What is Medicare Part A?

Choosing the right type of Medicare coverage is a big decision! You want to make sure you understand your options before you enroll. However, navigating through all of this information can be difficult so we’ve pulled the most important details and broken them down into bite-sized pieces. In this article, we’re going to focus on one of the most common Medicare questions, “What is Medicare Part A?”

What is Medicare Part A – and what does it cover?

Medicare Part A, also known as Hospital Insurance, helps cover hospital and inpatient services. These include:

  • Inpatient and long-term hospital care
  • Skilled nursing facility care
  • Emergency care
  • Hospice care
  • Home health services

From there, each of these can be broken down even further. Let’s take a look:

Inpatient hospital care

Includes:

  • Meals
  • General nursing
  • A semi-private room
  • Drugs as part of your inpatient treatment plan
  • Some additional hospital services and supplies

Does not include:

  • Private-duty nursing
  • A television or phone
  • Personal care items

Once you enroll, you can go to:

  • Acute care hospitals
  • Critical access hospitals
  • Long-term care hospitals
  • Inpatient rehabilitation facilities

To receive inpatient hospital care, these conditions need to be met:

  • The hospital accepts Medicare
  • Your doctor has determined that you need care for at least two nights
  • The care you need requires hospital treatment
  • The Utilization Review Committee of the hospital has approved your admission

*Long-term hospital care is also covered under Part A. Typically, someone is eligible when they have one (or more) serious conditions that can be treated and are ultimately sent home.

Skilled nursing facility care

Includes:

  • Meals
  • Medications
  • Medical social services
  • Skilled nursing care
  • A semi-private room
  • Dietary counseling
  • Access to medical supplies and equipment used in the facility
  • Ambulance transportation (when required for safety)

Your plan may also cover physical therapy, occupational therapy, and speech-language pathology services with a recommendation by a doctor or therapist.

To receive skilled nursing facility care, these conditions need to be met:

  • The skilled nursing facility is certified by Medicare
  • You still have additional days left in your benefit period
  • You have a qualifying hospital stay
  • Your doctor has determined that your care requires skilled nursing or therapy staff
  • You receive therapy each day it’s available specifically for rehabilitation services
  • You need care based on a hospital-related medical condition. Or you need care based on a condition that started while receiving care for a hospital-related medical condition in a skilled nursing facility

Hospice care

Depending on the terminal illness and related conditions, your plan may include:

  • In-home care or hospice inpatient facility care
  • Hospice aide and homemaker services
  • Nursing care
  • Doctor and social work services
  • Medical equipment and supplies
  • Physical and occupational therapy
  • Speech-language pathology services
  • Prescription drugs for pain relief or symptom control
  • Dietary counseling
  • Grief and loss counseling
  • Short-term inpatient care and respite care

To receive hospice care, these conditions need to be met:

  • Your doctor has determined that you’re terminally ill
  • You accept palliative care to relieve pain instead of care to cure your illness
  • You sign a document choosing hospice care instead of other Medicare-covered care

Home health services

Includes:

  • Physical therapy
  • Intermittent skilled nursing care
  • Speech-language pathology services
  • Continued occupational services

Do not include:

  • Personal care and homemaker services
  • 24-hour-a-day home care
  • Meals delivered to your home

These conditions need to be met in order to receive home health services:

  • You’re under the care of a doctor
  • The home health agency is certified by Medicare
  • Your doctor has determined that you’re homebound
  • You only need part-time or intermittent skilled nursing care
  • A treatment plan was put in place and is regularly reviewed by a doctor
  • Your doctor has determined that you need one or more of the following:
    • Intermittent skilled nursing care
    • Speech-language pathology, physical therapy or occupational therapy services (which are only covered under specific circumstances)

When can I enroll in Part A?

You are first eligible to enroll in Medicare Part A during your Initial Enrollment Period (IEP). This enrollment period includes the three months before your 65th birthday, the month you turn 65, and three months after your birthday. 

You will automatically enroll in Part A if you paid Medicare taxes for at least ten years. Otherwise, you can enroll manually and may have to pay a premium.

Find out when you can enroll in Medicare Part B here.

And finally, what are my next steps?

Choosing the right type of coverage can be tough. If you’re still wondering what Medicare plan is right for you, check out our Medicare homepage. Here you’ll find a simple breakdown on how each part works together.

HealthSherpa

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