The original Medicare is divided into two- Medicare Part A which is hospital insurance and Medicare Part B which is medical insurance. But to better understand them, each one will be discussed separately starting with Medicare Part A. Generally, Medicare Part A covers inpatient care, including care received while in a hospital, a skilled nursing facility, and, in limited circumstances, at home.
The majority of people are automatically eligible for this type of Medicare when they reach the age of 65 and by this time they are collecting their retirement benefits. On the other hand, one may still be qualified for Medicare Part A before the age of 65 if the person has disability, amyotrophic lateral sclerosis (ALS), or end-stage renal disease (ESRD).
Medicare Part A Coverage
- Limited home health services
- Hospice care
- Hospital care (inpatient)
- Skilled nursing facility care, provided that custodial care isn’t the only care required
If you are a Medicare Part A beneficiary, you will get scope for hospital costs that are basic to your inpatient care, for example, a semi-private room, food, nursing administrations, prescriptions that are a part of your inpatient treatment, and some other services and supplies from the doctor’s facility. This includes inpatient care that received through:
- Inpatient rehabilitation facilities
- Acute care hospitals
- Long-term care hospitals
- Critical access hospitals
- Mental health care
- Participation in a qualifying clinical research study
On the other hand, it is important to note that Part A will not be covering for blood. You will not be paying anything if the hospital can acquire blood from a blood bank. But if they to purchase blood from you, you will have to pay the first three units that you will receive each calendar year, unless it will be donated by someone else.
Home Health Care Benefits
Part A will be covering for home health care benefits when it is deemed to be necessary and as per doctor’s order. The services may include the following.
- Occupational therapy
- Part-time or intermittent home health aide services
- Part-time or intermittent skilled nursing care
- Medical social services
- Physical therapy
- Durable medical equipment, when ordered by your doctor*
- Speech-language pathology services
The home health care must be provided by a Medicare-certified home health agency, and a doctor must certify that you are home-bound. According to Medicare, you are “homebound” if both of the following are true:
- It is medically inadvisable for you to leave home without the help of another person, transportation, or special equipment.
- Under normal circumstances, you cannot leave home and doing so would require substantial effort.
Nursing Home Coverage
Skilled nursing facility stays are covered under Part A after a qualifying hospital inpatient stay for a related illness or injury. To qualify for this care, the hospital stay must be a minimum of three days. The day you are discharged does not count towards this minimum three-day requirement. Time spent under observation as an outpatient also does not count towards your qualifying stay.
In the event that your specialist has confirmed that you have a terminal sickness with an expected six months or less to live, you might be qualified for hospice coverage. In this case, the emphasis is on palliative care, not curing the disease. The objective is to mitigate torment and make the patient as agreeable as would be prudent.
Eligibility for Medicare Part A
In general, you are eligible for Medicare Part A if:
- You are already receiving retirement benefits.
- You have end-stage renal disease (ESRD).
- You are disabled and receiving disability benefits.
- You have amyotrophic lateral sclerosis (Lou Gehrig’s disease or ALS).
- You are age 65 or older and a U.S. citizen or permanent legal resident of at least five years in a row.