What is Medicare Part A

Part A of Medicare in its simplest term is inpatient Medical coverage.  Simply put, it covers you for when you go into a building and you stay overnight.  This, of course, is oversimplified but it is a good reference point for services you may need.  If you think, “will the treatment I receive result in an overnight stay?” Part A of Medicare will likely cover it.  Overview at Medicare’s website https://www.medicare.gov/what-medicare-covers/what-part-a-covers

What is the Premium of Part A of Medicare?

You qualify for Premium Free Part A of Medicare when you or a spouse has worked and paid into social security for 40 quarters or more. 

If you have not paid into social security for this amount of time, then you may purchase Part A of Medicare from the government. The Part A of Medicare premium for those that do not qualify for Premium Free Part A is $437 per month in 2019.

One half of Original Medicare is Part A.  Original Medicare consists of Part A and Part B of Medicare. In this article we are only going to talk about Part A.  We encourage you to view our article on Part B of medicare here https://trustedbenefitsdirect.com/what-is-medicare-part-b/ when you are ready.  

In General, What Does Part A Cover?

  • Inpatient care in a hospital 
  • Inpatient care in a skilled nursing facility (not custodial or long-term care) 
  • Hospice care
  • Home health care
  • Medicare covers semi-private rooms 
  • Meals
  • General nursing
  • Drugs as part of your inpatient treatment, and other hospital services and supplies. 

In General, What Does Part A does not cover?

  • Private Duty Nursing
  • Personal Care Items 
  • Private Room (unless medically necessary)
  • Notice nothing has been mentioned about doctor services.  Even though you are admitted as an inpatient and staying overnight the visits from the doctor are not covered.  This is covered under Part B of Medicare and is covered in a separate article. https://trustedbenefitsdirect.com/what-is-medicare-part-b/

When admitted as an inpatient to the hospital you are responsible for deductibles and coinsurance:

  • Inpatient Deductible is $1,364 per benefit period.  There is no coinsurance due for the first 60 days of the benefit period.
  • You pay coinsurance amount of $341 per day for days 61– 90 of each benefit period. 
  • For each day over 90 of your stay there is a coinsurance due of $682 for each day until you exhaust your total of 60 “lifetime reserve days”.
  • You are responsible for all costs after you exhaust your 60 lifetime reserve days.
  • These are the costs in 2019

What is a Benefit Period?

A benefit period starts when you begin an inpatient hospital stay or a Skilled Nursing Facility stay.  The official 2019 Medicare and You publication on page 113 provides a definition. You can download your own copy here https://trustedbenefitsdirect.com/wp-content/uploads/2019/08/10050-Medicare-and-You.pdf.

Benefit period: The way that Original Medicare measures your use of hospital and skilled nursing facility (SNF) services. The benefit period begins upon admission as an inpatient to the hospital or skilled nursing facility. The benefit period ends when you have not received any inpatient hospital care (or skilled care in a SNF) for 60 days in a row. If you go into a hospital or a SNF after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There’s no limit to the number of benefit periods. 

Please take note of the term 60 days in a row.  Upon admission as an inpatient to the hospital determines if you are responsible for an additional $1,364 Part A deductible. For example, admission as an inpatient to the hospital begins on January 1 and you leave January 15 you will be responsible for a $1,364 deductible. If you are readmitted as an inpatient, for the same condition, to the hospital anywhere between January 15 (in this example) to February 1 you are still under the original 60 benefit period and will not be responsible for an additional $1,364 deductible.  

What is Skilled Nursing Facility Care?

Covered under Part A of Medicare. A beneficiary qualifies for Skilled Nursing Facility Care when they have an inpatient hospital stay of at least a three days.  An inpatient hospital stay begins the day the hospital formally admits you as an inpatient based on a doctor’s order and doesn’t include the day you’re discharged.

Skilled nursing care or skilled therapy care may be approved if it’s necessary to help improve or maintain your current condition. To qualify for skilled nursing facility care coverage, your doctor must certify daily skilled care (like intravenous injections or physical therapy) which, as a practical matter, can only be provided in a skilled nursing facility if you’re an inpatient.  It is extremely important to note that a beneficiary must be admitted as an INPATIENT.

If the admission of the beneficiary is under observation care, this does not qualify to the three-day minimum. You can see more about this in our article “Differences Between Inpatient and Observation Care Stays” at www.xxxx.com

You pay: 

  • Nothing for the first 20 days of each benefit period 
  • A coinsurance amount of $170.50 per day for days 21–100 of each benefit period 
  • All costs for each day after day 100 in a benefit period

What is Hospice Care?

 In order to qualify for Hospice Care under Part A of Medicare you must meet all of the following criteria according to Medicare’s website at https://www.medicare.gov/coverage/hospice-care

  • 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).
  • You accept palliative care (for comfort) instead of care to cure your illness.
  • You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness and related conditions.

The plan your hospice care team creates can include any or all of these services.  

  • Doctor services
  • Nursing care
  • Medical equipment, like wheelchairs or walkers
  • Medical supplies, like bandages or catheters
  • Prescription drugs for symptom control or pain relief
  • Hospice aide and homemaker services
  • Physical therapy services
  • Occupational therapy services
  • Speech-language pathology services
  • Social work services
  • Dietary counseling
  • Grief and loss counseling for you and your family
  • Short-term inpatient care for pain and symptom management
  • Short term respite care . If your usual caregiver (like a family member) needs a rest, you can get inpatient respite care in a Medicare-approved facility (like a hospice inpatient facility, hospital, or nursing home). Your hospice provider will arrange this for you. You can stay up to 5 days each time you get respite care. You can get respite care more than once, but it can only be provided on an occasional basis.
  • Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness and related conditions, as recommended by your hospice team

Only your hospice doctor or your regular doctor (if you have one): 

can certify if you are terminally ill and in addition have a life expectancy of fewer than 6 months.  A face-to-face meeting with the hospice doctor or the hospice medical director is a requirement to recertify you are terminally ill if you live past the 6 months diagnosis.  The hospice care treatment will be in your home or hospice care facility. The location of treatment of hospice care will likely be in the beneficiaries home, but not always. When the choice is made to receive hospice care, usually the decision has been made that you no longer wish to have treatment to cure your condition and/or your doctor concludes efforts to cure your condition are not working.  Once you choose hospice care, your hospice benefit will usually cover everything you need. 

Medicare won’t cover any of these once your hospice benefit starts:

Treatment intended to cure your terminal illness and/or related conditions.

Talk to your doctor if you’re thinking about getting treatment to cure your illness. As a hospice patient, you always have the right to stop hospice care at any time. Prescription drugs to cure your illness (rather than for symptom control or pain relief).

Care from any hospice provider that wasn’t set up by the hospice medical team.

You must get hospice care from the hospice provider you chose. The performance of treatment for your terminal illness will be through your hospice team. The arrangement of treatment will be by the hospice team as well. You can’t get the same type of hospice care from a different hospice unless you change your hospice provider. However, you can still see your regular doctor or nurse practitioner if you chose him or her to be the attending medical professional who helps supervise your hospice care.

Room and board.

Medicare doesn’t cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.

Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation.

unless it’s either arranged by your hospice team or is unrelated to your terminal illness and related conditions.

What is Home Health Services?

Home health services You can use your home health benefits under Part A and/or Part B to pay for home health services. Medicare covers medically necessary part-time or intermittent skilled nursing care, and/or physical therapy, speech-language pathology services, or continued occupational therapy services. A doctor, or certain health care professionals who work with a doctor, must see you face-to-face before a doctor can certify that you need home health services. A doctor must order your care, and a Medicare-certified home health agency must provide it. Home health services may also include medical social services, part-time or intermittent home health aide services, durable medical equipment, and medical supplies for use at home. 

You must be homebound, which means: 

• 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. 

• Leaving your home isn’t recommended because of your condition. 

• You’re normally unable to leave your home because it’s a major effort. You pay nothing for covered home health services. You pay 20% of the Medicare-approved amount, and the Part B deductible applies, for Medicare covered medical equipment.

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