For the most part, the majority of people nearing or over the age of 65 has heard about Medicare Part A. But fewer of these people, understand what Medicare Part A is and what it does.
During our four part Medicare series, we are going to focus on one letter at a time and define its coverage, eligibility, costs, and enrollment requirements. We are going to kick things off from the beginning and dive into Medicare Part A. Here we go!
What is Part A?
Medicare Part A helps pay for inpatient hospital stays for “medically necessary” care for an illness or medical condition. In addition to covering your stay in the hospital, Medicare Part A also helps cover some follow-up care such as an extended stay in a skilled nursing facility, hospice care for the terminally ill, and some limited in-home care for the homebound.
What Does Part A Cover?
Medicare Part A covers a multitude of medical expenses, but it is important to understand the specifics of what is covered and what is it does not cover.
Part A will cover up to 60 days of inpatient hospital care in a semi-private room after meeting the deductible. This means that the patient is required to meet the deductible, and is not eligible for a private room.
In addition to the room stay, Medicare Part A will cover hospital meals, prescription drugs, medical supplies, lab testing, operating room and recovery room services, as well as physical rehabilitation when necessary.
The hospital coverage in Part A is designed to cover all of the expenses of the average hospital stay once the deductible is met.
Skilled Care in a Nursing Facility:
Medicare Part A covers certain skilled nursing care services needed daily in a skilled nursing facility for up to 100 days. In order to have the nursing facility covered, your doctor must decide that you need daily skilled care given by, or under the direct supervision of, skilled nursing or rehabilitation staff. It is important to note that this is in-home care only. For patients who go to a nursing facility 5 or 6 days a week for rehabilitation services only, the care is considered daily care.
Part-Time In-Home Nursing Care:
Medicare covers care given in a certified skilled nursing facility (SNF) if it's medically necessary as determined by a doctor for you to have skilled nursing care. For those who need in-home care such as bathing, dressing, and general custodial care, this is not covered by Medicare Part A.
Hospice care is given in the home and includes services such as counseling, dietary counseling, medical supplies, and short term symptom relief. Hospice care is covered when your doctor includes them in the plan of care for comfort purposes in cases of terminal illness and related conditions.
Home Health Services:
Part A covers eligible home health services such as intermittent skilled nursing care, physical therapy, speech-language pathology services, and continued occupational services when the doctor orders these services for you.
What Does Part A Not Cover?
Medicare Part A will not pay for personal costs in the hospital, like charges for a television or telephone calls. It also does not help with the cost of custodial care. This is care that helps with the activities of daily life like eating, bathing, or dressing. Custodial care does not require the kind of skilled care provided in a hospital or skilled nursing facility, so Medicare Part A does not cover it.
What Providers Can I See?
With Part A Medicare coverage, you can choose any qualified provider in the United States who has been accepted by Medicare and who is accepting new patients. Since Part A offers the same benefits in Louisville, KY as throughout the United States, you are not limited to a particular state or region for your care.
Who is Eligible for Part A?
Eligibility for Medicare begins three months before the month you turn age 65. It includes the month you turn 65 and ends three months after the month you turn 65. Some individuals with certain disabilities may also qualify before they turn 65.
How Much Does Part A Cost?
Remember all those taxes that came out of your paycheck? Part of those taxes went towards Medicare. And because of this, there is no premium for Medicare Part A. It is a federally administered health insurance that is of no cost to the participant.
As for the hospital inpatient deductible and coinsurance, the costs are as follows:
- $1,364 deductible for each benefit period
- Days 1-60: $0 coinsurance for each benefit period
- Days 61-90: $341 coinsurance per day of each benefit period
- Days 91 and beyond: $682 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)
- Beyond lifetime reserve days: all costs
If you did not work and you are having to purchase Medicare Part A, you'll pay up to $437 premium each month for 2019. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $437. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $240.
How Do I Enroll in Part A?
All U.S. citizens who turn 65 and are already receiving Social Security are automatically enrolled in Medicare Part A. If you age into Medicare and are not already receiving Social Security, you will need to contact your local Social Security office.
Just sign up during your “initial enrollment period” which last for seven months. It starts with the three months before you turn 65, the month in which you turn 65, and the three months after.
Can I Be Denied Part A Coverage?
Assuming you are eligible for Medicare, you can not be refused Medicare Part A coverage because of your medical history or a preexisting illness. The time when you coverage begins depends on when you sign up. If you sign up promptly at the start of your initial enrollment period, you coverage will begin on the first day of the month you become eligible.
How Do I Renew My Part A Coverage?
This part is easy. Your Medicare Part A coverage is renewed automatically from year to year. You do not have to do a thing!
Braden Insurance Is Here to Make Sure You Understand Your Coverage
Medicare Part A is an extremely beneficial thing to have. When you are injured or ill, the last thing you need to worry about is how you are going to pay for all of your medical care. That’s where Medicare Part A comes into play.
The independent agents at Braden Insurance are here to answer all of your questions and to make sure you are signed up when your enrollment period comes around. For more information about Medicare Part A and what is covers, schedule a free Medicare consultation with us today!