Original Medicare health care insurance is separated into two parts, Part A is your hospital insurance, and Part B is medical insurance. When you turn 65, you become eligible for Medicare benefits. If you are already receiving retirement benefits from either Social Security or the Railroad Retirement Board when you turn 65, these administrations automatically enroll you in both parts of Medicare.
You may also be automatically enrolled in Medicare if you are younger than 65 but have a qualifying disability and receive benefits for 24 months, or have end-stage renal disease, or ALS. If you or your spouse has worked and paid Medicare taxes for at least 40 quarters (10 years), you are eligible for premium-free Part A Medicare.
Here’s a detailed look at what Part A covers:
1. Inpatient care in a hospital
Part A pays for inpatient care in a hospital that accepts Medicare if your physician certifies that you need this care for treatment of an injury or illness. While you are in the hospital, your coverage includes:
• A semi-private room and your meals
• General nursing care
• Any drugs you need for your treatment in the hospital
• Some other services and supplies you get in the hospital
Under Part A, you also get coverage in:
• Acute care and critical access hospitals
• Inpatient rehabilitation and psychiatric facilities
• Long-term care hospitals
• Inpatient care if you are in a qualifying clinical research study
2. Skilled nursing facility care
Medicare hospital insurance (Part A), covers care in a skilled nursing facility on a short-term basis if you have days remaining in your current benefit period, you’ve been in the hospital and need more skilled nursing care to get better, or your doctor orders this care for a specific reason. Also, the facility must be certified by Medicare.
3. Long-term care hospital
Part A covers the cost of long-term care in a Medicare-approved facility for up to 60 days after you pay your deductible for the current benefit period. After 60 days you pay the costs that apply.
4. Hospice care
Part A covers your hospice care when you meet all of the following conditions:
• Your personal physician and hospice doctor both certify that you are terminally ill.
• You choose palliative care in place of treatment for illness and you agree to hospice care in place of other Medicare-covered benefits for treatment of your illness.
While you are in hospice care, and depending on the treatment plan your hospice team has made, the following care and services are also included in your Medicare benefits:
• Doctor services
• Nursing care
• Medical equipment and supplies
• Prescription drugs
• Hospice aide and homemaker services
• Physical, occupational, and speech-language therapies
• Social work services
• Dietary counseling
• Other counseling services for you and your family
• Short-term inpatient care
• Other Medicare-covered services
5. Home health services
Your Medicare Part A benefits also cover 100 percent of the cost for certain home health services if you’re eligible. If you need durable medical equipment, you pay 20 percent of the Medicare-approved cost for this equipment. The services that your hospital insurance covers include:
• Part-time or occasional skilled nursing care
• Physical or occupational therapy
• Speech-language pathology services
• Medical social services
• Home health aide services on a part-time or occasional basis
• Injectable osteoporosis drugs for qualifying women
If you need more than part-time or occasional care, you don’t qualify for the home health benefit, but you can leave home for short-term medical treatment or adult day care and still be eligible.
How Medicare Advantage affects your Part A coverage
If you choose to enroll in a Medicare Advantage plan, you will have at least the same coverage as Original Medicare Part A and Part B, but most Medicare Advantage plan include additional benefits. If you’ll be qualifying for Medicare soon, or want to explore your options, check out the Medicare Advantage plans in your area. You can compare plans online. You may find that you can get access to more benefits with little to no additional cost.