Medicare Part A

 

Original Medicare is defined as Part A (Hospital) and Part B (Medical) insurance. For an overview, refer to the article titled, “Understanding Medicare”. For more detail on Part B of Medicare, see “Medicare Part B”.

Click here for an explanation of 2021 Medicare Deductibles and Premiums.

 

For more on Part A, read on.

 

Original Medicare Part A covers certain medical services and supplies in hospitals and other approved in-patient facilities. Let’s take a closer look at what is covered, what is not and how this affects you or your loved one.

 

Part A – Hospital insurance helps cover the following:

  • Inpatient care in Medicare-approved hospitals

  • Inpatient care in a skilled nursing facility (NOT custodial or longterm care)

  • Hospice services

  • Home health care services

  • Inpatient care in a Religious Nonmedical Health Care Institution

 

Following is a more in-depth look.

 

Blood

During a hospital stay, the hospital typically obtains blood from a blood bank at no charge, but if it must purchase blood, you must either pay for the first 3 units of blood received in a calendar year or else have the blood donated.

 

Home Health Services

Medicare covers medically-necessary part-time or intermittent skilled nursing care, and/or physical therapy, speech-language pathology services, and/or services for occupational therapy. You pay nothing for covered home health care services. You pay 

20% for durable medical equipment, such as braces, walkers and wheelchairs. Remember, Medicare does not cover custodial or long-term care.

 

Hospice Care

You pay nothing for hospice care itself. However, the beneficiary would pay a copayment of up to $5 per prescription for drugs for pain and symptom management during this time of care. You pay 5% for inpatient respite care when the caregiver needs a break.

 

In order to qualify one must be certified to be terminally ill with an expectancy of only 6 months or less to live. Care can be received in your home or other approved facility such as a nursing home or hospice facility.

 

Hospital Care (Inpatient)

Medicare covers semi-private rooms, meals, general nursing duties, and drugs as part of your inpatient treatment, along with certain other hospital services and supplies. If you have Part B, it covers the doctor’s services you get while you’re in a hospital. You are responsible for various deductibles and copayments. Figures are omitted since they change annually. Check with Medicare for current numbers: 

  • A sizable deductible and no copayment for days 1–60 each benefit period.

  • A daily copayment for days 61–90 for each benefit period.

  • A larger daily copayment per “lifetime reserve day” after day 90 each benefit period (up to 60 days over lifetime).

  • All costs for each day after the lifetime reserve days.

  • Inpatient mental health care in a psychiatric hospital – limited to 190 days in a lifetime.

 

Religious Nonmedical Health Care Institution (Inpatient care)

Medicare only covers the nonmedical, non-religious health care items and services, 

such as room and board, in this type of facility.

 

Skilled Nursing Facility Care

Medicare covers services and supplies for approved, skilled nursing facilities only after a 3-day minimum medically necessary inpatient hospital stay and only for a related illness or injury. (Medicare does not cover long-term or custodial care.)

  • You pay nothing for the first 20 days of each benefit period.

  • You pay a daily copayment for days 21–100 of each benefit period.

  • You pay all of the costs for each day after day 100 in each benefit period.

 

For more information about Part A Hospital insurance (and more), a great resource is The Medicare & You handbook. This is CMS Publication # 10050 and can be viewed or downloaded at Medicare & You 2021 (PDF)

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