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Covered Services Under Medicare Part A

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If you’re a Medicare beneficiary, chances are you have Medicare Part A coverage (unless you decided to delay enrollment in Part A). Your red, white, and blue Medicare card tells you whether you’re enrolled in Part A. If you’re enrolled in a Medicare Advantage plan, the plan must provide at least as much coverage as Medicare Part A and Part B, except hospice care. Don’t worry- hospice care is still covered for you under Medicare Part A, even if you have a Medicare Advantage plan.

Medicare Part A – covered services include (with limits and restrictions) inpatient care in hospitals, home health services, hospice care, and skilled nursing facility care. See the table below for an overview of Medicare Part A benefits and covered services.

Source: Information from the official government handbook published by the Centers for Medicare and Medicaid Services: Medicare & You 2016
Hospital stays (inpatient) Examples of covered services include for hospital stays include, but are not limited to:

  • Semi-private (shared) room
  • Meals
  • Inpatient care at acute care hospitals
  • Prescription drugs as part of your inpatient treatment
  • Care at inpatient rehabilitation facilities, long-term care hospitals, and critical access hospitals
  • Inpatient care as part of a qualifying clinical research study
  • Mental health care

Here are some examples of what Medicare Part A coverage doesn’t include:

  • Private-duty nursing
  • A television or telephone in your room (if there is a separate charge for these items)
  • Personal care items such as razors or slipper socks
  • A private room, unless medically necessary

Medicare Part B covers the doctor and emergency room services you get while you are in a hospital.

Home health services Under Medicare Part A, home health services may include (but aren’t limited to):

  • Medically necessary part-time or intermittent skilled nursing care
  • Physical therapy, speech therapy, and a continuing need for occupational therapy
  • Medical social services
  • Part-time or intermittent home health aide services

There may be limits and restrictions to these covered services, and Medicare may cover certain other home health services. Your health care provider or your hospital discharge planner can give more information, based on the details of your care plan.

A doctor must order your care, and a Medicare-certified home health agency must provide it. You must be homebound, which means that leaving home would require a major effort.

Hospice care Medicare Part A benefits include hospice care for beneficiaries with terminal illness. Your doctor must certify that you are expected to live six months or less. Coverage includes many services, such as (but not limited to):

  • Prescription drugs for pain relief and symptom management (in some cases, you may need to make a copayment)
  • Medical, nursing, and social services
  • Short-term inpatient care
  • Homemaker services
  • Physical, occupational, and speech therapy
  • Short-term inpatient stays for pain and symptom management (in a Medicare-approved facility)
  • Respite care (a temporary stay in a Medicare-approved facility while your usual caregiver is unavailable or needs a break)
  • Certain health problems that aren’t related to your terminal illness
  • Grief counseling

A Medicare-approved hospice usually gives hospice care in your home (or other facility like a nursing home). You can continue to get hospice care as long as the hospice medical director or hospice doctor re-certifies that you are terminally ill.

Skilled nursing facility care For skilled nursing facility care, Medicare Part A pays for certain services after a three-day minimum inpatient hospital stay for a related illness or injury.

Covered services may include a semi-private room, meals, skilled nursing and rehabilitative services, and other services and supplies. To qualify for care in a skilled nursing facility, your doctor must certify that you need daily skilled care like intravenous injections or physical therapy. Medicare doesn’t cover long-term care or custodial care in this setting.

Transplants At Medicare-approved facilities, Medicare may cover certain organ transplants and stem cell transplants:

  • Heart
  • Lung
  • Kidney
  • Pancreas
  • Intestine

Other transplants may be covered under Medicare Part B. If your doctor decides that you need a transplant, you may want to make sure Medicare covers it first. You can ask Medicare (or your Medicare Advantage plan, if you have one), or your health provider.

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