Medicare Part A: What does it cover?

Medicare Part A is insurance that covers benefits for hospitalization, limited nursing home care, home health care, hospice care and inpatient psychiatric care. Medicare Part A insurance coverage usually comes into effect after a $875 deductible is paid (2004 dollar figures). The following are services that are covered and also those that are not covered under Medicare Part A:

Covered services (after an $875 deductible) under Medicare Part A:

Hospital stays. The first 60 days of hospitalization; the next 30 days require a copayment ($219 a day). This coverage begins anew with each "benefit period". For days 91-150, the copayment is quite high ($438 a day) and only 60 of these extra days will be covered in a lifetime.

Nursing home care. "Skilled care" (nurses, therapists) that follows a hospital stay of at least three days. The first 20 days in a benefit period are covered fully; a co-payment ($109.50 a day) is required for the next 80 days. Medication and meals.

Home health care. Part-time or intermittent "skilled" care (nurses, therapists, and aids) when prescribed by a doctor for treatment rehabilitation, and when the patient is homebound. Services must be provided by a "certified" home health agency.

Hospice care. All medical and nursing care, medical supplies, home care, and counseling. Short-term hospital respite care. Drugs for pain and symptom relief. Some inpatient respite care.

Inpatient psychiatric care. 190 days over a lifetime, in a freestanding psychiatric hospital (as opposed to inpatient care at a General Hospital, which is covered like any other hospitalization).

Blood received as an inpatient. All but the first three pints.

Services not covered under Medicare Part A:

Hospital stays. Copayments and all costs beyond 150 days. Private duty nurses. The extra cost of private rooms unless "medically necessary". Television or telephone.

Nursing home care. Copayments and all costs beyond 100 days in a benefit period. Custodial care (help with bathing, dressing, grooming, eating etc.). Any care that is not related to a hospital stay of three days or more. Extra charges for a private room.

Home health care. Custodial care (help with bathing, dressing, grooming, eating etc.)

Hospice care. Small copayment for drugs (less than $5.00). 5% of the cost of inpatient respite care.

Inpatient psychiatric care. Any care in a psychiatric hospital in excess of 190 days.

Blood received as an inpatient. The first 3 pints in each calendar year.

These Medicare Part A deductible figures are as of 2004.

Some information from How to Care for Aging Parents by Virginia Morris

Additional information and web page by Paul Susic M.A. Licensed Psychologist Ph.D. Candidate Clinical Director- Senior Care Psychological Consulting