As of July 2020, 17% of Americans (55 million) who rely on Medicare for their healthcare coverage. The Medicare program consists of four parts; here we will discuss what Medicare Part A covers. In general, individuals who have Medicare Part A do not have to pay a monthly premium, but there are other fees like copay, deductibles, and coinsurance that one has to pay when hospital admission is required.
Medicare Part A is essentially major medical healthcare insurance that helps cover some of the expenses when one is admitted as an inpatient to a medical and healthcare facility. Most individuals are automatically enrolled in Medicare Part A but others may need to sign up via the Social Security Administration (SSA). The majority of people enrolled for Medicare Part A do not have to pay a monthly premium as long as they have paid a minimum of 40 quarters of Medicare taxes prior to enrollment.
Here are some basic features of Medicare Part A:
What are the eligibility criteria for Medicare Part A?
- Those who have paid Medicare taxes for at least 40 or more quarters while working.
- Individuals ages 65 or older or are currently collecting Railroad Retirement Board (RRB) or Social Security Benefit.
- Individuals less than 65 but are eligible for social security or RRB disability benefits
- Individuals who are on regular dialysis or have had a kidney transplant and have submitted a Medicare application via the SSA
Medicare Part A Covers Basic Hospitalization
Medicare Part A covers hospitalization as long as one is admitted as an inpatient. Thus, it is vital that the individual ask the healthcare provider about the admission status, because it can affect Medicare Part A coverage or you will be saddled with a big bill. Medicare Part A covers stays at any healthcare facility including psychiatric hospitals. During the admission, Medicare Part A covers all physician services, lab tests, consultations, imaging studies, surgery, and medications.
After the deductible of $1408 is paid, Medicare Part A covers the rest of the medical bill for a hospital stay of up to 60 days. For those who need longer hospitalization, the bill is slightly bigger.
Medicare Part A Covers Temporary Stay in a Nursing Home
Medicare Part A does not provide long-term care in a skilled nursing facility but it will fund temporary stays as long as the patient needs specialized care. Medicare Part A covers the first 100 days in a skilled nursing facility but the care has to be delivered by a licensed physician, registered nurse, or a physical therapist. The general expectation is that the patient will recover from the injury or illness. The coverage will also pay for meals and a semi-private room. However, Part A will only pay for this care after one has been admitted to a healthcare facility for a minimum of 3 days and the care has to start within 4 weeks after discharge.
Medicare Part A Covers Some Home Health Care and Hospice
Medicare Part A covers some home healthcare services as long as they are ordered by a physician. The services may include occupational, physical and speech therapy, medical equipment (hospital beds, ambulatory devices, oxygen), social services, and even home health aides. While Medicare Part A covers the full costs of these services, this coverage is only limited to 60 days at a time.
In addition, Medicare Part A covers hospice care that includes both nursing and physician services, drugs for pain relief, counseling services, and care in a hospice facility or at home. In general, hospice care is for individuals who have less than 6 months to live but since life expectancy cannot be predicted, the coverage will usually extend for at least 6 months. The individual will pay 5% of the approved Medicare bill for inpatient hospice care. There may be a small copay per prescription for outpatient drugs for pain and symptom management.
What Medicare Part A Does Not Cover
- Private nursing care
- Telephone or TV in the hospital room and personal care items like socks, slippers, razors, etc
- Unless medically necessary, a private room in a healthcare facility of a skilled nursing facility
- The first three units of blood transfusion, unless the healthcare facility obtains it from its own blood bank at no cost. The patient can arrange to donate his/her own or ask a relative for donation- but there is a small administrative fee associated with it
- Cost of residing at a skilled nursing facility after discharge from the hospital when the individual was not admitted for a minimum of 3 days as an inpatient
- Costs of long-term residence in an assisted living facility or a nursing home. Medicare Part A covers only for necessary medical needs while in the long term residence but it does not cover custodial care such as bathing, ambulation, feeding, dressing, etc
- Most of dental care including dentures
- Eye exams and prescription glasses
- Cosmetic surgery
- General foot care
- Hearing evaluation and hearing aids
- Alternative medicine like acupuncture
How To Plan for What Medicare Part A Does Not Cover.
Because of limitations in Medicare Part A coverage, it is important to know about other Medicare services that can help broaden healthcare coverage- read below:
- Part B covers visits to the doctor, diagnostic screening, ambulance transportation, laboratory tests, and other outpatient services. Overall, Part B is more costly than Part A, but signing up can be deferred if one is working or covered by the spouse’s health plan. The monthly premium for Part B is around $144 and there is also a deductible fee
- Part C known as Medicare Advantage combines various portions of Medicare into one comprehensive plan. However, if one decides to enroll with Medicare Advantage, one must first enroll with Part A and Part B and pay the required monthly premiums. Services covered under Medicare C include vision and dental care, wheelchair ramps, meal delivery, transportation to and from the doctor’s clinic and provides additional prescription drug coverage. Since the covid-19 pandemic, part C also covers telehealth services.
- Part D will pay for some of the prescription medications. There is a monthly premium and there are other out of pocket expenses like copays and annual deductibles. Anyone considering Part D coverage should first check out the list of drugs covered by Medicare; the list of drugs changes regularly.