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Medicare: Part A

The hospital insurance program established under Part A of Medicare provides qualified individuals with basic protection against the costs of the following services: (1) inpatient hospital care; (2) extended care services furnished to skilled nursing facility inpatients; (3) home health care; and (4) hospice care for terminally ill persons. Inpatient hospital care may generally be provided by urban hospitals, most rural hospitals, certain psychiatric institutions, and Christian Science sanatoriums. 42 U.S.C.A. sections 1395c et seq. Specifically, the costs covered by Medicare include: bed and board at the hospital; most physician, nursing, and related services; most drugs, supplies, appliances, and equipment furnished by the hospital; diagnostic and rehabilitative services; occupational, respiratory, physical, and speech therapy; and social services for personal, emotional, and financial issues related to covered medical care. Anesthesia services provided by a certified registered nurse anesthetist, however, are expressly excluded from coverage.

Individuals who are ineligible for OASDI or railroad retirement benefits may establish entitlement to hospital insurance benefits under Medicare Part A if they have worked in Medicare qualified government employment or meet the requirements for “deemed entitlement” to OASDI benefits. Individuals who lack “fully insured” status are “deemed” entitled to OASDI benefits for the purpose of obtaining Part A coverage if they are 65 years old, are residents of the United States, are U. S. citizens or aliens law-fully admitted to the United States for permanent residence, and have filed an application for Medicare hospital insurance benefits. Individuals who cannot otherwise qualify for hospital insurance benefits may obtain Medicare Part A coverage by paying a premium.

Part A coverage is based on “benefit periods.” An episode of illness is termed a benefit period and starts when the patient enters the hospital or nursing home facility and ends sixty days after the patient has been discharged. A new benefit period starts with the next hospital stay, and there is no limit to the number of benefit periods a person can have. Medicare will pay the cost of hospitalization for up to 90 days. The patient must pay a one-time deductible for the first sixty days of a benefit period and an additional daily fee called a co-payment for hospital care provided during the following thirty days. Apart from these payments, Medicare covers the full cost of hospital care.

So long as the premiums and deductibles are fully paid in a timely manner, beneficiaries remain entitled to Medicare coverage through the later of (1) the month of the individual’s death, if the individual would have been entitled to OASDI or Railroad Retirement benefits if he or she had not died, or (2) the month in which the individual no longer meets Part A entitlement requirements. Individuals who die during the month in which they would have turned 65 are entitled to hospital insurance benefits for that month, even if death occurs before the individual’s birthday, provided the individual would have met conditions for Medicare Part A entitlement had he or she not died.

Inside Medicare: Part A