Medicare Part A
In general, Medicare Part A covers hospital care, skilled nursing facility care, home health, and hospice services. On a Medicare Part A card, it will have the word "Hospital" beside it. Because of that, Medicare Part A is most commonly known as the inpatient or hospitalization part of Medicare. Inpatient care is care received after you are formally admitted into a hospital by a physician. You are covered for up to 90 days each benefit period in a general hospital, plus 60 lifetime reserve days. Medicare also covers up to 190 lifetime days in a Medicare-certified psychiatric hospital.
While in the hospital, it covers many services utilized such as semi-private rooms, meals, general nursing, medications as part of your inpatient treatment, as well as other hospital services and supplies. In a skilled nursing facility, Medicare covers room, board, and a range of services provided, including administration of medications, tube feedings, and wound care. You are covered for up to 100 days each benefit period if you qualify for coverage and includes the first 20 days covered at 100%. For days 21-100, you pay $167.50 a day unless you also have another insurance plan that may cover the cost. To qualify, you must have spent at least three consecutive days as a hospital inpatient within 30 days of admission to the SNF, and need skilled nursing or therapy services. One thing that is often misunderstood is that sometimes you can go to the ER, be held one day for observation, and then admitted into the hospital for two days. This scenario does not constitute a "qualifying" hospital stay. Staying 3 "days" (for ex. Monday to Wednesday) in the hospital also does not qualify you. You need to stay 3 full midnights (ex. Monday to Thursday morning). To be sure you qualify, speak with a hospital case manager or social worker to help meet your goals and needs.
Medicare covers services in your home if you are homebound and need skilled care under home health care. You are covered for up to 100 days of daily care or an unlimited amount of intermittent care. To qualify for Part A coverage, you must have spent at least three consecutive days as a hospital inpatient within 14 days of receiving home health care and ordered by a doctor. You can get home health care through Medicare Part B if you do not meet all the requirements for Part A coverage. These services may include intermittent skilled nursing care, physical therapy, speech-language pathology services, occupational therapy, medical social services, intermittent home health aide services, and durable medical equipment when ordered by a doctor. Medicare Part A does not cover 24-hour home care, meals, or homemaker services if they are unrelated to your treatment. It also does not cover personal care services, such as help with bathing and dressing, if this is the only care that you need. Hospice care is care you may elect to receive if a provider determines you are terminally ill. You are covered for as long as your provider certifies you need care.
Check back with us as we will cover deductibles, benefit periods, and how to enroll. For more information, visit www.medicare.gov.