Medicare Part A Covers these services:

•  Inpatient Hospital Care: This type of care is received when a person is formally admitted into a hospital by a doctor. In this case, the beneficiary is covered for up to 60 days for each benefit period in a hospital by a set Medicare deductible, for days 61-90 there is a set daily copay, plus 60 lifetime reserve days after. Medicare will only cover 190 lifetime days in a certified psychiatric hospital.
•   Skilled Nursing Facility (SNF) care: Medicare will cover some aspects of a persons stay in a Skilled Nursing Facility. It will pay for room, board and most services provided in the SNF. This will also include administration of medications, tube feedings, and wound care. This coverage will be for up to 100 days per benefit period once somebody qualifies for SNF care. In order to qualify for SNF coverage you must spend at least three days as an inpatient hospital patient within 30 days of Admission to the SNF and need skilled nursing or therapy services.  
•  Home Health Care: Medicare will cover services if you are homebound or need skilled care. This coverage will be for up to 100 days of day-to-day care or an unlimited amount of care that is intermittent. This must be following a three consecutive day period of inpatient hospitalization within fourteen days of receiving home health care. It is possible to get Home Healthcare through Medicare Part B if you do not meet the requirements under Medicare Part A.
•  Hospice Care: This type of care is available if you are deemed terminally ill, and can stay in hospice care until you are no longer certified by a healthcare provider for the care.

 *Important – Medicare does not fully cover all of your cost for care. You will be responsible for a portion of the costs that you have as a result of healthcare usage ( Deductible, Coinsurance, Copays) for any Medicare Covered Services. 

 MEDICARE PART A

            Medicare Part A is the first half of what is called Original Medicare.  Medicare is a federal health insurance program made up of Part A (Hospitalization) and Part B ( Medical Insurance). Part A, in general covers supplies and Hospital treatments associated with medically necessary treatments.

     Another way of getting both Medicare Part A and Part B benefits it through a Medicare Part C plan or Medicare Advantage plan. The main difference between Original Medicare and a Medicare Advantage plan is how they are administered. Original Medicare is run by the government and Medicare Advantage plans are run by private health insurance companies. Medicare Advantage plans must cover the same benefits as covered under Original Medicare with the exception of Hospice care, which is still covered by Original Medicare even if you choose a Part C plan.  Medicare Advantage plans can also cover extra benefits that are not available through Original Medicare, this can include services like : Hearing services, Drug Coverage, Vision, Dental and Transportation.

 What does Medicare Part A cover?

            Hospital coverage under Medicare is covered by Medicare Part A. It will cover things like medical equipment and hospital services that are deemed medically necessary.  Included in Part A’s coverage is : in-patient hospital services, skilled nursing facilities (SNF), hospice care and some home health services. But it is important to note that each of these services will have their own cost that may vary from service to service. This can be costs like deductibles, copayments, and coinsurances.

 Medicare Hospital Coverage

 Listed below are some of the types of facilities that Medicare Part A will cover.

• General hospitals
• Long-term care hospitals
• Acute care or critical access hospitals
• Rehabilitation facilities (inpatient)
• Psychiatric hospitals
• Inpatient services you get through a qualifying clinical research study

This type of coverage includes:

•  Semi-private room stays
•  Meals
• General nursing care
• Medications administered during your hospital stay
•  Additional hospital services and supplies that are medically necessary for your care

Although Medicare Part A will cover most of the services you will need while in the hospital, it does not cover amenities like: television, personal items (toothbrush or razors) and telephones. This will all need to be paid 100% by the beneficiary. Additionally, Part A does not cover private duty nursing.

In order to be covered under Medicare Part A – Hospitalization the following must apply

•  You must be formally admitted into the hospital
•  You must be admitted for 2 nights of inpatient hospital care to treat your medical condition.
• Your treatments must be only obtainable in the hospital
•  Your hospital must accept Medicare

Medicare Skilled Nursing Facilities

  Only limited in-patient stays at a Skilled Nursing Facility (SNF), that  follows a qualified three day in patient hospital stay, are covered by Medicare Part A. Additionally your health condition must require a level of skill that can only be found in a Skilled Nursing Facility. It is important to note that Skilled Nursing care is different from custodial care or personal care which is normally provided in a nursing home.  Custodial care is mainly focused on Daily Living Tasks like eating and getting dressed. This type of coverage is not covered under Medicare Part A

Services Covered by Skilled Nursing Facilities

• Semi-private room
• Skilled nursing care
• Meals
• Physical and occupational therapy
• Medications
• Medical social services
• Medical equipment and supplies that you use in the skilled nursing facility
• Ambulance transportation
• Nutrition counseling

Medicare Inpatient Mental Health Coverage

Inpatient Mental Health Coverage is also part of the health services covered by Medicare Part A. This included care at a general hospital or a psychiatric hospital. The physician services used while in the hospital as an inpatient, will still be covered, but under Medicare Part B. This coverage is similar to general hospital services covered under Part A and has the same limitations on personal care and private duty nursing.

For care that is being obtained in a psychiatric hospital, 190 days will be covered under Medicare Part A for a lifetime.

 Medicare Hospice Coverage

Hospice services for terminally ill beneficiaries are covered under Medicare Part A. These services may be covered in a facility or at a beneficiaries home. In order to obtain hospice services :

•  You must have only 6 months to live, as confirmed by your regular doctor and your hospice doctor
•  You must agree to not seek curative treatments
•  You must sign and agree to take hospice care instead of other curative treatments covered by Medicare.

Hospice Services Covered by Medicare Part A:

•  Physician services
•  Nursing services
• Medical equipment and supplies
• Physical therapy
• Prescription drugs
•  Hospice aide services
• Homemaker services
•  Nutrition counseling
• Social work services
• Grief and loss counseling services
• Short-term inpatient care
• Short-term respite care for caregivers

 Medicare Home Health Services

  Certain Home Health Services are covered under Medicare Part A. These are services such as: physician therapy, occupational therapy, part time intermittent skilled nursing care. This coverage for services is dependent upon your doctor certifying that you are unable to leave the house “homebound” meaning that your health condition prohibits you from leaving the house without great difficulty. Home Health Services can only be used through a Medicare certified home health agency, and as a part of the plan of care that has been created by your physician.

One thing that is not included in Medicare Home Health Services is 24 hours home care, meal delivery, homemaking services and custodial care.

 Who is eligible for Medicare Part A Coverage?

To be eligible for Medicare Part A you must be a US citizen or be a permanent legal resident for at least five continuous years. In general, you must be 65 years or older unless you have specific health conditions like ALS or Lou Gehrig’s disease or End Stage Renal Disease (ESRD).

There is usually not a cost for Medicare Part A if the recipient has worked in the USA for 10 years or 40 quarters and paid into the Medicare Tax for that time. If somebody has not worked enough time to qualify for Medicare Part A they may be able to apply based on a spouse’s work history. If neither of these options are available, then the beneficiary may have to pay a monthly premium for Medicare Part A. The cost will vary based on a person’s income and the number of quarters that have been worked.

An alternate way to qualify for Medicare is if a beneficiary is under the age of 65 and they have been receiving disability for 24 months. On the 25th month of disability enrollment, these individuals will be automatically enrolled into a Medicare plan if they are eligible.

If a person has ALS or Lou Gehrig’s disease or End Stage Renal Disease (ESRD) they may be eligible for Medicare regardless of their age. If you qualify for Medicare because of these diseases, you will get automatically enrolled on the first month of disability benefits.

Unique to people qualifying for Medicare based on End Stage Renal Disease (ESRD), their Medicare benefits will normally start in the fourth month of dialysis treatment.

 How to get Medicare Part A?

For people who are receiving retirement benefits from Social Security or RailRoad Retirement benefits before the age 65; on the month of their 65 birthday they will be automatically enrolled into Medicare Part A and Part B. Three months prior they should also receive a welcome packet from Medicare which includes a red, white, and blue Medicare Beneficiary Card.  

Alternatively, if you are not receiving retirement benefits prior to turning 65 you may not be automatically enrolled into Medicare and may be required to apply for Medicare benefits. You are able to do this during a seven-month initial enrollment period (IEP) which starts three months before your 65 birthday and ends three months after your birthday month.

For those individuals who miss their initial enrollment period, they will be able to enroll again during the General Enrollment Period (GEP) which happens every year from January 1st through March 31st. But it is important to know that if somebody enrolls late into Medicare they may have to pay a penalty for not enrolling when they were initially eligible.

If a Medicare beneficiary is still working after the age of 65 they may be able to delay enrolling into Medicare and also avoid any penalties if the coverage offered through work is equally good or better than what is offered by Medicare. Once a person leaves their work coverage they will qualify for an eight Month Special Enrollment Period (SEP) that will start once the work coverage ends.

If you still have questions about your Medicare options or how you can get enrolled, please feel free to contact via our website at www.Enrollsocal.com or directly by phone 844-367-655. We are able to assist you review your Medicare options for free. You may have a variety of options with Medicare Supplement plans, Medicare Advantage plans or Stand Alone Medicare Prescription Drug plans, that can help you bring down your cost and provide additional benefits that are not covered by Original Medicare only.

We are the Covered California Enrollment Center, your place to get free assistance with your health insurance plan. We can assist you to sign up, enroll and update your private health Insurance, Covered California plan, Medi-Cal, Obamacare and Medicare insurances. Our California agency is certified by Covered California, to assist you in-person, over the phone or online in English and Spanish. 

We specialize in individual and family health insurance plans, Medicare, Medicare Advantage plans, Medicare Supplement (MediGap plans), Medicare Prescription Drug plans (Part D), as well as, Dental and Vision coverage. We can help you get enrolled into health insurance plans, compare healthcare options, provide required health coverage tax documents and review the plans that best fit your budget and healthcare needs.  

Call us today at 844-367-6555 for free assistance over the phone, visit our website at www.EnrollSocal.Com to make an appointment at our California Enrollment Centers Serving San Diego County, Los Angeles County and Imperial County. 

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.