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Medicare Part A, often referred to as hospital insurance, is Medicare coverage for hospital care, skilled nursing facility care, hospice care, and home health services. It is usually available premium-free if you or your spouse paid Medicare taxes for a certain amount of time while you worked, if you receive or are eligible to receive Social Security or Railroad Retirement Board benefits, or if you or your spouse had Medicare-covered government employment.
If you do not qualify for premium-free Part A, you may choose to buy it. For instance, you may pay up to $413 per month in 2017 for Part A insurance.
Part A helps covers the costs associated with:
It’s important to note that Medicare does not cover care that is primarily custodial, such as assistance with bathing and eating.
Original Medicare measures your coverage for hospital or skilled nursing care in terms of a benefit period. Beginning the day you are admitted into a hospital or skilled nursing facility, the benefit period will end when you go 60 consecutive days without care in a hospital or skilled nursing facility. A deductible applies for each benefit period.
Your benefit period with Medicare does not end until 60 days after discharge from the hospital or the skilled nursing facility. Therefore, if you are readmitted within those 60 days, you are considered to be in the same benefit period. If you are readmitted within 60 days, you are not charged another deductible. There is no limit on the number of benefit periods Medicare will cover in your lifetime.
Uncle George goes into the hospital June 1 and is discharged July 31. On November 1, he is readmitted to the hospital. He pays his deductible again because he is starting a new benefit period. If George had been re-admitted to the hospital within 60 days of his July 31 discharge, there would have been no additional deductible.
For inpatient hospital stays, Original Medicare will pay:
For Days 61-90, beneficiaries are responsible for coinsurance costs. (In 2017, beneficiaries must pay $329 per day.) Beneficiaries are entitled to use lifetime reserve days (60 additional days) after Day 91. If those reserve days are used, beneficiaries must pay $658 per day in 2017. If you choose not to use your lifetime reserve, all Medicare coverage stops after 90 days of inpatient care or after 60 days without any skilled care for this benefit period.
Grandpa is admitted to the hospital September 1, 2017. After he pays the deductible of $1,316, Medicare will pay for the cost of his stay for 60 days. If he stays in the hospital beyond 60 days, he will be responsible for paying $329 per day, with Medicare paying the balance.
If Grandpa has supplemental insurance, he can submit a claim for the $1,316 deductible and the $329 per day he paid. If he stays longer than 90 days, he may choose to use some of his lifetime reserve days to continue his Medicare coverage. If he does, he is responsible for paying $658/day for any days after 90 days, which, again, he can submit to his supplemental insurance company.
Part A coverage pays for all Medicare-approved inpatient hospital costs except for your physician bills, which are covered under Part B. Medicare approves costs considered reasonable and medically necessary.
Specific services covered under Part A include:
Medicare will not pay for items considered luxuries, such as a television in your room or for a private room, unless your condition renders it medically necessary.
What is a skilled nursing facility? A skilled nursing facility provides medically necessary nursing and/or rehabilitation services.
To receive Medicare coverage for care in a skilled nursing facility:
Coverage is limited to a maximum of 100 days per benefit period, with coinsurance requirements of $164.50 per day in 2017 for Days 21 through 100.
Home health care is care provided to you at home, typically by a visiting nurse or home health care aide. Medicare Part A covers medically necessary home health care offered by a provider certified by Medicare to provide home health care. Medicare pays the lower of:
To receive home health services under Medicare, the following rules apply:
You should also be aware that:
Following her back operation, Mom was confined to her home. Medicare covered the cost of visiting nurses who came to her home to change her surgical dressing and provide other necessary skilled nursing care. Medicare also covered the cost of care Mom received from a physical therapist who came to her home three times a week.
For inpatient psychiatric care, Medicare Part A will pay for the same kinds of services as if you were hospitalized in a general hospital:
An important distinction from care in a general hospital is that you must use a facility that accepts Medicare assignments on all claims. Deductibles and coinsurance costs are the same as for a regular inpatient hospital stay. In the course of your life, Medicare will only pay for 190 days of inpatient psychiatric care (lifetime limit).
Hospice care for the terminally ill is covered by Medicare Part A. It is comprehensive coverage, at home or in a facility where you live, for symptom management and pain control for the terminally ill. To receive coverage:
Services include nursing care, medical appliances and supplies, prescriptions, home health aide and homemaker services, medical social services, and counseling.
Sue is 95 and has terminal cancer. She decided she would rather have hospice care under her Medicare coverage so that she can stay at home and receive assistance to live her final days in as much comfort as possible. She receives pain medication, counseling, and assistance with meal preparation and other household tasks. Sue falls and breaks her hip. She will receive her regular Medicare coverage for treatment of her hip.
There are two categories of costs for which a Medicare hospice patient may be responsible:
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Last Revised 11/15/2017