Medicare Part A

What does Medicare Part A cover?

Medicare Part A helps pay for:

• Inpatient Hospital Stays
• Skilled Nursing Facility Stays (SNF)
• Home Health Care
• Hospice

Covered services for hospital inpatients include semi-private room, meals, general nursing and other hospital services and supplies.

Skilled Nursing Facility (SNF)

Medicare Part A will pay for Skilled Nursing Facility care for people with Medicare who meet all of the following conditions:

1. Your condition requires daily skilled nursing or skilled rehabilitation services which can only be provided in a Skilled Nursing Facility
2. You were an inpatient in a hospital 3 consecutive days or longer, not counting the day you leave the hospital, before you were admitted to a participating SNF
3. You were admitted to the SNF within 30 days after leaving the hospital
4. Your care in the SNF is for a condition that was treated in the hospital

The facility must participate in Medicare.

What is covered?

If you qualify, Medicare will cover the following SNF services: semi-private room, meals, skilled nursing care, physical, occupational and speech therapy, medical social services, medications and medical supplies/equipment used in the facility. Skilled care does not cover custodial care (also known as assistance with activities of daily living) which includes assistance with bathing, dressing, walking, and eating, if this is the only purpose of the skilled nursing stay.

Home Health Care

Medicare Part A pays for your home health care services for as long as you are eligible and your doctor says you need these services (Part B also may pay for home health care under certain conditions). To be eligible, you must meet four conditions:

1. Your doctor must decide you need skilled care in your home and must make a plan for your care at home
2. You must need at least one of the following services: Intermittent (not full-time) skilled nursing care, physical therapy, speech-language services, or continue to need occupational therapy
3. You must be home-bound, which means that you are normally unable to leave home or that leaving home is a major effort
4. The home health agency caring for you must be approved by Medicare

What is the cost?

If you qualify, home health care is fully covered by Medicare for each 60-day period that you need care. Your doctor and home health agency staff review your plan of care at least once every 60 days. You will continue to get home health care for as long as you are eligible.

Hospice

Part A also covers hospice care, which is a special way of caring for people who are terminally ill and their families. Hospice care is meant to help you make the most of the last months of life by giving you comfort and relief from pain. It involves a team that addresses your medical, physical, social, emotional, and spiritual needs. The goal of hospice is to care for you and your family, not to cure your illness. You can get hospice care as long as your doctor certifies that you are terminally ill and probably have less than six months to live if the disease runs its normal course.

What is Covered?

The hospice benefit covers many services, in addition to the regular Medicare-covered services such as doctor and nursing care, physical and occupational therapy, and speech therapy. The hospice benefit also covers: Medical equipment, medical supplies, drugs for symptom control and pain relief, short term care in the hospital when needed for pain and symptom management, home health aide and homemaker services, social worker services, dietary counseling, grief counseling for patient and family, inpatient respite care.

CLAIM Tip: When on hospice, before receiving any services always contact your hospice representative!

What is the cost?

For hospice care in Original Medicare, you pay a co-payment of no more than $5 for each prescription drugs for pain relief and 5% of the Medicare-approved payment amount for inpatient respite care. These costs are covered under most Medicare Supplement (Medigap) policies.

Participating hospitals, skilled nursing facilities, home health agencies, and hospice agencies are required to file all claims with Medicare. When a beneficiary uses a Part A service, they should receive a Medicare Summary Notice. This statement provides detailed information regarding the service, such as dates of service, the amount billed to Medicare and the amount the beneficiary owes the provider. This statement will also provide information on how to appeal any denied services. When Medicare denies payment for a service, you have a right to appeal the decision. Each level of appeal has its own guidelines and time restraints. You are always given information on how to appeal or further appeal a decision.