The concept of affordable healthcare is the main premise for the creation of Medicare as it’s divided into two programs: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) whose primary goal is assisting with treating illnesses and conditions. And for those new to Medicare, the whole process can be quite confusing. It’s in your best interest to learn the differences between each part of Medicare and find out exactly what you’re covered for under each program.
We’ll try to define Medicare Part A here as it was created to cover all common hospital expenses. What does that mean? Well, Medicare Part A will cover inpatient care while convalescing inside a hospital, skilled nursing facility (custodial care isn’t required), home healthcare and hospice. What isn’t covered is doctor’s office visits, lab work, x-rays, and outpatient surgeries. Why? Well, this is taken care of by Medicare Part B, which also offers other preventative medicine services like yearly cancer screening and flu shots.
Medicare Part A is a healthcare program that assists with paying an inpatient’s hospital stay for a necessary medical ailment. Usually, it’s for a serious illness or chronic condition that requires a follow-up stay at a skilled nursing facility after spending a short time at a hospital. In some extreme cases, it could include hospice care for terminally ill patients or limited home healthcare for those homebound sufferers.
Medicare Part A Coverage Parameters
The Medicare Part A coverage program offers a wide range of support for all medical expenses. Still, Medicare users have a difficult time understanding the specifics of their coverage. It’s important to remember that Medicare Part A will cover up to 60 days of inpatient hospital care in a semi-private room.
Other coverage amenities include:
- All Necessary Operations
- Lab Testing
- Physical Rehabilitation
- Medical Supplies
- Prescription Drugs
This coverage program isn’t too different from a standard healthcare agreement. The inpatient deductible is $ 1,340 per benefit period, which will be paid once you have been admitted into the hospital. The only other difference is with the option of being an inpatient inside a skilled nursing facility, hospice, and home healthcare.
Who is Eligible for Medicare Part A
Sometimes, Medicare Part A is called a “premium-free” healthcare program as the vast majority of beneficiaries pay no monthly premium. Medicare Part A is designed as a federally-funded healthcare program.
Enrollment is simple and easy as most participants are automatically eligible for the Medicare Part A healthcare program because they have reached the age of 65-years old and are receiving retirement benefits from Social Security or the Railroad Retirement Board. Other individuals become eligible for Medicare Part A if they apply three months prior to their 65th birthday or wait to apply three months after turning 65 years old. Some beneficiaries become eligible if their spouse had a Medicare-covered government position.
In certain circumstances, some individuals do qualify for Medicare Part A because they have certain disabilities, end-stage renal disease (ERSD) and amyotrophic lateral sclerosis (ALS). They achieve eligibility for the Medicare Part A healthcare program because they worked at least 10 years and paid Medicare taxes during that time period prior to their illness.
Medicare coverage is based on federal and state laws because it’s a national healthcare program. Local coverage is decided by companies in each state that processes Medicare claims during the fiscal year. Often, government officials will have final say on what type of healthcare and medical equipment will be covered in the comprehensive insurance coverage program.
Individuals who aren’t eligible for Medicare Part A can still enroll in the healthcare program, but they will have to pay a premium price. The cost can range up to $ 437 per month. Some will gain acceptance into the program if they have paid Medicare taxes for less than 30 months as their premium will be $ 437 each month. Others who have paid Medicare taxes between 30 to 39 months will have a significantly lower premium as they will pay $ 240 per period.
Medicare Part A Hospital Care Benefits
A major part of Medicare Part A is the coverage for hospital care as the expenses are quite critical in choosing the right course of treating a patient. It could include receiving further care at:
- Acute Care Hospitals
- Critical Access Hospitals
- Long-term Care Hospitals
- Inpatient Rehabilitation Facilities
- Mental Healthcare
- Participation in a Clinical Research Program
It should be noted that Medicare Part A hospital coverage program will not pay for the cost of a private room, private nursing care or extraneous hospital charges like a television or telephone. Also, Medicare Part A doesn’t cover the cost of blood, but you will not have to pay for withdrawals from a local blood bank. If the hospital doesn’t purchase blood for your care, then you will be forced to pay for the first three units of blood received each calendar year, unless the blood is donated by you or another person in your honor.
Medicare Part A Skilled Nursing Care Benefits
The benefits received from Medicare Part A covers for treatment at specially-designed skilled nursing facility as your stay could last up to 100 days. The minimum is an inpatient stay of at least three days or longer, but your discharge date will not count towards the “three-day” minimum requirement. Also, time spent “under observation” as an outpatient will not count towards your qualified stay as well.
Your attending physician must recommend this course of treatment as your long-term care. The designed program could be under direct supervision, skilled nursing care or from a rehabilitation staff. The latter is considered for in-home care only as a patient must come to a skilled nursing facility at least five or six days a week for specific treatments.
Other covered services include rehabilitation care if it is necessary to treat your illness, all medication administered while in a skilled nursing care facility and all ambulance transportation to and from the closest care provider if a required treatment isn’t available at the skilled nursing care facility. Your doctor may have to certify that you need this type of treatment to carry out daily living skills to survive each day as this care isn’t available at your home. Some of this special treatment could include intravenous drugs, physical therapy, but not long-term care.
Medicare Part A Home Healthcare Benefits
Medicare Part A does cover the cost of home healthcare services, but it must be provided by a Medicare-certified home healthcare agency. First, your doctor must confirm that you’re a home-bound patient. The medical definition of a home-bound patient is a person who cannot leave their residence without some form (a medical aid, transportation or special treatment) of assistance
Part-time home nursing care is covered by Medicare Part A, but all treatment must be done inside the patient’s home. The could include bathing, dressing, and general custodial care. If it’s deemed medically necessary and ordered by your physician, then you may have additional treatment programs included:
- Intermittent Skilled Nursing Care
- Physical Therapy
- Occupational Therapy
- Intermittent skilled nursing care including physical therapy speech-language pathology services and continued occupational care as each program is specifically-designed to assist with making a full recovery.
If you meet eligibility requirements, your doctor may suggest putting medical equipment inside your home as part of your recovery program, but that request will only be covered by the Medicare Part B healthcare program. Usually, it will cover 80 percent of the approved amount.
Finally, Medicare Part A will not cover 24-hour home care, special meals or other home services if they’re unrelated to the prescribed treatment program. Some of those personal home services that aren’t covered include bathing and dressing of the patient.
Medicare Part A Hospice Benefits
Hospice care is confined to the home and includes assistance for counseling, dietary program, medical supplies and short-term symptom relief. Many of the treatment programs are all about comforting an individual suffering from a terminal illness and other medical issues.
The benefits program is designed for patients who have a terminal illness with an estimate time of six months or less to live. The medical staff’s focus is palliative (comfort care treatments) care and not curing the disease. The goal is to relieve the pain and make the patient as comfortable as possible.
To qualify for the benefits program: you must be enrolled in Medicare Part A healthcare coverage program and agree to give up all curative treatment for your terminal illness. Though, Medicare will still cover all palliative care while treating other related symptoms and conditions.
Under hospice care, Medicare Part A will cover spiritual and grief counseling, which isn’t available in most general insurance benefit programs. Remember, you do have the right to stop hospice care at any time in the process. It’s important to speak with your physician before choosing to go back to curative treatments.
In conclusion, before applying for Medicare Part A healthcare program, it’s important to speak with your physician or a healthcare provider to gain a better understanding on what type of coverage and services are needed to keep you healthy and active in life. Asking questions will help to make your final decision as simple as possible. The information provided will give you more choices to choose from under the Medicare umbrella. Your healthcare is all depended upon the coverage program that was selected.
Medicare will cover most of those expenses. If not, then you may have to sign a waiver that confirms Medicare Part A will not cover the cost, and pay for those treatments out of your own pocket.