Medicare Part A: Hospital Coverage

Inpatient hospital care is covered by Medicare Part A when all of the following is true:

• You are admitted to the hospital as an inpatient after an official doctor’s order, which says you need inpatient hospital care to treat your illness or injury.
• The hospital accepts Medicare.
• In certain cases, the Utilization Review Committee of the hospital approves your stay while you are in the hospital.

You can think of Part A as your “room and board” in the hospital. It is going to pay for a semi-private hospital room with a bed for you, three meals per day, and the nurse that comes around to visit you. In addition, Part A pays for medications furnished to you by the hospital and any necessary lab services or medical supplies. However, before Medicare Part A pays anything, you must first pay Part A deductible $1408 in 2020.

Inpatient hospitals care includes:

• Acute care hospitals
• Critical access hospitals
• Inpatient rehabilitation facilities
• Long-term care hospitals
• Inpatient care as part of qualifying clinical research study
• Mental health care

Medicare Part A does not include:

• Private-duty nursing
• Private room (unless medically necessary)
• Television and phone in your room (there may be a separate charge for these)
• Personal care items such as toothpaste, socks, or razors

What Does Medicare Part A Cover?

In general, Medicare Part A covers:

• Inpatient care in a hospital
• Inpatient care in Skilled Nursing Facility (SNF)
• Hospice care
• Home Health care

Skilled Nursing Facility (SNF) care

Medicare Part A pays for skilled nursing care provided by a SNF under certain conditions and for a limited time. Skilled care is nursing and therapy care that can only be safely and effectively performed by or under the supervision of professionals. It is healthcare given when you need skilled nursing or skilled therapy to treat, manage, observe your condition and evaluate your care.

What does Skilled Nursing Care cost?

Medicare Part A pays for up to 20 days of skilled nursing or therapy staff. However, you pay $176 coinsurance in 2020 for 21 days to 100 days of care. You pay all costs beyond 100 days.

What is covered by Skilled Nursing Facility?

Medicare-covered services include, but are not included to:

• Semi-private room (a room you share with other patients)
• Meals
• Physical therapy
• Occupation therapy
• Speech-language pathology services
• Medical social services
• Medications
• Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that are not available at the SNF
• Dietary counseling
• Swing bed services

Long-Term Care Hospital (LTCH) care

After you have paid your Part A deductible of $1408 in 2020, Part A pays for long-term care in a LTCH for the first 60 days of hospitalization. However, between 61 days and 90 days you pay $352 coinsurance each day in 2020. Furthermore, after 90 days you pay $682 coinsurance per each “lifetime reserve day” in 2020. After you are discharged from a LTCH, many people get care in a Skilled Nursing Facility or custodial care in a long-term care facility.

Hospice care

Medicare Part A pays for your hospice care. However, you may need to pay a co-payment of no more than $5 for each prescription drug. For example, drugs for pain relief and symptom control while you are at home. In addition, you may need to pay 5% of the Medicare-approved amount for inpatient respite care.

What is Hospice care?

Hospice care services are for terminal illness and related conditions. Care can include any or all of the following services:

• Doctor services
• Nursing care
• Medical equipment, such as wheelchairs or walkers
• Medical supplies, such as bandages or catheters
• Prescription drugs for symptoms control or pain relief
• Hospice aide and homemaker services
• Physical therapy services
• Occupational therapy services
• Speech-language pathology services
• Social work services
• Dietary counseling
• Grief and loss counseling for you and your family
• Short-term inpatient care for pain and symptom management
• Short-term respite care.

What is respite care?

Medicare Part A pays for respite care. This is temporary care for a loved one that allows the primary caregiver time away from the responsibilities as a caregiver. The primary caregiver can use that time to visit other friends or family, to leave the house, or get a much-needed break. The types of respite care you can receive include: inpatient care in hospice, hospital, or nursing home. You can stay up to 5 days each time you get respite care. Moreover, you can get respite care more than once.

How do you get hospice?

To get hospice your doctor must certify you are terminally ill and have a life expectancy of 6 months or less. After 6 months, you can continue to get hospice care as long as your doctor re-certifies (at face-to-face meeting) that you are terminally ill. You can receive hospice care in your home or in a hospice inpatient facility. Once you choose hospice care, you decide not to cure your terminal illness and/or your doctor determines efforts to cure your illness are not working.

What hospice will not cover

Medicare Part A will not pay any of the following once your hospice benefits start:

• Treatment to cure your terminal illness and/or related conditions
• Prescription drugs to cure your illness
• Room and board – Medicare does not pay for extended stays in nursing home or hospice inpatient facility
• Unless arranged by your hospice team or is related to your terminal illness and related conditions, hospital outpatient (including emergency room) and ambulance transportation and inpatient hospital care is not covered.

Care for your other (non-terminal) conditions

After you pay Medicare Part A deductible, you will be covered for any health problems that aren’t part of your terminal illness and related conditions. In addition, you must also pay the co-insurance amounts for all Medicare-covered services you get to treat health problems that are not part of your terminal illness and related conditions.

Home Health Services

Home health care is a wide range of health care services which are administered in your home for an illness or injury. For example, skilled home health care services include:

• Wound care for pressure sores or a surgical wound
• Patient and caregiver education
• Intravenous or nutrition therapy
• Injections
• Monitoring serious illness and unstable health status

In general, the goal of home health care is to treat an illness or injury. Home health care helps you:

• Get better
• Regain your independence
• Become as self-sufficient as possible

How do you get home health care?

You must need and a doctor must certify that you need one or more of the following:

• Intermittent skilled nursing care (other than drawing blood)
• Physical therapy, speech-language pathology, or continued occupational therapy services.

Your condition must be expected to improve in a reasonable and generally predictable period of time. Furthermore, you must be homebound and a doctor must certify you are homebound. Moreover, your need for home health care must be part-time.

Medicare does not pay for:

• 24-hour-a-day care at home
• Meals delivered to your home
• Homemaker services (such as shopping, cleaning, and laundry)
• Custodial or personal care (such as bathing, dressing, or using the bathroom)

Medicare Part A monthly premiums

Is Medicare Part A premium free?

Yes, if you have worked and paid Social Security taxes for at least 40 quarters (10 years) and your net earnings amount equaled the yearly maximum of 4 credits. For example, in 2019 a net earning of $5,440 or more earns you the maximum 4 credits. Otherwise, you will pay $252 monthly premium in 2020 if you worked 30-39 quarters; $458 monthly premium in 2020 if you worked less than 30 quarters.

All Earned Income is Subject to Social Security Tax

Whether you work form an employer or you are self-employed, all earned income is subject to social security taxes. This includes self-employment income (net income) and wages. However, there are some types of income which do not pay social security tax. If you own shares of stock in your own company or publicly traded company and earn dividends, this income pays no social security tax. Likewise, if you earn interest on bonds or loans, you pay no social security tax. In addition, if you own rental property, rental income is not subject to social security tax. Finally, income from a limited partnership pays no social security tax.

How do I enroll in Medicare Part A?

You will automatically be enrolled in Medicare Part A if you are already receiving Social Security income benefits. You will receive you Medicare card in your mailbox 2-3 months before you turn 65. Otherwise, you can enroll in Medicare Part A in the following three ways:

• Go online at www.ssa.gov
• Call 1-800-772-1213
• Visit your local social security office and register in person

Get more information about Medicare including when to enroll and when coverage start.

What else does Medicare Part A cover?

To find out if Medicare covers what you need, talk to your doctor or other health care provider. Ask if Medicare will cover them. The following benefits are covered by Medicare Part A:

Medicare Part A – Blood

Medicare Part A covers blood you get as a hospital inpatient. In most cases, the hospital gets blood from a blood bank at no charge to you. However, if the hospital has to buy blood for you, you will need to pay hospital costs for the first 3 units of blood in a calendar year. Otherwise, you will need a blood donor.

Inpatient blood transfusions are covered

As a hospital patient Medicare Part A cover blood transfusions.You may receive a blood transfusion to restore blood volume after a serious injury (hemorrhage). Furthermore, you can get blood transfusions to improve the oxygen carrying capacity of blood due to sever anemia.

Medicare Part A – Chemotherapy

Medicare Part A pays for chemotherapy if you have cancer and you are a hospital inpatient. When you are discharged from the hospital, you will need Medicare Part B to pay chemotherapy as a hospital outpatient or a patient in a doctor’s office or clinic.

Inpatient Anesthesia Costs

Medicare Part A pays for anesthesia services provided by a hospital if you are an inpatient. However, you will pay 20% of the Medicare-approved amount for the anesthesia services provided by a doctor or certified registered nurse anesthetist. Moreover, the anesthesia service must be associated with the underlying medical or surgical service. In addition, you may have to pay the facility a co-payment.

Bariatric Surgery Covered

When you meet certain conditions related to morbid obesity, Medicare Part A will pay for some bariatric surgical procedures. For example, gastric bypass surgery and laparoscopic banding surgery.