PART A



What does Part A cover?

Part A (Hospital Insurance) helps cover:

Inpatient care in hospitals
Inpatient care in a skilled nursing facility (not custodial or long‑term care)
Hospice care services
Home health care services
Inpatient care in a religious non medical health care institution

You can find out if you have Part A by looking at your Medicare card. If you have Original Medicare, you’ll use
this card to get your Medicare-covered services. If you join a Medicare health plan, in most cases, you must use the
card from the plan to get your Medicare-covered services.

What do I pay for Part A-covered services?

Copayments, coinsurance, or deductibles may apply for each service listed in the following chart. Visit Medicare.gov, or call 1‑800‑MEDICARE (1‑800‑633‑4227) to get specific cost information. TTY users should call 1‑877‑486‑2048.

If you’re in a Medicare health plan or have other insurance (like a Medicare Supplement Insurance (Medigap) policy, or employer or union coverage), your costs may be different. Contact the plans you’re interested in to find out about the costs, or visit the Medicare Plan Finder at Medicare.gov/find-a-plan.

Part A-covered services

Blood
If the hospital gets blood from a blood bank at no charge, you won’t have to pay for it or replace it. If the hospital has to buy blood for you, you must either pay the hospital costs for the first 3 units of blood you get in a calendar year or have the blood donated by you or someone else.

Home health services
Medicare covers medically necessary part-time or intermittent skilled nursing care, and/or physical therapy, speech-language pathology services, and/or services for people with a continuing need for occupational therapy. A doctor, or certain health care providers who work with a doctor, must see you face-to-face before a doctor can certify that you need
home health services. A doctor must order your care and a Medicare certified home health agency must provide it. Home health services may also include medical social services, part-time or intermittent home health aide services, and medical supplies for use at home. You must be homebound, which means both of these are true:
1. You’re normally unable to leave home and doing so requires a considerable and taxing effort.
2. Because of an illness or injury, leaving home isn’t medically advisable or isn’t possible without the aid of supportive devices, use of special transportation, or the assistance of another person.
You pay nothing for covered home health care services and 20% of the Medicare‑approved amount for durable medical equipment.

Hospice care
To qualify for hospice care, a hospice doctor and your doctor must certify that you’re terminally ill and expected to live 6 months or less. If you’re already getting hospice care, a hospice doctor or nurse practitioner will need to see you about 6 months after you enter hospice to certify that you’re still terminally ill.                                                                                         Coverage includes:
All items and services needed for pain relief and symptom management
Medical, nursing, and social services
Drugs
Certain durable medical equipment
Other covered services, as well as services Medicare usually doesn’t cover, like spiritual and grief counseling
A Medicare-approved hospice usually gives hospice care in your home or other facility where you live, like a nursing home. Hospice care doesn’t pay for your stay in a facility (room and board) unless the hospice medical team determines that you need short-term inpatient stays for pain and symptom management that can’t be addressed at home. These stays must be in a Medicare‑approved facility, like a hospice facility, hospital, or skilled nursing facility that contracts with the hospice.
Medicare also covers inpatient respite care which is care you get in a Medicare-approved facility so that your usual caregiver can rest. You can stay up to 5 days each time you get respite care. Medicare will pay for covered services for health problems that aren’t related to your terminal illness. You can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies that you’re terminally ill.
You pay nothing for hospice care.
You pay a copayment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management.
You pay 5% of the Medicare-approved amount for inpatient respite care.

Hospital care (inpatient)
Medicare covers semi-private rooms, meals, general nursing, and drugs as part of your inpatient treatment, and other hospital services and supplies. This includes care you get in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, inpatient care as part of a qualifying clinical research study, and mental health care. This doesn’t include private-duty nursing, a television or phone in your room (if there’s a separate
charge for these items), or personal care items, like razors or slipper socks. It also doesn’t include a private room, unless medically necessary. If you have Part B, it covers the doctor’s services you get while you’re in a hospital.
You pay a deductible and no coinsurance for days 1–60 of each benefit period.
You pay coinsurance for days 61–90 of each benefit period.
You pay coinsurance per “lifetime reserve day” after day 90 of each benefit period (up to 60 days over your lifetime).
You pay all costs for each day after you use all of your lifetime reserve days.
Inpatient psychiatric care in a freestanding psychiatric hospital is limited to 190 days in a lifetime.
Staying overnight in a hospital doesn’t always mean you’re an inpatient. You only become an inpatient when a hospital formally admits you as an inpatient, after a doctor orders it. You’re still an outpatient if you’ve not been formally admitted as an inpatient, even if you’re getting emergency department services, observation services, outpatient surgery, lab tests, or X-rays. You or a family member should always ask if you’re an inpatient or an outpatient each day during your stay, since it affects what you pay and whether you’ll qualify for Part A coverage in a skilled nursing facility.
For more information, visit Medicare.gov/publications to view the fact sheet “Are You a Hospital Inpatient or Outpatient? If You Have Medicare—Ask!” You can also call 1-800-MEDICARE (1‑800‑633‑4227) to find out if a copy can be mailed to you. TTY users should call 1-877-486-2048.

Religious non-medical health care institution (inpatient care)
In these facilities, religious beliefs prohibit conventional and unconventional medical care. If you qualify for hospital or skilled nursing facility care, Medicare will only cover the inpatient, non‑religious, non-medical items and services. An example is room and board, or any items and services that don’t require a doctor’s order or prescription, like unmedicated wound dressings or use of a simple walker.

Skilled nursing facility care
Medicare covers semi-private rooms, meals, skilled nursing and rehabilitative services, and other medically necessary services and supplies after a 3-day minimum medically necessary inpatient hospital stay for a related illness or injury. An inpatient hospital stay begins the day you’re formally admitted with a doctor’s order and doesn’t include the day you’re discharged. To qualify for care in a skilled nursing facility, your doctor must certify that you need daily skilled care like intravenous injections or physical therapy. Medicare doesn’t cover long-term care or custodial care.
You pay nothing for the first 20 days of each benefit period.
You pay a coinsurance per day for days 21–100 of each benefit period.
You pay all costs for each day after day 100 in a benefit period.
Note: Visit Medicare.gov, or call 1-800-MEDICARE (1‑800‑633‑4227) to find out what you pay for inpatient hospital
stays and skilled nursing facility care in 2014. TTY users should call 1-877-486-2048.

Medicare Part A - Hospital

In the first of 5 video's we take a look at Medicare Part A - Hospital coverage. A lot gets covered in this video from the Part A Deductible, Copays, Lifetime Reserve days, Benefit periods and more!