When most people think about Medicare Part A, they immediately think of hospital stays. While that's certainly a key aspect of the coverage, Medicare Part A offers a lot more than just hospital insurance. Understanding the full extent of what Medicare Part A covers can help you make informed decisions about your healthcare.

What Is Medicare Part A?

Medicare Part A, also known as "hospital insurance," is part of the Original Medicare plan. It helps cover services related to inpatient care in hospitals, skilled nursing facility care, hospice, and even some home health care services. While it doesn’t cover every medical expense, it is essential for protecting you against the high costs associated with hospital stays and other forms of care that might require you to stay overnight or longer.

The good news is that for most people, Medicare Part A is premium-free, as long as you or your spouse paid Medicare taxes for at least 10 years (40 quarters). If you don't meet this criterion, you may need to pay a monthly premium to receive Part A coverage. You can learn more about these eligibility requirements on Medicare.gov.

Beyond Hospital Stays: What Else Does Part A Cover?

Yes, Medicare Part A covers hospital stays, but its benefits go well beyond that. Let's look at the other types of coverage Part A provides.

Skilled Nursing Facility Care

If you need specialized care after a hospital stay, Medicare Part A helps cover skilled nursing facility care. However, this care is only covered if:

  • You’ve had a qualifying hospital stay of at least three days.
  • Your doctor recommends skilled nursing care.
  • The facility is Medicare-approved.

Keep in mind, this is not long-term or custodial care. The services covered are more focused on recovery, such as physical therapy or wound care. Medicare will cover 100% of the costs for the first 20 days, but after that, you may need to pay coinsurance for days 21-100. After 100 days, Medicare stops covering the costs. You can find more details on Medicare.gov.

Hospice Care

If you or a loved one is diagnosed with a terminal illness, Medicare Part A will cover hospice care to ensure you receive the necessary services to manage symptoms and live as comfortably as possible. Hospice care under Part A includes services like:

  • Pain relief and symptom management
  • Grief counseling for you and your family
  • Respite care to provide temporary relief for your primary caregivers

Medicare fully covers most hospice services, though for certain prescriptions or respite care, there may be a small copayment. For more on what’s included, see the Medicare.gov page on hospice care.

Home Health Care

Another significant benefit under Medicare Part A is home health care, though this is more limited compared to what’s offered by Medicare Part B. Part A will cover short-term home health care services if:

  • You’re homebound (meaning you need significant help to leave your home).
  • Your doctor prescribes home health services, and you receive care from a Medicare-certified agency.

Home health care services can include physical therapy, occupational therapy, and speech-language pathology services, among other medical services you might need during recovery. Learn more about Medicare’s home health care coverage here.

What Is Not Covered by Part A?

It's equally important to understand what Medicare Part A does not cover. This way, you can better prepare for any potential out-of-pocket expenses.

  • Doctor Visits: Doctor’s visits and outpatient care are covered by Medicare Part B, not Part A.
  • Prescription Drugs: While some medications administered during your hospital stay are covered, most prescription drugs are not.
  • Long-Term Care: Medicare Part A does not cover long-term or custodial care, like assistance with bathing, dressing, or eating if that is the only care needed. You can explore these details further at Medicare.gov.

Tips for Making the Most of Your Medicare Part A Coverage

To get the most out of your Medicare Part A coverage, here are some steps to consider:

  • Understand your eligibility: Verify whether you qualify for premium-free Part A and make sure you meet any requirements for skilled nursing or hospice care.
  • Plan for additional coverage: Since Medicare Part A doesn’t cover everything, consider adding Medicare Part B for outpatient care or enrolling in a Medicare Advantage Plan, which may offer additional benefits.
  • Review your health needs annually: Healthcare needs change, so it’s important to review your Medicare plan annually to ensure it still meets your needs.

Navigating Medicare doesn’t have to be overwhelming. If you're looking to better understand your Medicare benefits or want to explore how Medicare Part A fits into your healthcare needs, check out the Medicare classes offered on GetSetUp.

Reviewed By: Keith Gilbert