Medicare Part A
Medicare Part A is the part of Medicare that people are automatically enrolled in if they enroll in Medicare. Part A mainly covers hospital and skilled nursing care. Specifically, it covers:
- Inpatient hospital stays
- Skilled Nursing Facility Care
- Hospice Care
- Some Home Health Care
Let’s review each of these topics in more detail.
Inpatient Hospital Stays
Inpatient versus outpatient hospital care can be tricky to determine. If you are admitted to the hospital, your admission does not necessarily qualify as an inpatient stay. Some hospitals have certain criteria that patients must meet for their stay to qualify as an inpatient admission. Additionally, the doctor in charge of your care must formally admit you to their service to qualify as inpatient admission.
If you are in the hospital for inpatient care, Medicare Part A covers a shared room, meals, general nursing tasks, and medications that are a part of your inpatient treatment. This also includes care in an inpatient mental health facility. However, Medicare Part A does not cover private-duty nursing, a television or phone if the hospitals charge for these items, or personal care items.
Inpatient hospital stay coverage includes blood units. Specifically, if a hospital receives the blood from a blood bank at no charge, you are not required to pay for that blood. However, if the hospital purchases that blood, you must pay for the first three units of blood you will receive in the calendar year.
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Skilled Nursing Facility
A Skilled Nursing Facility, often referred to as an SNF, is a place of rehabilitation that patients often stay in after a hospital stay. An SNF allows patients to recover and rehabilitate when they have nursing needs but do not necessarily need all of the resources of a full hospital admission. Medicare Part A covers certain parts of an SNF stay, such as shared rooms, meals, skilled nursing and rehabilitative services, and the relevant supplies.
To qualify for SNF coverage, your doctor must certify that you need daily skilled care. Additionally, you must have an inpatient hospital stay for a minimum of three days for a condition related to the SNF stay. The inpatient admission must be medically necessary.
Hospice care is for patients who are terminally ill with a life expectancy of fewer than six months, as described by a doctor. Hospice care coverage includes comfort measures, such as medications for pain relief and symptom management, nursing, aides, and equipment. Spiritual and grief counseling are not included in this coverage.
Home Health Services
Home health services are when different medical professionals, often nurses or physical therapists, visit patients at home. This normally occurs after a hospital stay when the doctors conclude that a patient needs more help at home but is well enough to stay out of the hospital or SNF. To qualify for Medicare coverage:
- You must be homebound, meaning your doctor says you should stay home due to your condition
- Each service must be medically necessary
- A doctor must order this care
- A Medicare-certified home health agency must administer the care
Home health services are covered under Part A and Part B. Medicare Parts A and B cover medically necessary part-time skilled nursing care, physical and occupational therapy, and speech-language pathology.
Medicare Part A covers inpatient care, SNF care, home health care, and hospice care. Certain things that are not covered, and the requirements you must meet in order to be covered can be tricky to understand.