Medicare Part A is the main part of Original Medicare and it is basically hospital insurance that covers a variety of hospital services as well as it covers the entire cost for covered home healthcare services. In general Part A always covers inpatient hospital stays, skilled nursing care, hospice care, and limited home healthcare services.
PART A COVERAGE
Medicare Part A covers next services:
- Inpatient hospital care
Limited home healthcare
Short-term skilled nursing facility stays
- Nursing home care (for a limited time only)
Inpatient hospital care covers any tests or treatments needed while admitted to the hospital. It includes services like meals, nursing services, physical therapy, and medications that a doctor prescribes.
Limited home healthcare refers to the coverage of needed care from a home health aid after you’ve been released from an inpatient hospital stay. Medicare will cover medically necessary care while you recover.
Hospice care is also covered under Medicare Part A, once the choice is made to seek hospice care instead of hospital treatment for a terminal disease diagnosed.
Short-term skilled nursing facility stays are covered under Part A for a certain amount of time. Skilled nursing facility stays are covered after qualifying hospital inpatient stays for a related illness or injury. The skilled nursing facilities must be certified by Medicare to be under Part A coverage. To qualify for this type of care, the hospital stay must be a minimum of three days.
WHAT DOES MEDICARE PART A NOT COVER?
There are some hospital costs that are not covered under Part A of Medicare.
Part A does not cover your first 3 pints of blood, but if a hospital receives blood for you from a central blood bank, you may not be charged.
Medicare Part A does not cover private rooms, inpatient care in a hospital is meant for you to stay in a semi-private room.
If you have long-term care needs, such as a nursing home, you will have to pay for your own care out of pocket, because Part A is intended to provide care during the acute illness or injury.
MEDICARE PART A COSTS
Most people who qualify for Medicare do not pay for Part A, under one condition and that is if you or your spouse worked for at least 40 quarters (10 years) paying Medicare taxes. If you didn’t there are some cost rules for hospitalization that are important to know. Inpatient hospitalization days 91 and higher are considered lifetime reserve days. You receive 60 lifetime reserve days to use over the course of your life. If you go beyond these days, you are responsible for all costs after day 91. A benefit period begins when you are an inpatient and ends when you have not received inpatient care for 60 days in a row. The cost for days 1-60 of inpatient care is $0/per day. If you need to stay more than 60 days, then the costs are $389/per day for days 61-90 of inpatient care, and they are $778/per day from day 91 on.
MEDICARE PART A ELIGIBILITY
To be able to enroll in Medicare Part A, you must meet one of the four criteria:
You are 65 years old or older,
You have a disability determined by the doctor and you receive Social Security benefits for at least 2 years (24 months) in a row,
You have been diagnosed with End-Stage Renal Disease (ESRD) or
You have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), known as Lou Gehrig`s disease.
If you are currently receiving Social Security benefits and are under age 65, you will be automatically enrolled in Medicare parts A and B when you turn age 65.
MEDICARE PART A ENROLLMENT
Individuals who are already receiving Social Security benefits at least 4 months before being eligible for Medicare and residing in the United States (except residents of Puerto Rico) are automatically enrolled in both premium-free Part A and Part B when they turn 65th birthday.
People who are not receiving a Social Security benefit are not automatically enrolled and they must apply by contacting Social Security. directly (in person or via phone/mail). Then there are two types of enrollment: Initial enrollment and Special enrollment. The initial enrollment period is starting 3 months before your`s 65th birthday (including the month of the birthday) and lasts until 3 months after your 65th birthday. Special enrollment is for cases when you did not enroll in the Initial enrollment period but still want to enroll in Part A late. You may qualify to enroll during this period if you were employed by a company that had more than 20 employees when you turned 65 years old and had health insurance through your job, union, or spouse.