Medicare Part A (Hospitalization)

• Inpatient hospital care
• Hospice care
• Skilled nursing facility care (available if custody care is not the sole care requirement)
• Partial home health services

Please be aware that some benefits may only be provided under specific conditions. Our insurance agent will be happy to discuss these situations in more detail with you if you have questions.

• A disability for which you are receiving disability benefits
• You are already receiving retirement benefits
• End-stage renal disease (ESRD) with required dialysis
• Amyotrophic lateral sclerosis (ALS)

To receive Part A coverage, you must be a citizen of the United States or a legal permanent resident with five continuous years in the country.
A majority of beneficiaries will not pay a Medicare Part A premium when they have worked a minimum of 10 years (40 quarters) while paying Medicare dues for that period. Individuals who are not eligible for Part A coverage without paying premiums may still enroll in Part A and pay a dividend instead.

Recipients who are late to enroll in Part A coverage after they qualify for it may incur penalties for late enrollment after registering.

The Initial Enrollment Period (IAP) lasts seven months and begins three months before your 65th birthday. Your coverage will begin depending on the month you enroll. If you wait until the last minute to enroll or forget to enroll you will need to wait until the general enrollment period to receive coverage.

If you are disabled, your enrollment in Medicare Part A hospital insurance and Medicare Part B medical insurance will begin once you have received Social Security disability benefits for 24 months. Coverage will begin in the 25th month. You should receive your Medicare card three months before coverage begins.

A special enrollment period (SEP) covers eight months, starting the month after your employment or other group coverage ends. Should your employment end within the period of what would have been your IAP, you will need to follow the standard rules for initial enrollment in a Part A plan.
If you qualify for an IAP, you will need to pay the late enrollment penalty. Your Part A coverage will begin on the first day of the month following your registration, and your health insurance card should arrive within 30 days of registration.

• Acute care hospitals
• Critical access hospitals
• Inpatient rehabilitation facilities
• Long-term care hospitals
• Mental health facilities
• Participation in qualifying clinical trials and studies

Please note that Part A will not cover the following costs:

• Private rooms (unless there is a medical necessity)
• Private-duty nursing
• Shampoo, razors and other personal care items
• Television or telephones
• Units of blood

Medicare Part A covers several home-based health services when they are medically necessary and prescribed by your physician. Services which may be covered include:

• Physical therapy
• Occupational therapy
• Medical social services
• Speech-language pathology services
• Part time or alternating skilled nursing care
• Part time or alternating home health care services

Durable medical equipment may be covered separately in Medicare Part B if prescribed by your doctor.
Medicare Part A does not cover:

• Round-the-clock home care, meals or homemaker services unless related to your treatment or therapy.
• Personal care services, including help with bathing or dressing.

Your home health care services are to be provided through a Medicare-certified home health agency, with a doctor to certify you as a home-bound individual. You are categorized as “home-bound” under Medicare’s terms if the following are true:

1. You cannot leave your home under ordinary circumstances, and it would require an immense effort for you to do so.
2. You are medically advised against leaving your home unless accompanied by another person, transportation or specialized equipment.

You may be eligible for hospice care cover under Medicare Part A if you have a terminal illness and an estimated lifespan of no more than six months. The focus of hospice care is in palliative care, as the goal of this care is to alleviate pain and make you as comfortable as possible.To be eligible for Medicare-covered hospice care you must meet the following criteria:

• You must be enrolled in Medicare Part A.
• You must receive your hospice care through a Medicare-approved hospice facility.
• Your physician or health care provider must certify you as terminally ill and having only six months to live.
• You must agree to forego remedial treatments toward your illness. However, coverage of palliative and comfort-focused care for your illness is continued.

Hospice care is typically provided in the patient’s home and may include:

• Doctor services and nursing care
• Pain relief medications
• Durable medical equipment
• Social and hospice support services
• Medical supplies and physical or occupational therapy
• Dietary counseling
• Homemaker services
• Short-term hospital care as necessary for pain or symptom control
• Short-term respite care

While patients are receiving hospice care, Part A coverage may also meet individual costs that are not normally included, such as grief and spiritual counseling.

Medicare Part A only covers hospital room and board if the hospital medical staff requests short-term inpatient care for pain or other treatment of symptoms.

You are entitled to discontinue hospice care at any time. If you plan on receiving curative therapies or remedial treatments, speak with your physician.