(866) 341-8542 & (281) 255-4444

The Basics About Medicare Part A Coverage

In this brief article, we’ll walk you through each Medicare Part A coverage, including the services provided and how much you might expect to pay.

Part A is the first portion of Original Medicare, which, along with Part B, is managed by the federal government.

As a whole, Part A provides for 80% of the services covered by Medicare, including inpatient hospital care, skilled nursing facility care, hospice care, and limited home health care and preventative services.

It automatically activates approximately three months before your 65th birthday, at which point you’ll receive your red, white, and blue card in the mail.

Are you expecting your card soon? Wondering what types of coverage you’ll have once your Medicare Part A goes into effect? We’ll quickly break everything down.

Which Coverage Does Medicare Part A Provide?

According to the Medicare.gov website, whether or not coverage is available for your situation depends on three main factors:

  1. Federal and state laws.
  2. National coverage decisions made by Medicare about whether something is covered.
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

With this caveat in mind, let’s take a closer look at each coverage provided under Medicare Part A.

Does Part A Provide Hospital Insurance?

If you’re admitted to a hospital that accepts Medicare on a doctor’s orders to treat your illness or injury, your inpatient care could be covered. This includes a semi-private room, meals, general nursing, drugs related to your treatment, as well as other relevant “services and supplies.”

On the other hand, Medicare Part A coverage does not pay for a private room unless it’s medically necessary. Required or otherwise, they also won’t cover “private-duty nursing, a television, or a phone in your room.”

What Long-term Care Hospital Services Does Medicare Part A Offer?

Medicare Part A also covers the cost of long-term care in a long-term care hospital (LTCH), which they define as those specializing “in treating patients that are hospitalized for more than 25 days.”

“Patients may include people who’ve used ventilators for an extended period of time, or experience a severe wound or head injury,” they explain.

The Medicare website points out that in many instances, LTCH patients discharge to a skilled nursing facility, or move into custodial care provided by a long-term care facility—one of which is covered, while the other isn’t.

Let’s talk more about this next.

Are Skilled Nursing Facility (SNF) & Custodial Care Services Covered Under Part A?

If you need to stay in a skilled nursing facility on a short-term basis (less than 25 days) for a hospital-related medical condition, Part A of your Medicare insurance could provide coverage if your doctor decides it’s medically necessary. The facility will also need to be certified by Medicare, and care “must be given by, or under the supervision of, skilled nursing or therapy staff.”

IHS Pro Tip: On the other hand, the Medicare website expressly points out that custodial care—which most nursing home care falls under—is not covered, if it’s the only kind you need. 

Instead, they explain Part A only covers services to “treat, manage, observe, and evaluate your care,” which are performed “under the supervision of professionals or technical personnel.”

These include (by no means a comprehensive list) semi-private rooms, meals, medical social services, medications, medical supplies and equipment, and dietary counseling. Medicare Part A may also cover physical and occupational therapies, as well as speech-language pathology services.

Does Medicare Part A Cover Hospice & Palliative Care?

If your hospice and regular doctors certify that you’re terminally ill and have six months or less to live, you’re willing to “accept palliative care (for comfort) instead of care to cure your illness,” and will sign a statement indicating such, Medicare Part A could cover your hospice care.

Depending on your illness and related conditions, services include doctor and nursing care, medical equipment and supplies, prescription drugs, physical and occupational therapy, grief and loss counseling, and short-term inpatient and respite care.

Along these same lines, the Medicare website discloses that Part A won’t cover treatment or prescriptions to cure your condition. Nor will they pay for room and board, care you receive as a hospital outpatient, or care received from anyone other than the provider set up by the hospice medical team.

What about regular home health care, though? Continue reading to learn more.

Will Medicare Part A Cover Your Home Health Care?

Along with Part B[D4] , Part A could cover home health services like part-time skilled nursing care, medical social services, home health aide services, along with physical and/or occupational therapy.

However, Medicare has some stringent guidelines in place: You must be homebound and under a doctor’s regular care, who also has to certify that you medically require safe and effective treatments and services from a Medicare-certified home health agency. This agency will coordinate your doctor’s orders for you.

On the other hand, Medicare Part A doesn’t cover 24-hour at-home care, home-delivered meals, homemaker services, and custodial care if it’s the only type of care you require.

Just because Part A offers coverage, though, doesn’t necessarily mean patients won’t incur any out-of-pocket expenses. We’ll discuss more next.

What Can You Expect to Pay For Your 2019 Medicare Part A Premium?

The Medicare website emphasizes that only your doctor or health care provider can tell you the specific amount your test, item, or service will cost. Why? They advise that it can depend on a variety of factors, including:

  • Other insurance you may have
  • How much your doctor charges
  • Whether your doctor accepts assignment
  • The type of facility
  • Where you get your test, item, or service

With these details in mind, here’s a quick table listing Part A’s different coverage costs, depending on the situation:

 

How Much Will Your Medicare Part A Coverage Cost?
Coverage Out of Pocket Expenses Notes
Inpatient Hospital Care $1,364 deductible per benefit period; $0–$682 coinsurance Additional costs for a private room, private-duty nursing, a TV, or an in-room phone.
Long-Term Hospital Care (LTCH) $1,364 deductible first 60 days; $341 coinsurance per day after 60–90 days; $682 coinsurance per day after 91+ days up to lifetime reserve If you already paid a deductible for hospitalization, you may not need to pay a separate once for LTCH.
Skilled Nursing Facility (SNF) Care $0 per benefit period for first 20 days; $170.50 coinsurance per day for 21–100 days; all costs 101+ days Refusing or taking a lengthy break from skilled nursing services could cause patients to lose their coverage.
Hospice Care You pay nothing, other than a potential maximum $5 copayment for each prescription drug (which Part D [D6] may also cover) Regarding inpatient respite care, you may be responsible for 5% of the Medicare-approved amount. Medicare doesn’t cover room and board under hospice.
Home Health Care Medicare Part A provides full coverage ($0 to patients) for home health care services. You may have to pay 20% of the Medicare-approved amount for durable medical equipment (DME).

Their website emphasizes the agency should tell you how much Medicare will pay in advance, and how much you’ll have to pay (via an Advance Beneficiary Notice (ABN)).

Do You Have Questions About Your Medicare Part A Coverage?

There’s no getting around it: Medicare is a complex topic, whether you’re discussing Part A or any other coverage it provides.

Fortunately, the licensed Medicare coverage specialists IHS Insurance are available to answer your questions and help in whatever way possible.

Give us a call direct at (281) 255-4444, toll-free at 1-866-480-5063, or fill out the contact form below. We’ll be in touch shortly!

>> Continue reading: What is Medicare Part B Coverage?

Call Now!