Part A (Hospital Insurance)

Part A is also known as Hospital Insurance. Part A helps cover costs for inpatient care in a skilled nursing facility, inpatient care in a hospital, home health care, hospice care, inpatient care in a religious nonmedical health care institution and more.

 

If you have already received your red, white, and blue Medicare card you can find out if you have Part A by looking towards the bottom center.  You will see Hospital (PART A) followed by a date.  The date represents when you first became eligible for Part A benefits.  See sample:

Blood

If you need a blood transfusion and the hospital can obtain the blood from a blood bank at no charge, you will not have to pay for it and you will not have to replace it.  However, 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

You can use your Home health benefits under Part A and /or Part B. Medicare covers medically necessary part-time or intermittent physical therapy, pathology services, skilled nursing care, speech-language, and/or services if you have a continuing need for occupational therapy. Before a doctor can certify that you need home health services, he/she must see you face to face. Certain other health care professionals who work with doctors may also see you. A Medicare-certified home health agency must provide your care, and it must be ordered by a doctor.

 

Home Health Services may also comprise part-time or intermittent Home Health aide services, medical social services, durable Medical Equipment, and for use-at-home medical supplies.  You must have trouble leaving your home without the assistance of a walker, cane, crutches, wheel chair, special transportation, or the assistance of another person because of an illness or injury. You must also be unable to leave your home and/or leaving it would not be recommended because of your condition. In essence, you must be home bound.

 

Hospice Care

Hospice care is covered if your doctor and a hospice doctor, certify that you are terminally ill. Terminally ill means that you have a life expectancy of six months or less.  If you are currently receiving hospice care, you will need to be seen by a hospice doctor or nurse practitioner six months after the commencement of your hospice care and he/she will need to certify that your condition remains the same.

 

All services, and all objects necessary for pain relief and symptom management are covered as well as drugs, nursing, medical, social services, aide and homemaker services, and certain durable Medical Equipment (ME).

 

Hospice care is usually given by a Medicare approved hospice in your home or other facility where you live, such as a nursing home.

 

If the hospice medical team determines that your pain and symptoms management can’t be addressed at home and you need short-term inpatient stays, then costs are covered.  However, hospice care does not pay room and board for your stay in a facility. If a stay is required, it must be in a Medicare-approved facility such as a hospital, hospice facility, or skilled nursing facility contracted with the hospice. Inpatient respite care is also covered. Respite care is care you receive in a Medicare approved facility so that your normal caregiver may have the time to rest. Respite care is approved for up to five days each time. Health problems not related to your terminal illness or related conditions are also covered. Hospice care will continue for as long as a hospice doctor or the hospice medical director recertifies that your terminally ill condition continues. Even though you pay nothing for hospice care, there are some copayments that you will be responsible for. You may have to pay up to $5 for each outpatient prescription drug. You will also pay 5% of the cost approved for inpatient respite care.

  

Inpatient hospital care

Inpatient treatment and other hospital supplies and services are covered by Medicare Part A. Also covered are general nursing, semi-private rooms, meals, and drugs received as part of your inpatient treatment. This applies if you receive care in inpatient rehabilitation facilities, acute care hospitals, long term care hospitals, critical access hospitals, and mental health care. Not covered by Medicare are items and services such as a phone or television in your room, private-duty nursing, or personal care objects such as razors, slippers, or slipper socks. Unless medically necessary, private rooms are also not covered. Medicare Part B will cover 80% of the approved amount for doctors’ services you receive while in a hospital.

 

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 does not 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 private room, unless medically necessary.  If you have part B, it generally covers 80% of the Medicare-approved amount for doctor’s services you get while you are in a hospital.

 

Religious non-Medical Health care institution (inpatient care)

Conventional and unconventional Medical Care is prohibited by religious beliefs in these types of facilities.  If you qualify for hospital or skilled nursing facility care, Medicare Part A will cover inpatient, non-religious, non-medical items and services such as room and board, over the counter items such as wound dressings that are not medicated, walkers, and nonprescription drugs. 

 

Skilled nursing facility care

Medically necessary services like semi-private rooms, skilled nursing services, rehabilitative services, meals, and other medically necessary services and supplies are covered by Medicare Part A after a three-day minimum inpatient hospital stay. Inpatient hospital stays do not begin until you are formally admitted as an inpatient per doctor’s orders.  The day of discharge is not included as part of your inpatient hospital stay.  Skilled nursing care and/or skilled therapy care may be obtained to aid and improve your medical condition and/or prevent it from worsening. Your doctor must certify that you need this type of care in order for the care to be covered. For each benefit period, you pay nothing for the first 20 days. For days 21 through 100 you pay a per-day co insurance. After day 100, you are responsible for all costs.