Breaking Down the Basics: What Does Medicare Part A Cover?

Medicare Part A is an important pillar of the healthcare coverage provided by the U.S. federal government.

It's available to all American citizens or permanent residents aged 65 and above who have paid into the Medicare system or who meet certain eligibility criteria.

While Part A covers a broad range of healthcare services, there are certain limitations and restrictions that you want to be aware of before seeking medical care.

In this article, we'll walk you through everything Medicare Part A covers and what it doesn't cover. Our goal is to set you up with the necessary knowledge to make informed decisions and feel more prepared when it comes to your healthcare needs.

Read more: If You Don’t Understand Medicare At All, Start Here

What Does Medicare Part A Cover?

Medicare Part A, also known as hospital insurance, covers inpatient care in hospitals, hospice care, skilled nursing facility care, and home health care.

But it's important to understand that "covers" doesn't mean that all costs will be entirely covered. There may still be out-of-pocket expenses to consider, such as deductibles and copayments.

Additionally, your doctor or healthcare provider may suggest that you get services more frequently than Medicare will cover or services that aren't covered by Medicare at all.

The exact costs to you may depend on a few different factors like other insurance you may have and the type of facility you receive treatment. We highly suggest adding a Medicare Supplement plan if you want to fill in some of these gaps in coverage.

Let's take a closer look at the specifics of what is covered by Medicare Part A so that you have a clear understanding.

Inpatient care in a hospital

Medicare Part A covers inpatient hospital care as long as you meet two conditions:

1. You need to be admitted to the hospital as an inpatient per an official doctor's order.
2. The hospital must accept Medicare.

If your stay meets those two conditions, Medicare Part A will cover a range of essential hospital services including:

• Semi-private rooms
• Meals
• General nursing care
• Other various hospital services and supplies

Inpatient mental health care in a psychiatric hospital may also be covered by Medicare Part A, but it's limited to 190 days.

On the other hand, there are certain items and services that you may encounter during your hospital stay that Medicare doesn't cover. For example:

• Private-duty nursing
• Private room (unless medically necessary)
• Television or phone in your room (if there's a separate charge for these items)
• Personal care items (like razors or slipper socks)

The good news is, hospitals are now required to disclose their costs for standard services and items. This means you now have access to this important information, allowing you to make more informed decisions when it comes to your healthcare and any potential financial responsibilities.

Skilled nursing facility care

Skilled care refers to specialized nursing and therapy services that are performed by qualified professionals or under their supervision.

Medicare Part A will cover skilled nursing care on a short-term basis, for a limited time. But in order for Medicare Part A to cover skilled nursing facility (SNF) care, all of the following conditions must be met:

1. You must have days left to use in your benefit period.
2. You must have a 3-day qualifying hospital stay.
3. Your doctor must deem daily skilled care medically necessary.
4. The services must be provided by skilled nursing or therapy staff in a Medicare-certified SNF.
5. You need this skilled care for a medical condition that is either directly related to your hospital stay or developed while receiving care in a skilled nursing facility for a hospital-related medical condition.

If you meet all of those conditions, covered services in a skilled nursing facility may include:

• Semi-private room
• Meals
• Skilled nursing care
• Physical, occupational, or speech therapy (if medically necessary)
• Medical social services
• Medications
• Medical supplies and equipment
• Ambulance transportation
• Dietary counseling (if necessary)

Medicare Part A covers the first 20 days of SNF care at full cost, and from day 21 to day 100, there is a daily coinsurance payment that you are responsible for. After day 100, Medicare coverage for SNF care ends, and you would be responsible for the full cost.

Hospice care

Medicare Part A offers hospice care for individuals who are terminally ill. To qualify, you need to:

1. Be certified by your hospice doctor and regular doctor as terminally ill with a life expectancy of six months or less.
2. Accept comfort or palliative care instead of curative treatment.
3. Sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

Hospice care is usually available to you in your home, a nursing home, or even an inpatient hospice facility if necessary.

It's important to be aware that once your hospice benefit takes effect, Medicare Part A does not cover certain expenses related to treatment, drugs intended to cure your terminal illness, or other hospital care unless it has been pre-arranged by your hospice team.

Home health care

If you need part-time or intermittent skilled services, Medicare Part A and/or Part B may cover eligible home health services. To qualify for home health care coverage, you must:

1. Be under the care of a doctor or other approved healthcare practitioner and receive services as part of a documented plan of care that is created and regularly reviewed by a doctor.
2. Need intermittent skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy services.
3. Be homebound, which means you have difficulty leaving your home without help due ty, leaving is not recommended due to your condition, or it is a major effort for you to leave.

Home health services that are covered include:

• Part-time or intermittent skilled nursing care
• Physical therapy
• Occupational therapy
• Speech-language pathology services
• Medical social services
• Part-time or intermittent home health aide care
• Injectable osteoporosis drugs for women
• Durable medical equipment
• Medical supplies for use at home

However, Medicare Part A will not pay for 24-hour-a-day care, meal delivery, shopping or cleaning services, or personal care that only assists with daily living activities like bathing, dressing, or using the bathroom.

What is NOT Covered by Medicare Part A?

As we've mentioned above, there are certain expenses that Medicare Part A will not cover.

Another thing that is not covered is custodial care or assistance with daily activities like bathing, dressing, and eating that do not require the skills of medical or nursing personnel.

Most nursing home care falls under the category of custodial care, so if that is the only type of care you need, it is not typically covered by Medicare Part A.

How Do I Find Out if Medicare Covers What I Need?

We know this can be a bit confusing, but luckily, there are a few places you can turn to for help.

Medicare.gov has a great online tool to help you look up your test, item, or service and find out how much it will cost.

If you can't find it on that list, you can always ask your doctor or healthcare provider. They should be able to explain what is and isn't covered by Medicare Part A.

You can also download the Medicare & You handbook to look up specific items and see if they're covered.

The Takeaway

When it comes to your health insurance, it’s important to know exactly what is covered to avoid any unexpected financial surprises. Being well-informed empowers you to make the right decisions, and may also help you decide if you’d like to add any supplemental insurance.

For guidance on what is covered by Medicare Part A and other Medicare plans, the knowledgeable team at Sams/Hockaday is here to help!

We specialize in educating individuals about the ins and outs of Medicare, ensuring a smoother experience and giving you that much-needed peace of mind. 

Don't hesitate to reach out to us for all your Medicare questions and let us guide you through the process with our expertise and friendly approach.