What kind of coverage does Medicare Part A provide?

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Medicare Part A helps pay for the care you get when you’ve been admitted to the hospital. This includes general nursing, meals, a semi-private room, and drugs that you get as an inpatient. Medicare Part A also helps pay for mental health care in a hospital or psychiatric hospital, stays in a Skilled Nursing Facility, hospice care, home health services, and blood you get from a transfusion.

Will Part A pay for 100% of these services?

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Medicare Part A will help pay for expenses that are medically necessary. Part A does not, however, pay for 100% of most of these expenses. What is covered depends on the services you receive and when you receive them.

How can I qualify for Medicare Part A?

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You will get Medicare Part A if you have:

In some cases, widows, widowers, divorced widows, divorced widowers, and children may be eligible for Medicare if they have a disability.

Do I have to pay a premium for Part A?

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Most people do not have to pay a premium for Part A. If you do, the state may be able to help pay for it.

Which Medicare Savings programs will help pay my Part A expenses?

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If you qualify, the Qualified Medicare Beneficiary (QMB) program pays for Medicare Part A and B premiums, coinsurance, copayments, and deductibles. The Qualified Disabled Working Individual (QDWI) program pays Part A premiums for people who lose SSDI because they’re earning too much money. See Medicare Part A: Help Paying for Part A Costs for more details.

Does Medicare pay for long-term care coverage?

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Medicare does not generally pay for long-term care. Medi-Cal might help pay for these costs. The California Health Advocates website has more information on long-term care.

I have to stay in the hospital for an extended period of time. Will Medicare pay for that?

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Medicare pays for different amounts during different periods of your hospital stay. See Medicare Part A: Hospital Stays for more details.

Does Part A help pay for services I get in a Skilled Nursing Facility?

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Under certain circumstances, Medicare pays for short-term stays in Skilled Nursing Facilities. See Medicare Part A: Skilled Nursing Facilities for more details.

What is a benefit period?

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A benefit period is the timeframe that Medicare uses to measure your use of hospital or Skilled Nursing Facility care. A benefit period begins the day you enter a hospital or SNF. It ends after you are released and haven't gotten any further hospital or SNF care for 60 days in a row.

If you go back into the hospital after one benefit period has ended, a new benefit period begins. There is no limit to the number of benefit periods you can have over your lifetime.

What if I go back into the hospital before 60 days have gone by?

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Then you’re still in the same benefit period, and in terms of coverage, you pick up where you left off when you re-enter the hospital. If you spent 50 days in the hospital, left for a month, and then reentered the hospital for another 40 days, you’ll be on day 90 of your original hospital stay as far as Medicare is concerned.