Summary of Medicare Part A

Navigating the healthcare system is confusing and frustrating.  In an effort to simplify some pertinent information, I have referenced the medicare website for definition and summary.

Medicare is currently defined under two classifications, Medicare Part A and Medicare Part B.  Briefly, Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. It is best described as “hospital insurance”.

This is differentiated from Part B, which is “medical insurance”.  Medicare Part B covers eligible home health services such as intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and more. It provides elders coverage for certain doctors’ services, outpatient care, medical supplies, and preventive services.

Medicare also covers two very broad categories. Under it’s umbrella are certain “services” such as lab testing, surgeries, and doctor visits. And “supplies” which are considered medically necessary to treat a disease or condition, such as wheelchairs and walkers. (If you’re in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare.) Some services may only be covered in certain settings or for patients with certain conditions.

In general, Medicare Part A covers:

A.)  Hospital care, which includes inpatient hospital care; skilled nursing facility care; and long-term care hospitals.

B.) Skilled nursing facility care coverage, which covers assessments and care plans.

C.)  Nursing home care – as long as custodial care isn’t the only care you need. Or, in other words, there is a “skilled” component to the patient needs. Medicare only pays for home care if you meet certain conditions. An elder who needs assistance to eat, getting in or out of a bed or chair, moving around, and using the bathroom may be covered. It may also include the kind of health-related care that most people do themselves, like using eye drops. But in most cases, Medicare doesn’t pay for custodial care.

D.) Hospice:  If you qualify for hospice care, you’ll have a specially trained team and support staff available to help you and your family cope with your illness. Your doctor and the hospice team will work with you and your family to set up a plan of care that meets your needs.

E.) Home health services: Medicare does not pay for:

  • 24-hour-a-day care at home
  • Meals delivered to your home
  • Homemaker services include shopping, cleaning, and laundry when this is the only care you need, and when these services aren’t related to your plan of care.
  • Personal care is care given by home health aides, like bathing, dressing, and using the bathroom, when this is the only care you need.

How do you determine whether Medicare covers what you need?

Talk to your doctor or other health care provider about why you need certain services or supplies, and ask if Medicare will cover them. If you need something that’s usually covered and your provider thinks that Medicare won’t cover it in your situation, you’ll have to read and sign a notice saying that you may have to pay for the item, service, or supply.