What Does Medicare Part A Cover?
Medicare Part A covers you while you stay in the hospital, a skilled nursing facility, nursing home, hospice care, or receive home health care.
It does not provide long term custodial care in a nursing facility. It also does not pay for the services of the doctor while in the hospital.
Let's dig into the details.
How Does Medicare Part A Cover Hospital Stays?
Medicare Part A covers your hospital stay if you meet the qualifications.
First, you must have a doctor's order requiring inpatient treatment of an illness or injury.
Second, the hospital must accept Medicare benefits.
Third, in some cases, the hospital's Utilization Review Committee must approve your stay.
Next, Medicare Part A covers specific costs in the hospital. This includes meals, general nursing, semi-private rooms, inpatient drugs, general hospital services, and supplies.
If you require hospital inpatient mental health care, the maximum benefit is for 190 days in a lifetime. Treatment includes inpatient psychiatric facilities, acute care hospitals, critical access hospitals, long term care hospitals, and inpatient care if participating in a clinical research study.
What Does Medicare Part A Not Cover?
Medicare Part A does not pay for private-duty nursing, a private room unless medically necessary, television or phone in your room if there is a separate charge for them, or personal care items like a razor or slipper socks.
Medicare Part A also does not cover the first 3 pints of blood if needed. It includes blood after the first 3 pints.
Also, Part A does not cover doctor's services. Medicare Part B covers doctor's services.
Even though Medicare Part A covers some skilled nursing facility and nursing home services, it is limited. Medicare does not cover long term custodial care.
How Does Medicare Part A Cover Nursing Homes or Skilled Nursing Facilities?
Yes, it covers some situations in a nursing home or skilled nursing facility, but there are specific limits.
First, Medicare Part A only pays for treatment after you had a qualifying hospital stay. Medicare requires that you stay in the hospital for at least three days before receiving skilled nursing services. You must check into the nursing facility within 30 days of hospital discharge.
Second, your plan must have benefit period days available.
Third, your doctor must determine that you need daily skilled care.
Fourth, a Medicare-certified facility must provide skilled nursing services.
Finally, Medicare Part A cannot cover long term, custodial care. Skilled nursing care intended for temporary recovery after a hospital stay. The doctor expects your condition to resolve within 60 days.
If your doctor recommends more services that Medicare does not cover, you may have to pay some or all of the costs. Ask your doctor questions, so you understand why your doctor is recommending certain services and whether Medicare will pay for them.
Does Medicare Part A Cover Hospice?
You can receive hospice care if your regular doctor and hospice doctor certify that you are terminally ill. Also, you would agree to have palliative care (comfort treatment) instead of curative treatment. Finally, you would sign an agreement choosing hospice care over other Medicare-covered benefits for treatment.
Medicare Part A also covers inpatient respite hospice care. If your family needs a rest from providing care, you can go to a Medicare-approved hospice inpatient center. There you receive the treatment you had at home while your family takes a break. Respite care stays can last up to 5 days, but the number of visits is unlimited.
For hospice care, you do not have to pay for treatment. For drugs, you pay a $5 copay and a 5% coinsurance for respite care. However, Medicare Part A does not cover room and board costs if you receive treatment at home or in a nursing facility.
How Do I Enroll in Medicare Part A?
Most people automatically enroll in Medicare Part A when they turn 65 through the Social Security Administration. Other people who are disabled or have end-stage kidney failure can sign up before 65.
Once you have Medicare Part A, you do not need to keep signing up every year. The plan will automatically renew. But if you want a different program, you can change plans once a year.
How Much Does Medicare Part A Cost?
Medicare Part A has a $0 premium if you worked long enough before enrolling to qualify.
If you did not work enough, you would pay either $252 or $458 per month, depending on how long you paid Medicare taxes.
Hospitalization - $1,408 for each benefit period. The benefit period ends 60 days after the hospital discharged you.
Skilled nursing care – None
- Days 1-60 – $0
- Days 61-90 – $352 per day
- Days 91+ – $704 per day until you use up lifetime reserve days (60 days)
- Lifetime reserve days – 100% of all costs
Skilled Nursing Care
- Days 1-20 – $0
- Days 21-100 – $176 per day
- Days 101+ – 100% of all costs
Part A Out-of-Pocket Maximum
Where Can I Buy a Medicare Supplement?
AARDY is the nation's fastest Medicare insurance marketplace. You can compare Medicare supplements and Medicare Advantage plans to find the one that best fits your needs.