Part A provides for inpatient care in hospitals, in a skilled nursing facility, home health care, and hospice care. Coverage for each of these varies, as explained in this article.
PART A (Hospital Insurance) - Coverage and Benefits
Part A provides for inpatient care in hospitals, care in a skilled nursing facility, home health care, and hospice care, all of which have to be certified by a doctor as needed by the patient.
Coverage for hospitalization and skilled nursing facility (SNF) is provided on a ‘benefit period’ basis which can be defined as a ‘spell of illness’. There is no limit to the number of ‘benefit periods’ in a year. A ‘benefit period’ can span several hospital stays if they are related to the same ‘spell of illness’.
Inpatient care at a hospital
To get you back on your feet and out of the hospital, Medicare Part A provides fairly extensive hospitalization coverage. It includes your hospital stay, nursing services, drugs used for treatment, equipment and medical appliances, as well as physical and other types of therapy. Doctor’s services are billed separately through Part B. Inpatient psychiatric care in a specialized hospital is included.
Coverage does not include private rooms (includes semi-private rooms only), private-duty nursing or personal care items. If you need blood and the hospital has to buy it, you must either pay for the first three pints of blood you get in a calendar year or have someone donate blood.
Skilled Nursing Facility care (SNF)
You are eligible to get skilled nursing care or skilled therapy care if it is necessary to help improve your condition, maintain your current condition or prevent or delay it from getting worse. There should be a daily need for skilled services, and care must be related to a condition already treated at a hospital.
Apart from a semi-private room, meals, and skilled nursing care, coverage at an SNF includes physical therapy, medications, related social services, equipment, and supplies.
Home health care
Getting home health care requires you to meet several conditions. You must be homebound, your physician should have a treatment plan, and you must need at least one of the skilled services (physical therapy, speech therapy, continued occupational therapy or skilled nursing care) on an intermittent basis. If these skilled services are needed on a regular, full-time basis, care at an SNF may be a better option.
Medicare does not pay for 24-hour-a-day care at home, personal care, meals delivered to your home, or for home-maker services. However, medical social services, intermittent home health aide services, and medical supplies for use at home are covered.
Coverage applies to those who are terminally ill (have life expectancy of 6 months or less). Care is not focussed on curing the illness but rather on providing comfort and pain relief to the patient and family.
Apart from needed short-term hospitalization, doctor's services, nursing care and equipment/supplies, hospice care also includes medication for pain relief and for controlling and managing symptoms, hospice aide, social worker and homemaker services, and counseling.
Religious Nonmedical Health Care Institution (RNHCI)
If your religious beliefs prohibit conventional medical care at a hospital or SNF, Part A provides inpatient coverage for non-religious, non-medical items and services such as unmedicated wound dressing or use of equipment such as a walking stick or walker.
To qualify, you should be in need of hospitalization or SNF care if you were not an inpatient at the RNHCI.
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Last Updated: 01-10-2021