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Medicare Part A
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Question - Assistance - Enrollment
Medicare Part A, also known as Hospital Insurance, provides coverage for:
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Inpatient Hospital Care
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Skilled Nursing Facility (SNF) Care
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Behavioral & Mental Health
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Hospice Care
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Home Health Services
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Nursing Home Care
It is generally free for those who have worked and paid Medicare taxes for at least 10 years
Inpatient Hospital Care
Medicare-covered inpatient hospital services include:
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Semi-private rooms
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Meals
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General nursing
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Drugs (including methadone to treat an Opioid Use Disorder)
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Other hospital services and supplies as part of your inpatient treatment
Medicare DOESN'T cover:
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Private-duty nursing
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A private room (unless medically necessary)
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A television or phone in your room (if there's a separate charge for these items)
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Personal care items (like razors or slipper socks)
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Things to know
Inpatient hospital care includes care you get in:
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Acute care hospitals
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Critical access hospitals
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Inpatient rehabilitation facilities
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Inpatient psychiatric facilities
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Long-term care hospitals
It also includes inpatient care you get as part of a qualifying clinical research study.
Skilled Nursing Facilities
Skilled Nursing Facilities (SNFs) are places for people to live temporarily while they’re getting rehabilitation and medical treatments after hospitalization for an illness or injury. Medicare Part A covers SNF care for a limited time, under certain conditions. Skilled care is often given in a nursing home, but Medicare Part A doesn’t cover long-term or custodial care in a nursing home. Part A will generally cover your drug costs if you’re getting Medicare-covered skilled nursing care in a SNF.
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Skilled nursing facility care
Medicare Part A (Hospital Insurance) covers skilled nursing facility care for a limited time (on a short-term basis) if you meet all of these conditions:
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You have Part A and have days left in your benefit period to use.
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You have a qualifying inpatient hospital stay.
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You enter the SNF within a short time (generally 30 days) of leaving the hospital.
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Your doctor or other health care provider has decided that you need daily skilled care (like intravenous fluids/medications or physical therapy). You must get the care from, or under the supervision of, skilled nursing or therapy staff.
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You get these skilled services in a Medicare-certified SNF.
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You need skilled services for one of these:
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An ongoing condition that was also treated during your qualifying inpatient hospital stay (even if it wasn't the reason you were admitted to the hospital).
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A new condition that started while you were getting SNF care for the ongoing condition.
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You need skilled nursing care or therapy to improve or maintain your current condition, or to prevent or delay it from getting worse.
To Learn more visit: https://www.medicare.gov/coverage/skilled-nursing-facility-care
Mental Health & Substance use Disorders
Medicare covers certain screenings, services, and programs that aid in the treatment and recovery of mental health and substance use disorders.
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Types of Mental Health Care
Outpatient
Mental Health
Care
Services to help and treat mental health conditions (often called counseling or psychotherapy).
Intensive
Outpatient
Program Services
Part-time mental health care for people who need at least 9 hours of services per week
Partial
Hospitalization
Full-day mental health care for people who need at least 20 hours of services per week
Inpatient Care
Mental health care cervices when you're admitted to a general or psychiatric hospital.
Preventive Screenings & Counseling
Depression
screening
Assesses sighs and symptoms of depression
Opioid Use
Disorder
Treatments
Ciybsekubg, therapy, assessments, and more to help recover form opioid use disorder.
Tobacco Use
Counseling
Counseling for smoking and tobacco use cessation
Alcohol Misuse
Screenings
To Identify unhealthy drinking habits and counseling needs.
To Learn More visit: https://www.medicare.gov/coverage/mental-health-substance-use-disorder
Hospice care
You qualify for Hospice Care if you have Medicare Part A (Hospital Insurance) and meet all of these conditions:
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Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less).
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You accept comfort care (palliative care) instead of care to cure your illness.
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You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.
If you qualify, you can get hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods. You have the right to change your hospice provider once during each benefit period. How do I choose a Hospice Care Provider?
You can usually get Medicare-approved hospice care in your home or other facility where you live, like a nursing home. You can also get hospice care in an inpatient hospice facility. If your hospice care team determines you need inpatient care at a hospital, they must make the arrangements for your stay. If they don’t, you might be responsible for the entire cost of your hospital care. What's a Hospice Care Team?
Once you choose hospice care, your hospice benefit should cover everything you need. You and your family will work with your hospice care team to set up your plan of care. What kinds of services does a plan of care include?
Learn more visit: https://www.medicare.gov/coverage/hospice-care
Home Health Services
Home health is a wide range of health care services that you can get in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF).
Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health services as long as you need part-time or intermittent skilled services and you’re “homebound,” which means:
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You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury.
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Leaving your home isn’t recommended because of your condition.
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You’re normally unable to leave your home because it’s a major effort.
Covered home health services include:
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Medically necessary part-time or intermittent skilled nursing care, like:
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Wound care for pressure sores or a surgical wound
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Patient and caregiver education
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Intravenous or nutrition therapy
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Injections
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Monitoring serious illness and unstable health status
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​Physical therapy, occupational therapy, and speech-language pathology services (if you meet certain conditions)
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Medical social services
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Part-time or intermittent home health aide care (only if you’re also getting skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy at the same time), like:
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Help with walking
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Bathing or grooming
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Changing bed linens
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Feeding
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Injectable osteoporosis drugs for women who meet certain criteria
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Durable medical equipment
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Medical supplies for use at home
A health care provider (like a nurse practitioner) must assess you face-to-face before certifying that you need home health services. A health care provider must order your care, and a Medicare-certified home health agency must provide it.
If your provider decides you need home health care, they should give you a list of agencies that serve your area. They must tell you if their organization has a financial interest in any agency listed.
In most cases, "part-time or intermittent" means you may be able to get skilled nursing care and home health aide services up to 8 hours a day (combined), for a maximum of 28 hours per week. You may be able to get more frequent care for a short time (less than 8 hours each day and no more than 35 hours each week) if your provider determines it's necessary.
Medicare doesn't pay for:
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24-hour-a-day care at your home
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Home meal delivery
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Homemaker services (like shopping and cleaning) unrelated to your care plan
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Custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need
You won't qualify for the home health benefit if you need more than part-time or "intermittent" skilled care. You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.
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Learn more visit: https://www.medicare.gov/coverage/home-health-services
Nursing Homes Care
Nursing homes are facilities where people can live and get full-time medical care on a long-term basis. Most nursing home care is custodial care, which helps people with activities of daily living (like bathing, dressing, and eating). Original Medicare doesn’t cover custodial care if it’s the only care you need. Original Medicare may cover skilled care at a nursing home, or in your home (with home health care), if you need short-term skilled care for an illness or injury and you meet certain conditions.
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Medicare Part A (Hospital Insurance) may cover skilled nursing care in a nursing home. It must be medically necessary  for you to get skilled nursing care  (like if you need help changing sterile dressings).
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Medicare doesn't cover Custodial Care if it's the only care you need.
What it is
Most nursing home care is custodial care, which helps you with activities of daily living (like bathing, dressing, using the bathroom, and eating) or personal needs that could be done safely and reasonably without professional skills or training. 
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Things to know
If you're in a  Medicare Advantage Plan (Part C)  (like an HMO or PPO) or other Medicare health plan, check with your plan to see if  it covers nursing home care. Usually, plans don't help pay for this care unless the nursing home has a contract with the plan. Ask your plan about nursing home coverage and check the facility’s quality ratings before you make any arrangements to enter a nursing home.
