What is Medicare Part A?
Medicare Part A is considered hospital insurance. The great majority of citizens in the United States receive Medicare Part A automatically, but it is not a guaranteed right for all individuals. For most people, it is granted automatically for those people, or their spouses, with 40 quarters of work history. If you are unsure if you meet that criteria, it is important you contact your local social security office before proceeding any further.
Medicare Part A generally covers:
- Inpatient care in hospitals
- Inpatient care in a skilled nursing facility (not custodial or long-term care)
- Hospice care
- Home health care
- Inpatient care in a religious nonmedical health care institution
Some Things to Know About Inpatient Hospital Care:
Medicare covers semi-private rooms, meals, general nursing, and drugs as part of your inpatient treatment, and other hospital services and supplies. This includes care you get in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, inpatient care as part of a qualifying clinical research study, and mental health care. Coverage doesn’t include private-duty nursing, a television or phone in your room, or personal care items, like razors or slipper socks. It also doesn’t include a private room, unless medically necessary. If you have Medicare Part B, it covers the doctor’s services you get while you’re in a hospital.
There are deductibles, co-pays, and co-insurance associated with Medicare part A benefits that change annually. You are responsible for these charges to either pay them yourself or seek out appropriate 3rd party sources, such as insurance, to pay these charges.
Even though Medicare Part A lists skilled nursing facility coverage in its list of covered benefits, Medicare does NOT cover long-term care.
Not all hospital stays are inpatient stays. You only become an inpatient when a hospital formally admits you as an inpatient, after a doctor orders it. You’re still an outpatient if you haven’t been formally admitted as an inpatient, even if you’re getting emergency department services, observation services, outpatient surgery, lab tests, or X-rays. You or a family member should always ask if you’re an inpatient or an outpatient each day during your stay, since it affects what you pay and can affect whether you’ll qualify for Part A coverage in a skilled nursing facility. Hospital stays which do not qualify for part A might qualify as part B hospitalization services and would be billed accordingly.