Medicare Part A and B is health care insurance provided by the Federal government. Part A and B are the original parts of the Medicare system.
Medicare Part A is hospital insurance. Hospital insurance helps cover the cost of your hospital stay. Part A also covers home health care and hospice.
You are eligible for Medicare if you, or your spouse, have paid Medicare taxes while you were working. Then, on your 65th birthday, you receive part A at no extra cost to you. It is premium free. You automatically get Medicare benefits once you start receiving Social Security or Railroad Retirement Board Benefits.
Medicare Part A Covers
- Inpatient care in hospitals
- Critical access hospitals
- Inpatient rehabilitation facilities
- Long-term care hospitals
- Inpatient care in a Religious Non-Medical Health Care Institution
- Hospice care services
- Home health care services
Medicare Part A Does Not Cover:
- Custodial long-term care
- Doctor’s services while you are in a hospital (covered by Part B).
Inpatient Care
When you stay in a hospital, Medicare Part A includes a semi-private room, meals, general nursing and drugs. Other hospital services and supplies required by inpatient care are also covered. A private room is not covered unless medically necessary.
Skilled Nursing Facility
After you have had a minimum three-day inpatient stay a hospital, Part A will cover care in a skilled nursing facility for services related to illness or injury. Examples of this are intravenous injections or physical therapy. In these cases, the doctor must certify that you need daily skilled care.
Religious Non-Medical Health Care Institution
For some people, medical care is not congruent with their religious belief and values. In these cases part A covers inpatient care in a Religious Non-Medical Health Care Institution. Medicare will only cover the non-medical, non-religious health care items and services.
Hospice Care
Hospice care is for people with a terminal illness. For coverage, your doctor must certify that you are expected to live 6 months or less. Hospice care occur at either an inpatient facility, or provided at home. For home hospice care, Medicare Part A offers five days of respite for the caregiver.
Home Health Care
Home health care is for medically necessary part-time or intermittent services. These include: skilled nursing care, physical therapy, speech-language pathology and occupational therapy. To qualify, a doctor must order this care and it must be provided by a Medicare-certified home health agency.
Medicare Part A Premium
Generally you do not pay a monthly premium for Part A coverage. This is true if you or your spouse have paid Medicare taxes while working.
If you have not paid Medicare Taxes, you may still be eligible to receive Part A, but you must pay a premium. You can buy Medicare Part A if:
- You either are age 65 or older,
- Meet citizenship or residency requirements, and
- qualify for Part B.
Or, you are under age 65, disabled, and you have returned to work, thereby ending premium-free Medicare.
Healthcare Catch-22
Sometimes a hospital stay is not a hospital stay. Just because you stayed overnight in a hospital, does not mean you are an inpatient. You must be formally admitted into the hospital with a doctor’s order. If you are not admitted, you are considered outpatient.
If you are considered outpatient, then you are generally excluded form Medicare Part A coverage. Be sure to ask if you have a hospital stay, because the benefits are different. A combination of Medicare Part A and B is useful whenever you do anything with a hospital.