What Medicare Part A Covers - Medicare Consumer - Medicare Consumer

What Medicare Part A Covers

Medicare Part A is considered a part of the Original Medicare plan. Although Part A and Part B of Medicare cover different items, often these two parts will work in tandem with one another in order to get you the overall coverage that you need. Part A of Medicare provides hospitalization coverage, and it covers services such as inpatient surgery and other hospital case, as well as:

  • Skilled nursing home care
  • Hospice care
  • Home health care

 

Medicare-Covered Hospitalization Care

The inpatient hospital care that is provided by Medicare Part A includes items such as a semi-private room, your meals while you are in the hospital, general nursing care, the medication you receive as a part of your treatment, and other necessary hospital services and supplies.

This coverage also includes the care that you receive in acute care hospitals, as well as care in critical access hospitals, inpatient rehab facilities, long-term care hospitals, and inpatient care as part of a qualifying clinical research study. In addition, Medicare Part A will also cover mental health care – with certain limitations.

 

Part A Skilled Nursing Home Coverage

Medicare Part A may also cover your care in a skilled nursing home facility, provided that certain conditions have been met. In this case, you will need to have had a prior qualifying hospital stay of at least “three midnights,” and you must have remaining days in your hospitalization benefit period.

In addition, you must enter the nursing home facility for the same condition in which you were hospitalized, and your doctor must have determined that you require skilled care provided by, or under the supervision of, either skilled nursing or therapy staff.

The Medicare Part A covered services that you receive may include:

  • A semi-private room
  • Your meals
  • Skilled nursing care
  • Physical and occupational therapy – provided that these are needed in order to meet your health goal
  • Speech-language pathology services – also provided that these are needed in order to meet your health goal
  • Medical social services
  • Your medications
  • Medical supplies and equipment that is used in the nursing facility
  • Dietary counseling
  • Ambulance transportation to the nearest supplier of necessary services that are not available at the skilled nursing facility (when other transportation may be a danger to your health)

It is important to note that Medicare Part A’s coverage of skilled nursing home facility care may differ from its coverage for long-term care hospitals. Long-term care hospitals specialize in treating individuals who may have more than just one serious condition, but who may improve with care and time, and who may eventually return to their home.

 

Hospice Care Coverage Through Medicare Part A

Medicare Part A also provides coverage for hospice care. This care is typically provided in an individual’s home. However, it could also be offered in a hospice inpatient facility. Depending on your terminal illness and on the plan of care that is developed, coverage may include any or all of the following:

  • Doctor services
  • Nursing care
  • Medicare equipment and supplies
  • Prescription drugs
  • Hospice aide and homemaker services
  • Physical and occupational therapy
  • Speech-language pathology services
  • Social worker services
  • Dietary counseling
  • Grief and loss counseling for the patient and his or her family
  • Short-term inpatient care
  • Short-term respite care
  • Other Medicare-covered services that are necessary for pain management and / or other symptoms that are related to the individual’s illness and related conditions as recommended by the hospice team

Although your out-of-pocket Medicare-covered costs for hospice care are $0, you may need to pay a co-payment of no more than $5 for each prescription drug or other similar product that you require for pain relief. There could also be a charge of 5% of the Medicare-approved amount for inpatient respite care if this should be required. Respite care refers to temporary care that would be provided in either a nursing home, hospice inpatient facility, or a hospital so that a family member or friend who is your caregiver at home may take time off.

 

Your Out-of-Pocket Costs

While Medicare Part A offers a broad array of coverage, there are out-of-pocket costs required in the form of co-insurance and deductibles. For example, in 2015, there is a required hospitalization deductible of $1,260 for each benefit period.

Depending on how long you remain hospitalized, you may also be required to pay additional co-insurance charges. For instance, in 2015, the Medicare Part A hospitalization co-insurance charges are:

  • Days 61 through 90 – $315 co-insurance per day for each benefit period
  • Days 91 and beyond – $630 co-insurance per day for each benefit period

You do have the option of using what are called “lifetime reserve” days to help pay for your hospitalization expenses over the co-insurance amount for the days that you remain in the hospital after Day 90. All Medicare enrollees receive 60 lifetime reserve days that may be used. However, once you have used up all of your lifetime reserve days, you will be responsible for paying all of the costs in a benefit period over the daily co-insurance expenses beyond Day 90.

You may also be responsible for certain out-of-pocket costs if you require Medicare-covered care in a skilled nursing facility. Those who qualify for Part A coverage will need to pay the following (in 2015):

  • Days 1 through 20 – $0
  • Days 21 through 100 – $157.50 per day co-insurance
  • Days 101 and beyond – All costs

It may be possible to have some or all of these out-of-pocket costs picked up by a Medicare Supplement insurance policy. Depending on the plan that you choose, you could have your Part A co-insurance and hospital costs covered, as well as the amount for the skilled nursing facility co-insurance charges.

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