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What is Medicare Part A?

What is Medicare Part A?

May 04, 2020
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Lyndon B. Johnson signed Medicare into law in 1965. Original Medicare consists of two parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Inpatient care, including care received while in a hospital, a skilled nursing facility, and, in limited circumstances, at home are all covered under Part A.

To qualify for Part A of Medicare, you must be either a United States citizen or a legal permanent resident of the United States for at least five continuous years. It is normal for a person already collecting retirement benefits from the Social Security Administration or the Railroad Retirement Board to be automatically eligible for Medicare Part A at age 65. However, you may qualify for Medicare Part A before age 65 if you have a disability, or are suffering from end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).

Coverage for hospital expenses that are critical to your inpatient care, are covered under Medicare Part A benefits. These include a semi-private room, meals, nursing services, medications that are part of your inpatient treatment, and any other services and supplies from the hospital. Such services can be rendered as inpatient care received through:

  • Acute care hospitals
  • Critical access hospitals
  • Inpatient rehabilitation facilities
  • Long-term care hospitals
  • Mental health care
  • Participation in a qualifying clinical research study

Home health care services are covered under Part A when deemed medically necessary and ordered by your doctor. Included in these services are:

  • Part-time or intermittent skilled nursing care
  • Physical therapy
  • Speech-language pathology services
  • Occupational therapy
  • Medical social services
  • Part-time or intermittent home health aide services
  • Durable medical equipment, when ordered by your doctor

The home health care must be provided by a Medicare-certified home health agency, and a doctor must certify that you are homebound. According to Medicare, you are “homebound” if both of the following are true:

  • Under normal circumstances, you cannot leave home and doing so would require substantial effort.
  • It is medically inadvisable for you to leave home without the help of another person, transportation, or special equipment.

Upon being formally admitted into inpatient care at a hospital for a qualifying stay, Part A will cover a skilled nursing facility (SNF) stay. To qualify, one must be an inpatient a minimum of three (3) days, beginning on the day you are formally admitted as an inpatient. The day you are discharged does not count towards this minimum three-day requirement. Time spent under observation as an outpatient also does not count towards your qualifying stay. Your doctor must certify that you need daily skilled care that you cannot receive at home, such as intravenous drugs or physical therapy.

If you have a terminal illness with an estimated six months or less to live, you may be eligible for hospice care coverage. Your doctor has to certify this, and the care must be palliative care, not curing the disease. The goal is to relieve pain and make the patient as comfortable as possible.

To qualify for Medicare-covered hospice care, you must meet all of the following conditions:

  • You must be enrolled in Medicare Part A.
  • Your doctor or health care provider must certify that you are terminally ill and have six months or less to live.
  • You must agree to give up curative treatments for your terminal illness, although Medicare will still cover palliative (comfort-focused) treatment for your terminal illness, along with related symptoms or conditions.
  • You must receive hospice care from a Medicare-approved hospice facility.