What is Medicare Part A Coverage

Medicare Part A is a hospital insurance provided by Medicare. Most people do not have to pay a premium for Part A because the individual or their spouse paid Medicare taxes while working.

It provides inpatient care in hospitals, nursing homes, skilled nursing facilities, and critical access hospitals. If you meet specific requirements then Medicare gives hospice and home healthcare eligibility. Part A does not include long-term or custodial care.

Medicare Part A coverage is available to individuals age 65 and over who:

 are already receiving retirement benefits from Social Security or the Railroad Retirement Board (RRB).
 are eligible to receive Social Security or Railroad benefits but who have not yet filled for them.
 had Medicare-covered government employment.

Medicare Part A coverage is available to individuals under age 65 who:

 are disabled per SSA or RRB guidelines.
 have received SSA or RRB disability benefits for 24 months.
 are kidney dialysis or kidney transplant patients.

• Hospitalizations: Medicare pays only a portion of a patient’s acute care hospitalization expenses, and the patient’s out-of-pocket expenses are calculated on a “benefit period basis.” A benefit period begins with the first day of hospitalization and ends when the patient has been out of the hospital for 60 consecutive days.

Hospital stays must be at least 3 days (72 hours) and does not include any hours on the discharge date.

• Skilled Nursing Facility Stays: After a 3-day-minimum acute hospital say, some individuals require short-term skilled nursing care or daily rehabilitation services in a skilled nursing facility (SNF) before returning home. Medicare pays for up to 100 days of such "subacute" care for elderly and disabled beneficiaries who have been hospitalized for at least three days.

• Home Health Services: Medicare home health services must be prescribed by a physician. Home Health Services is limited to medically-necessary part-time or intermittent skilled nursing care, or physical therapy, speech-language pathology, or a continuing need for occupational therapy. A doctor must order your care, and a Medicare-certified home health agency must provide it. Medicare covered home health service have no deductible or coinsurance responsibilities for services provided. Patients must be confined to the home, but they do not have to be hospitalized in an acute care hospital before qualifying for home health benefits. The patient is responsible for a 20% deductible of the approved amount for durable medical equipment.

• Hospice Care: All terminally ill patients qualify for hospice care. Hospice is an autonomous, centrally administered program of coordinated inpatient and outpatient palliative (relief of symptoms) services for terminally ill patients. This program is for patients for whom there is nothing further the provider can do to stop the progression of disease, and the patient is treated only to relieve pain or other discomfort. In addition to medical care, a physician-directed interdisciplinary team provides psychological, sociological and spiritual care. Coverage includes drugs for pain relief and symptom management; medical, nursing, social services; and other covered services as well as services Medicare usually doesn’t cover, such as grief counseling. A Medicare-approved hospice usually gives hospice care in your home (or other facility like a nursing home).

• End – Stage Renal Disease (ESRD) Coverage: End-stage renal disease (ESRD) refers to that stage of kidney impairment that appears irreversible and permanent and requires a regular course of dialysis or kidney transplantation to maintain life. Special coverage is available for Medicare-eligible persons in need of renal dialysis or transplant due to ESRD.