Medicare Part A Explained - Medicare Consumer - Medicare Consumer

Medicare Part A Explained

Medicare Part A helps cover your inpatient care in a hospital. This includes critical illness hospitals and skilled nursing facilities (certain conditions apply). Medicare Part A also helps cover hospice and home health care. But you must meet certain conditions to get these Medicare Part A benefits.

Most people automatically get Medicare Part A coverage without paying a monthly premium. This is because they or their spouse paid Medicare taxes while they were working.

Medicare Part A coverage includes:

  • Hospital Stays. This includes a semi-private room, meals, general nursing and other hospital services and supplies. Medicare Part A coverage also includes inpatient care that you get in critical access hospitals and mental health care. Medicare Part A does not include private-duty nursing or a television or telephone in your hospital room, nor does Medicare Part A pay for a private room – unless it is considered to be medically necessary.
  • Blood. This includes pints of blood that you get at a hospital or skilled nursing facility during a covered stay.
  • Skilled Nursing Facility Care. Medicare Part A covers a semi-private room, meals, skilled nursing and rehabilitative services, and other services and supplies – but only after a three-day inpatient hospital stay for a related illness or injury, and only for up to 100 days in a benefit period. This is also only provided that certain conditions are met. Medicare Part A does not cover most long-term care.
  • Home Health Services. This type of Medicare Part A coverage is limited to reasonable and medically necessary part-time or intermittent skilled nursing care and home health aide services, and physical therapy, occupational therapy, and speech-language pathology that is ordered by your doctor and provided by a Medicare-certified home health agency. Medicare Part A also includes medical social services, other services, durable medical equipment such as wheelchairs, hospital beds, oxygen, and walkers, and medical supplies for use at home. Medicare does not pay for homemaker services, personal care, or meals that are delivered to your home.
  • Hospice Care. Hospice care is used for people with a terminal illness. Medicare Part A coverage includes drugs for symptom control and pain relief, medical and support services from a Medicare-approved hospice, and other services not otherwise covered by Medicare (like grief counseling). Hospice care is usually given in your home, or it may be in a facility. Medicare Part A will cover some short-term hospital and inpatient respite care (care given to a hospice patient so that their regular caregiver can rest).

You generally don’t pay a monthly premium for Medicare Part A if you or your spouse paid Medicare taxes while working. This is called “premium-free Medicare Part A.” However, if you are not eligible for premium-free Medicare Part A, you may be able to buy Medicare Part A if you meet one of these conditions:

  • You’re age 65 or older, you are entitled to or enrolling in Medicare Part B, and you meet the citizenship or residency requirements;
  • You are under age 65, disabled, and your premium-free Medicare Part A coverage ended because you returned to work.

If you choose to purchase Medicare Part A, you must also have Medicare Part B and pay monthly premiums for both.

If your income is limited, your state may help you to pay for Medicare Part A and / or Medicare Part B.

 

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