Part A
Medicare Part A, in combination with Medicare Part B, is known as Original Medicare. Generally, Medicare Part A coverage includes:
- Inpatient care in a hospital
- Nursing home care
- Skilled nursing facility care
- Hospice care
- Home health care
Part A
Inpatient Care
Medicare Part A covers inpatient care in a hospital when your case meets the following conditions:
- Your hospital accepts Medicare
- You have an official doctor’s order that says inpatient hospital care is required to treat your injury or illness
- In some cases, the Utilization Review Committee of the hospital must approve your stay
Not all hospital services during your stay are covered. Covered services include meals, general nursing, semi-private rooms, drugs required for inpatient treatment, and other supplies and services deemed necessary for your inpatient treatment.
Inpatient care includes services you can get in these types of facilities:
- Critical access hospitals
- Acute care hospitals
- Inpatient psychiatric facilities (Inpatient mental health care in a psychiatric hospital has a limit of 190 days in your lifetime)
- Inpatient rehabilitation facilities
- Long-term care hospital
- Inpatient care as part of a qualifying clinical research study
Nursing Home Care
Most nursing home care is custodial, which is not covered by Medicare if that’s the only care you need. Custodial care is care that supports your daily activities (like bathing, getting dressed, and using the bathroom) or personal needs that unskilled people can do safely and reasonably.
However, Medicare does cover inpatient care in a skilled nursing facility that’s not custodial or long-term care.
Skilled Nursing Care
Skilled nursing care is care provided by registered nurses, doctors, and other licensed health care workers. Medicare Part A covers skilled nursing facility care when the following conditions are met:
- You have a qualifying hospital stay (typically, you need to enter the skilled nursing facility within 30 days of leaving the hospital and require skilled nursing services related to your hospital stay)
- Your skilled nursing facility is certified by Medicare
- Your doctor has decided that daily skilled care is necessary
- You require skilled services for a medical condition that meets one of these qualifications:
- A hospital-related medical condition treated during your qualifying hospital stay
- A condition that began when you were in the skilled nursing facility for a hospital-related medical condition
Hospice Care
With Medicare Part A, your hospice care is covered if a hospice doctor and your doctor have certified that you’re terminally ill (meaning you have a life expectancy of 6 months or less). This is palliative care or comfort care, rather than care intended to cure your illness. It is usually given to you in your home or another facility, like a nursing home, where you live full-time.
Hospice care coverage includes:
- All the items and services you need for symptom management and pain relief
- Medical, nursing, and social services
- Durable medical equipment for symptom management and pain relief
- Aide and homemaker services
- Pain management drugs
- Spiritual and grief counseling
- Other services you need to manage your pain and other symptoms
Home Health Care
With Medicare Part A, your home health care is covered if these conditions are met:
- You are under a doctor’s care and getting services under a care plan created and regularly reviewed by a doctor
- Your condition is expected to improve in a reasonable time period and/or you need a skilled therapist to effectively support you
- A doctor has certified that you need one or more of the following: part-time skilled nursing care other than drawing blood, physical therapy, speech-language pathology, or occupational therapy services
- A doctor has certified that you’re homebound
- The home health agency caring for you is Medicare certified
Eligible home health services including the following are covered:
- Physical therapy
- Part-time skilled nursing care
- Speech-language pathology services
- Occupational therapy
- Medical social services
- Part-time home health aide services (personal hands-on care)
- Necessary medical supplies for use at home, medical equipment, and injectable osteoporosis drugs
- Injectable osteoporosis drugs for women
However, the following services are not included under Medicare Part A:
- 24-hour-a-day care at home
- Homemaker services (for example, cleaning and laundry) when this is the only care you need
- Meal delivery
- Custodial care (like getting dressed or using the bathroom) if this is the only kind of care you need
Senior Health Solutions: Your Trusted Medicare Advisors
Senior Health Solutions in Opelika, AL has been advocating for the senior community for more than 15 years. We are here to help you get the insurance coverage you need at the prices you can afford, and get you the peace of mind you need so you can enjoy your life stress-free.
Give us a call today at (866) 445-5215 to get your coverage started the right way.
