Getting to Know Medicare Part A

Medicare Benefits Solutions
Nov 23, 2019

Medicare is made up of four parts you may be familiar with – Part A, Part B, Part C, and Part D. If you are just approaching Medicare eligibility, you may be wondering what insurance coverage Part A will provide and how you enroll. Let’s get you acquainted with Medicare Part A.

Most people are automatically enrolled in Medicare Part A when they turn 65 years of age, have been receiving disability benefits from Social Security or the Railroad Retirement Board (RRB) for 24 months, or have been diagnosed with ESRD or ALS. Many people receive premium-free Part A because they have paid taxes while working for a certain period of time (40 quarters).

Also known as Hospital Insurance, Medicare Part A will help cover the costs of:

• Hospital care
• Skilled nursing facility care
• Nursing Home care (excluding custodial care)
• Hospice
• Home health services

Inpatient Hospital Care

It can be stressful enough to be admitted into a hospital, but your healthcare insurance shouldn’t add to your concerns. Understanding your benefits will help you feel at ease and allow you to focus on your recovery.

In order for Medicare Part A coverage to apply, the hospital must formally admit you, accept assignment, and provide care you cannot receive elsewhere. Inpatient care may include semi-private rooms, meals, general nursing care, and drugs you need as part of your inpatient treatment. Your coverage may include services and supplies that you receive in an acute care hospital, critical access hospital, inpatient rehabilitation facility, or long-term care hospital. In order to receive coverage as an inpatient, your doctor must deem it medically necessary and write an order for you to spend 2 or more midnights in a hospital to treat your illness or injury. The Utilization Review Committee of the hospital must also approve your stay.

Skilled Nursing Facility Care

Many people are admitted into skilled nursing care to continue their recovery after a stay in a hospital. Medicare Part A helps cover the cost of care in a skilled nursing facility (SNF) under certain conditions for a limited amount of time. In order to qualify, you must meet the following criteria:

• You have a qualifying hospital stay
• Your physician deems it medically necessary for you to receive care given by skilled nursing or therapy staff
• The SNF is certified by Medicare
• You have a hospital-related medical condition, or a condition that started while you were getting care in a hospital or skilled nursing facility

Hospice Care

Hospice can play an important role in providing comfort and care for patients who are considered terminally ill and their loved ones. Medicare Part A covers hospice care for individuals who are nearing end of life at home, in a hospital, or in a hospice inpatient facility. A hospice team of providers will work with a patient and their family to create a comfortable environment focused on pain and symptom management, grief counseling, and care.

Home Health Care

Getting care at home can help speed up a recovery process and make a patient more comfortable. Home health services may include part time or intermittent skilled nursing care that takes place in the home, and can include physical therapy, occupational therapy, speech and language pathology services, and medical social services. A doctor must certify that you are homebound and in need of this care.