This third in our series about understanding Medicare is an important one. We bandy about the terms Medicare Part A and Medicare Part B; however, do you really know what they mean? In this article, we take a look inside Medicare Part A.
Medicare Part A
Did you know if you’re eligible for Medicare that you’re entitled to receive coverage under Part A at no cost? That’s the good news, but there are costs to you which we cover below.
Medicare Part A is your in-patient coverage, including:
• Hospital stays
• Skilled nursing facilities
• Home health care after being discharged
When you’re in the hospital, Medicare Part A does NOT cover private rooms, private nursing, a telephone or television. Coverage includes what you would expect:
• Meals in a semi-private room
• General nursing
• Operating and recovery rooms
• Inpatient drugs
• Lab tests and X-rays
• Inpatient rehab or medically necessary long-term hospitalization
Skilled Nursing Facility
If you stayed in hospital for three days or more, then you will get covered by Medicare Part A in a skilled nursing facility if you enter the facility within 30 days of that 3-day hospital stay.
Physicians understand the rules, and there are times they will help the patient get into a skilled nursing facility by registering them as an inpatient in a hospital (for diagnostic testing, for example) so the patient can get covered.
If you are planning for a surgical procedure, it’s important you understand your coverage guidelines, too.
Home Health Care
If a doctor recommends home health care after a hospital stay, then Medicare Part A coverage covers:
• Part-time skilled nursing care
• Physical therapy
• Occupational therapy
• Speech-language therapy
• Home health aide services
• Medical social services
• Durable medical equipment (wheelchair, bed, oxygen, walker)
• Medical supplies
In order to get hospice coverage by Medicare Part A, the program must be Medicare-approved. Coverage includes drugs for symptom control and pain relief. There is coverage for other services not typically covered by Medicare.
People should inquire about getting hospice coverage in the home. In various circumstances, there may be a short-term hospital for respite care that’s recommended. Respite care is short term and provides for around-the-clock nursing or caregiving. Medicare covers hospice for the terminally ill.
Medicare Part A Is Not Free
Surprise! Nothing is free, right? This is also where it becomes confusing. When you go into the hospital, 100% of your costs are not covered. You will pay a deductible as well as coinsurance for each hospital stay.
In your benefit period that begins when you enter a hospital or skilled nursing facility and ends 60 days AFTER care has ended, you will pay an inpatient deductible of $1,100 in 2010, for example.
You are entitled to unlimited benefit periods; however, if you have not completed the care you need within that 60 day period, you will pay coinsurance for 61 to 90 days of $275 in 2010; coinsurance for 91 to 150 days of $550 in 2010), and then you’re responsible for all costs after 150 days of care.
Annually, Medicare sets new coinsurance and deductible rates. Please ensure you check what these are from year to year. It’s important to understand there is an upward sliding scale of cost to you after a benefit period is extended.