First, let's review the conditions for eligibility in Original Medicare Part A and Part B. To qualify, individuals must be U.S. citizens or permanent residents for at least 5 years and meet one of the following conditions:
- Individuals who are 65 years or older
- Individuals who are receiving disability benefits through Social Security or the Railroad Retirement Board
- Individuals who have been diagnosed with amyotrophic lateral sclerosis (Lou Gehrig's Disease) or end-stage renal disease
Medicare Part A Coverage
Medicare Part A pays for services and equipment supplied during a stay in a Medicare-enrolled hospital. Coverage for some expenses depends on the hospital setting. Generally, covered expenses include the following:
- Semi-private rooms
- Skilled nursing care
- Medical supplies and equipment
- Ambulance transportation
Different Hospital Settings
Expenses covered by Medicare Part A include semi-private rooms, prescription drugs (during your hospital stay), meals and nursing.
Long-term Care Hospitals
When transferred from an acute-care hospital or if admitted within 60 days of discharge from an inpatient hospital, Medicare will cover the expenses of long-term care hospitals.
Skilled Nursing Facilities
Medicare Part A will pay for some services and equipment/supplies when a doctor deems a Medicare-certified skilled nursing facility necessary. This necessity is for skilled nursing rather than custodial care. For example, assistance with bathing, dressing and eating would not be considered skilled nursing care. Expenses are usually only covered for a limited period.
The following conditions need to be met in order for Medicare Part A to cover hospice expenses:
- A doctor must agree that the patient is terminally ill and likely to live six months or less.
- The patient must agree to use care that is palliative (relieving pain) rather than curative (finding a cure).
- The patient must agree in writing that he/she is using hospice care rather than other treatments covered by Medicare.
Home Health Services
When recovering from being in a hospital, Medicare Part A will cover some home health services for a limited period. The agency providing the care must be Medicare-certified. Covered services include the following:
- At-home nursing care
- Physical therapy
- Occupational therapy