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Medicare Part A

Explanation of Medicare Part A

Medicare has several parts to consider when making your health care insurance choices. Understanding Medicare and how it works will allow you to choose the best plan to fit your needs. One part of the Medicare program is called Part A. Most people do not have to pay a premium for Part A because the individual or their spouse paid Medicare taxes while working. Others can buy Part A if they meet certain criteria.

Below is an explanation of Medicare Part A and the coverage received under this plan. Use this information to decide if Part A is for you.

What is Part A?

medicare part aMedicare Part A is a type of hospital insurance provided by Medicare. The coverage provided by Part A includes inpatient care in hospitals, nursing homes, skilled nursing facilities, and critical access hospitals. Part A does not include long-term or custodial care. If you meet specific requirements, then you may also be eligible for hospice or home health care.

Fiscal Intermediaries handle the claims for the Medicare Part A plan. These are private insurance companies that act as agents for the federal government in processing and paying Medicare claims.

What does Part A Cover?

Before learning about what Part A covers, you should also know that Medicare does not cover everything, nor does it cover the total cost for many of the covered services or medical supplies. Coverage amounts are based on which Medicare plan you have. Part A helps cover only the medically necessary services below:

Blood Transfusions

This is blood (pints) that you receive during a covered stay in a hospital, critical access hospital, or a skilled nursing facility.

Hospital Stays

Part A covers hospital stays, which includes a semi-private room, meals, general nursing, and miscellaneous hospital services and supplies. Inpatient care in critical access hospitals and mental health care (up to 190 lifetime maximum) are also covered. Hospital stays must be at least 3 days (72 hours). The time begins the first midnight after admission and does not include any hours on the discharge date.

Nursing Home or Skilled Nursing Facility

Nursing home or skilled nursing facility stays must be related to diagnosis during a hospital stay. For instance, your hospital stay was for a stroke. Then, a nursing home or skilled nursing facility stay for rehabilitation would be covered. A nursing home or skilled nursing facility stay includes a semi-private room, meals, and rehabilitative and skilled nursing services and care.

The coverage is limited to a maximum of 100 days in a benefit period. The first 20 days are paid in full, and the remaining 80 days will require a co-payment. Medicare Part A will not cover long-term care, non-skilled, daily living, or custodial activities.

Home Health Services

Home health services include limited reasonable and only medically necessary part-time care and services such as skilled nursing care, physical or occupational therapy, home health aide service, speech language pathology, and medical social services. It also includes certain home-use medical equipment (wheelchairs, hospital beds, walkers, oxygen), and other medical supplies.

Hospice Care

Hospice care is for the terminally ill who have six months or less to live. Coverage includes pain relief and symptom control drugs, medical and support services, grief counseling, and other services. Care is provided by a nearby, Medicare-approved Hospice caregiver who will visit you at your home. Medicare also provides additional care for a Hospice patient so that the usual caregiver can take a time of rest. Medicare does not cover many of the services that are provided to patients who receive Hospice assistance.

Whatever health care insurance coverage you choose, make sure you have a clear understanding of all the options, coverage and premiums. Don’t be afraid to ask questions and seek a Medicare representative that can help you fully understand and tell you what you will need to do to sign up.