What Is Medicare Part A? Understanding Your Inpatient Benefits And Costs
Medicare Part A is the hospital/inpatient coverage portion of the traditional Medicare program provided by the federal government. Medicare Part A covers inpatient services and supplies during hospital and skilled nursing facility (SNF) with a small amount of coverage for home health in rare circumstances.
Medicare Part A typically allows for:
- Inpatient hospital services
- Inpatient skilled nursing care
- Hospice coverage
- Home health
Certain restrictions may apply based on your eligibility status with the Medicare program.
Medicare Part A Eligibility:
As long as you have completed 10 years of employment with Medicare payroll taxes deducted, your enrollment eligibility for premium-free Medicare Part A will start at age 65 as long as you are a US citizen collecting Social Security/ Railroad Retirement benefits or a legal resident in the United States for five continuous years. While 65 is the qualifying age for most people, in the event you have a diagnosis of end-stage renal disease or ALS you will be eligible to receive Medicare benefits prior to age 65.
In the event you do not have 10 years (40 quarters) of employment with Medicare payroll taxes taken out, you can still qualify after 65 for Medicare; however, Medicare Part A will carry a premium based on the amount of time you paid in. Those who choose to enroll in Medicare after the enrollment period may be subject to a late enrollment penalty.
If you are currently receiving disability benefits from Social Security or Railroad Retirement and are under the age of 65, you are eligible to receive Medicare Part A coverage.
Medicare Part A – Inpatient Hospital
Medicare Part A covers your costs for inpatient hospital Medicare approved charges for physician and nursing services, room, meals, supplies, and medications for your treatment during a stay at a hospital.
Treatment will be covered through facilities like:
- Inpatient rehabilitation
- Clinical research studies
- Critical and acute care hospitals
- Long term hospitals
- Inpatient mental health facilities
Note that in most cases, the following is not covered:
- Private rooms
- Non-medical charges like entertainment or personal care items
- Blood, if the hospital pays for the blood. You will only be responsible for the cost of the first 3 liters of blood per calendar year, the remaining amount is not charged to you.
Medicare Part A- Skilled Nursing
If you have a qualified injury or illness and require extra time for recovery in an inpatient setting, Medicare Part A will cover your stay in a skilled nursing facility (SNF). These facilities are similar to hospitals, but are cheaper and provide more recovery focused care instead of acute care administered at an inpatient hospital. In order to be qualified for skilled nursing care, your stay as inpatient in a hospital must be at least 3 days. Discharge or outpatient observation days does not count toward this minimum. In most cases the hospital administration will assist in locating a Medicare-approved facility for your transfer.
It is important to note that you doctor must certify medical necessity for these services and you are unable to receive these services at home. Medicare Part A does not cover long-term care (LTC) or personal care charges.
Skilled nursing generally covers:
- Physician and nursing services
- Room and meals
- Transportation to local providers for care if not available at the facility
- Medications and supplies while inpatient
- Rehabilitation services as medically necessary
- Social services
Medicare Part A- Hospice
Hospice coverage under Medicare Part A works a little different than other inpatient types of coverage in that Part A covers the typical medical costs for inpatient care, but also occasionally allows for some non-medical related charges and covers at-home hospice services.
Once in hospice status, Medicare Part A will only cover additional inpatient hospital charges for treatment of symptoms and pain that cannot be managed at the hospice setting itself and no longer covers additional treatments to cure the condition.
Hospice care under Medicare Part A generally covers:
- Short term respite care
- Short term inpatient care for relieving pain
- Physician and nurse services
- Medical supplies and equipment
- Hospice and home care aide services
- Pain medications
- Physical and occupational therapy as needed
In order to qualify for hospice coverage, you must:
- Be diagnosed as terminally ill or less than six months to live by a physician
- Be actively enrolled in Medicare Part A
- Be willing to forego additional treatments for the diagnosed illness in exchange for hospice care. Medicare will cover the treatment for pain and services that help ensure comfort.
- Be willing to receive hospice services from a Medicare-approved provider.
Note: You have the right to stop hospice care at any given time. Consult with your doctor on best options available that are covered under your Medicare coverage.
Medicare Part A- Home Health
If deemed medically necessary, Medicare Part A will cover the ordered home health service; however, it will not cover 24 hour care, meals, personal care (bathing, dressing, etc…) and other services that are in direct relation to medical treatment. Medical equipment (durable medical equipment) ordered by the physician for your care will be covered under your Medicare Part B benefits and subject to a 80/20 coinsurance.
***Durable Medical Equipment is medical equipment that can be reused like CPAPs for sleep apnea, oxygen regulators, IV infusion equipment, etc…***
In order to qualify for coverage, the home health services selected must be a Medicare-approved provider with orders from your physician that you are classified as home-bound and home health care is required.
To be homebound means:
- You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury OR
- Leaving your home isn’t recommended because of your condition AND
- You’re normally unable to leave your home and leaving home is a major effort
You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services.
Home Health care covers:
- Part-time nursing and aide services
- Physical, speech, and occupational therapy
- Supplies used by medical professionals for your treatment at home
How To Enroll In Medicare Part A
- You can enroll online at the Social Security website
- Calling the Social Security Administration at 1-800-772-1213
- Visiting your local Social Security office
When Should I Enroll In Medicare Part A?
|Are you turning 65 AND receiving Social Security/ Railroad Retirement benefits?||Medicare Part A enrollment should be automatic on the first day of the month you turn 65. You will receive your Medicare card about 3 months prior.|
|Are you under 65 and on disability from Social Security/ Railroad Retirement?||After 24 months of disability coverage from Social Security/ Railroad Retirement, Medicare Part B enrollment is automatic starting the 25th|
|Have you been diagnosed with end-stage renal disease?||Medicare coverage will begin the first day of the fourth month of dialysis treatment. NOTE: you must manually enroll if under 65.|
|Have you been diagnosed with ALS (Lou Gehrig’s disease?||Automatic coverage when you start receiving Social Security disability benefits.You should receive card about 30 days after Social Security begins.|
|Are you 65, but not taking retirement benefits?||Requires manual enrollment during the Initial Enrollment Period (starts 3 months before your 65th birthday for 7 months total). If enrollment is missed during this time, penalties will apply or you must wait until General Enrollment begins (Jan 1- Mar 31)|