Part A Coverage in 2017 | A Guide to What You Need to Know

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Part A Coverage

Part A is often referred to as hospital insurance, but what exactly does it cover? Simply put, its coverage includes most of your costs while you are at a hospital or skilled nursing facility as an inpatient, or in certain cases, your home health care and hospice costs.

Generally, it covers the following services:

  • Hospital care
  • Skilled nursing facility care
  • Home health services
  • Hospice

Keep reading to find out exactly what it covers and what it does not.

Hospital Care

A simple visit to the doctor isn’t covered by Part A. However, it does cover the costs of your care if you’re admitted to a hospital for at least “two midnights.” In other words, you’re covered if you stay overnight in the hospital for at least two nights in a row. Once you meet that threshold, and you pay your deductible, coverage begins.

As a beneficiary, you have coverage for inpatient hospital care in the following facilities:

  • Acute care hospitals
  • Critical access hospitals
  • Inpatient rehab facilities
  • Long-term care hospitals

It covers your expenses if all of the following occur:

  • A doctor officially determines that you need to be admitted into the hospital for two or more nights
  • You need the kind of care that can only be given in a hospital
  • The hospital accepts Medicare
  • The hospital’s Utilization Review Committee approves your stay

If you are admitted to a hospital, it covers the following services for a certain period of time:

  • Semi-private rooms (or a private room, if medically necessary)
  • Meals
  • Regular nursing services
  • Special care units (e.g., intensive care)
  • Drugs and medical supplies including casts, splints, and wheelchairs
  • Lab tests, X-rays and radiation treatments
  • Operating and recovery room
  • Rehabilitation services while in the hospital

Keep in mind there are certain things it does not cover:

  • Private room (unless medically necessary)
  • Private nurses
  • TV and phone in your room (if there is a separate charge for these)
  • Personal items, such as razors or socks

If your doctor recommends services that Medicare will not cover, you may have to pay some or all of the costs. To learn more about costs, visit our Guide to Part A.

Skilled Nursing Facility Care

If you’ve been in the hospital for a minimum of three days and your doctor determines that you require follow-up care that you cannot receive at home, you’ll qualify for skilled nursing facility care coverage.

Skilled nursing facility care includes the following services:

  • Semi-private room
  • Meals
  • Skilled nursing care
  • Physical and occupational therapy
  • Medications
  • Medical equipment and supplies
  • Ambulance transportation, if necessary
  • Dietary counseling

A Medicare-certified facility must provide the skilled nursing facility care.

Home Health Services

Part A covers eligible home health services, such as certain skilled nursing care, physical and speech therapy, and continued occupational services.

Beneficiaries must meet the following conditions:

  • You must be under the regular care of a doctor
  • Your doctor must certify that you need one or more of these:
    • Intermittent skilled nursing care
    • Physical therapy, speech-language pathology, or continued occupational therapy. The amount, frequency, and timing of these services needs to be reasonable, and the services must be available only through qualified therapists.
  • The home health agency must be Medicare-certified
  • A doctor must certify that you are confined to your home

You are not eligible for this coverage if you need more than part-time or occasional skilled nursing care.

It does not cover the following expenses:

  • 24-hour at-home care
  • Meal delivery
  • Homemaker services
  • Personal care

Your home health agency should be able to tell you how much of the costs Medicare will cover. They should also give you a notice called the “Home Health Advance Beneficiary Notice” before caring for you and giving you supplies that aren’t covered.

Generally, you pay $0 for home health care services, and 20% of the Medicare-approved amount for medical equipment.

Hospice Care

Hospice care is specialized support for you and your loved ones during an advanced terminal illness. Instead of focusing on a cure, hospice care focuses on comfort and quality of life.

You are eligible for hospice care coverage if you meet all of the following conditions:

  • Your hospice doctor and regular doctor certify that you are terminally ill with a life expectancy of six months or less.
  • You accept care for comfort purposes instead of a cure for your illness.
  • You sign a statement that says you choose hospice care instead of other Medicare-covered treatments for your illness.

Depending on your illness, your hospice care could include the following expenses:

  • Doctor services
  • Nursing care
  • Medical equipment
  • Prescription drugs for pain management or symptom control
  • Dietary counseling
  • Grief and loss counseling for you and your family
  • Short-term respite care
  • Social work services
  • Any other service deemed necessary by your hospice team

Once you choose hospice care, it will not cover certain expenses:

  • Treatment intended to cure your terminal illness (talk to your doctor if you wish to stop your hospice care)
  • Prescription drugs meant to cure your illness
  • Care from additional hospice providers that were not part of your original Medicare-approved hospice team
  • Room and board
  • Care you receive as a hospital inpatient or outpatient, or ambulance transportation (unless cleared by your hospice team or unrelated to your terminal illness)

Make sure to contact your hospice team before getting any of the above services, or you may have to pay the full costs.

Generally, these are the costs you may pay for hospice care:

  • $0 for hospice care
  • A copayment of no more than $5 for each prescription drug designated for pain relief or symptom control (if your drug is not covered by the hospice benefit, your hospice provider should contact your plan to see if it would be covered under Part D)
  • 5% of the Medicare-approved amount for inpatient respite care
  • Room and board costs

More Questions?

Want to learn more about your options? You may be able to sign up for an Advantage Plan, a Supplement Plan, or a Part D Prescription Drug Plan. Use our Suggest-A-Plan tool to help determine which plan may be right for you.

 

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