Medicare Part A (Hospital Insurance)

What is it? Medicare Part A helps pay for your inpatient care in a hospital and provides limited
coverage for care and rehabilitation immediately after you get out of the hospital in a skilled
nursing facility and in your home. Many people mistakenly assume that Medicare will provide
for their long-term care. It will not.
What does Part A cover? In addition to inpatient hospital stays, Part A covers skilled nursing
facilities that provide skilled nursing and rehabilitation, hospice care, psychiatric inpatient care,
and some home health care such as physical therapy ordered by a doctor. However, these afterhospital
services have very strict qualifying rules and are time sensitive.
Skilled Nursing Facility: While Medicare Part A does not cover typical nursing
home care, it does cover care in a skilled nursing facility. However, coverage is
limited to a maximum of 100 days per benefit period, with coinsurance payments
required after day 20.
Home Health Care: Medicare may provide “necessary and/or intermittent”
skilled nursing care, home health aids, physical therapy, and occupational therapy
that are ordered by a doctor and provided by a Medicare-certified home care
agency. Medicare may also provide for durable medical equipment for use at
home—things like a wheelchair or walker.
Hospice Care: Medicare provides home health and other services, as well as
drugs for pain relief and respite care for people with less than six months to live.
Lifetime Reserve Days: If a person is in the hospital for more than 90 days,
Medicare provides a total of 60 “reserve” days that can be used over a lifetime.

For each reserve day, Medicare pays all costs except for
the coinsurance.
What is not covered by Part A? Medicare does not cover care that is or becomes primarily custodial. In other words, if you have a chronic disabling condition or disease and need assistance with eating, dressing, using the bathroom, moving from the bed to a chair, or bathing (called “activities of daily living”), Medicare benefits will not cover that assistance for an extended period of time. Simply put, Medicare does not cover long-term care in a nursing home, assisted living facility, or your own home.
What does Part A cost? There is no premium for Part A if you or your spouse worked and paid FICA taxes for 10 years or more (i.e., have 40 quarters of Social Security coverage). If you don’t qualify for free coverage, you may be able to buy into the program. If your resources and income are limited, you may qualify for help from your state.
There are deductibles and coinsurance requirements for different types of covered care. For example, if you are in a skilled nursing facility, your first 20 days of each benefits period are free, but days 21-100 are $124 per day. The rules vary by number of days, benefit period, and type of care. For more information about the Medicare Part A rules and requirements, visit www.medicare.gov or call (800)-Medicare. You may also find Medicare information at www.socialsecurity.gov or by calling (800) 772-1213 or TTY (877) 486-2048.