month you turn 65. If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month. If you are under 65 you are eligible for Parts A and Part B after you get disability benefits from Social Security for 24 months.
Your red, white and blue Medicare card will be sent to you within the 3 months before your eligibility begins.
Medicare Part A – Costs and Deductible
For most people, there is no cost for Medicare Part A as long as you meet the above eligibility criteria.
What deductibles to I pay under Medicare Part A services? With Part A coverage, there are deductibles and co-payments that are passed on to the Medicare beneficiary.
The following chart explains what Medicare Part A pays for, and what you will be responsible for:
Medicare Part A: 2015 Hospital Services per Benefit Period*
|Service||Medicare Pays||You Pay|
Semiprivate room and board, general nursing and miscellaneous services and supplies.
|First 60 days||All but $1260||$1260 (Part A Deductible)|
|Days 61-90||All but $315 per day||$315 per day|
|Days 91 and later while using 60 lifetime reserve days||All but $630 per day||$630 per day|
|After lifetime reserve days are used, an additional 365 days||$0||All Costs|
|Skilled Nursing Facility Care*
You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital.
|First 20 days||All approved amounts||$0|
|Days 21-100||All but $157.50 per day||Up to $157.50 per day|
|Days 101 and later||$0||All Costs|
|Blood||First 3 pints||$0||3 pints|
Available as long as you meet Medicare’s requirements, your doctor certifies you are terminally ill and you elect to receive these services.
|All but very limited co-payment/co-insurance for outpatient drugs and inpatient respite care||Co-payment/ co-insurance for outpatient drugs and inpatient respite care|
* A benefit period begins on the first day you receive services as an outpatient and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.