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Medicare Part A: What is Covered and What is Not

Medicare Basics

Medicare Part A: What is Covered and What is Not

Not many things are more intimidating than working through the specifics of a healthcare plan. When you add the pressures of a fixed financial budget and the love and concern for an aging or sick loved one, it can feel like an enormous mountain to climb. Medicare is here to offer assistance, but it can be confusing. 

Medicare Basics

Medicare was started in the 1960’s and is a healthcare plan dedicated to those over 65. There are a few minimal requirements to get started. Medicare is funded by the federal government, so it is offered only to citizens of the United States. A legal immigrant living in the United States consecutively for the past five years is also eligible. To be eligible, citizens must be over the age of 65 or have a disability that qualifies them for early coverage. There are exceptions for those suffering from ALS (amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease) and end-stage renal disease or kidney failure.

Medicare is not free. You will have options of coverage to choose from that can vary and can be personalized based on what is best for you and your loved one. For starters there are different types or “parts” of Medicare and cost will be different. The three methods of paying for or dividing cost are

  • Deductible – a set amount is paid out of pocket before Medicare kicks in
  • Copay- a fixed amount is paid at the time of care like when visiting a doctor or picking up a prescription
  • Coinsurance-a percentage of total cost is your share for the service and the rest is covered 

Medicare Part A

Largely, Medicare Part A provides support for the cost of inpatient hospital care. There is a supplementary Medicare Part B which covers things like doctors’ visits, therapy, and medical equipment, and in some cases prescription drugs. The eligibility requirements are like those of Medicare Part A. There are also Medicare Parts C & D and Medigap which cover an even broader spectrum of services. 

Medicare Part A Summary of Coverage 

Covered Not Covered 
  • Inpatient care including semiprivate rooms, meals, prescription drugs
  • Skilled Nursing Care Facility
  • Limited time home nursing 
  • Hospice
  • Limited time home health care
  • Private room in a hospital or skilled nursing facility
  • Private nurse
  • Personal items like razors or luxuries like an in room television or telephone
  • Initial blood transfusion
  • Long-term skilled nursing facility
  • Long-term nursing home specialized care


Important Dates

Whether looking at Medicare Part A or Part B, there are important dates shared on the website to be aware of 

  • Initial Enrollment: Three months prior to your 65th birthday
  • General Enrollment: January 1 – March 31 for Medicare Part B if not set up during enrollment
  • Open Enrollment: October 15 – December 7 

In addition to important dates, is a safe, informative website that will answer most of the general questions about the program and coverage. Please keep in mind we have experts right here on our team that can speak to you directly and specifically about what is best for your loved one and your family. It would be our privilege to ease your anxiety and unmask the mysteries of Medicare together.