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Understanding Medicare Part A

Understanding Medicare Part A

Medicare Part A is considered the hospitalization portion of Medicare. It covers services that are received in regular hospital facilities, as well as in critical illness hospitals, and in skilled nursing homes (after a person qualifies).

Also, Medicare Part A will also help in paying for certain types of home health care services, and for some hospice services – provided that the enrollee meets the conditions that are necessary for obtaining these particular Part A benefits. There are also supplemental plans out there that you can enroll in to help costs that Medicare will not cover, such as Medicare Supplemental Plan F or Medicare Supplemental Plan G.

medicare part a coverage

What Benefits Does Medicare Part A Cover?

The coverage that is received through Medicare Part A includes the following benefits:

  • Inpatient Hospital Stays – Medicare Part A pays benefits for inpatient hospitalization stays. This typically includes coverage for a semi-private room. It also includes coverage for an enrollee’s meals, general nursing costs, and other hospitalization services and supplies. Part A of Medicare also offers coverage for inpatient care that is received in critical access hospitals, as well as coverage for mental health care. There are certain benefits that are excluded from coverage by Medicare Part A. These include private duty nursing costs. These exclusions also include the cost of a telephone and / or a television in the enrollee’s room, if there is a separate charge for such items. Medicare Part A will also not pay for a private hospital room for a Medicare enrollee – unless a private room is medically necessary for that person’s treatment.
  • Blood – Coverage under Medicare Part A for blood includes the pints of blood that are received at a hospital or at a skilled nursing home facility during a covered stay. There are annual limitations on how much will be covered for an enrollee each year.
  • Skilled Nursing Home Facility Care – Part A of Medicare provides coverage for a semi-private room, meals, skilled nursing and rehab services, and other related services and supplies. However, this coverage is provided only after the enrollee qualifies. This occurs following a three-day inpatient hospital stay for a related injury or illness. If qualified, Medicare Part A will pay for up to 20 days in full, and then a limited amount of coverage for up to another 80 days of skilled nursing facility care in a benefit period for the enrollee.
  • Home Health Care Services – Home health care services are limited only to what is considered reasonable and medically necessary part-time or intermittent skilled nursing care and home health aide services, and / or physical therapy, occupational therapy, and speech-language therapy. These services must be ordered by the Medicare enrollee’s doctor, and they must also be provided to the enrollee by a Medicare-certified home health care agency. In addition, Medicare Part A may also include coverage for medical social services, as well as durable medical equipment such as hospital beds, wheelchairs, walkers, oxygen, and other related medical supplies for the enrollee’s use at their home. However, Part A of Medicare does not provide coverage for personal care or homemaker services, as well as for meals that are delivered to an individual’s home.
  • Hospice – Medicare Part A provides some hospice care. This coverage includes that for drugs that are used for symptom control and pain relief. It may also provide coverage for medical and support services from a Medicare-approved hospice such as grief counseling. Additional services may also be provided such as inpatient respite care and / or short-term hospital care.

How Much Does Medicare Part A Cost?

Most enrollees are not required to pay a premium for their Medicare Part A coverage. This is because many people (or their spouses) will have worked and paid taxes into the Medicare system throughout their working lives. They will also have built up enough “credits” in order to qualify for Medicare coverage. This is typically 40 working quarters (or 10 years).

If, however, an enrollee has not met these qualifications in order to obtain premium-free Medicare Part A coverage, he or she is still eligible to obtain this coverage. They will, however, be required to pay a premium. In 2016, the amount of this monthly premium can be up to $411.

There are other potential costs that are associated with Medicare Part A as well. These can come in the form of deductibles, copayments, and coinsurance. For example, in 2016, Medicare Part A has a deductible amount of $1,288 that is charged for each benefit period. Also, should an enrollee be hospitalized, the following out-of-pocket charges can apply:

  • Days 1 through 60: Coinsurance of $0 for each benefit period.
  • Days 61 through 90: Coinsurance of $322 per day for each benefit period.
  • Days 91 and beyond: Coinsurance of $644 per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over an enrollee’s lifetime).

An enrollee will then be responsible for all of their inpatient hospital costs beyond their lifetime reserve days after that.

It will first be important to qualify for a Medicare Part A hospital stay, however. To do so, the enrollee’s doctor must first state that the individual requires, at least, two or more “midnights” of inpatient care that is medically necessary in order to treat his or her injury or illness. The hospital must also formally admit the enrollee.

Also, the enrollee must require the type of care that can only be provided within a hospital – and, the hospital in which the person is admitted must accept Medicare as a payment method. Likewise, the Utilization Review Committee at the hospital must approve the enrollee’s stay while he or she is in the hospital.

Expanding Medicare Part A and Part B Coverage

For those who wish to get more than what Medicare Part A and Part B offer – but still want to be enrolled in Medicare – a Medicare Advantage plan may be a good alternative. These plans, also known as Medicare Part C, offer another way to receive Medicare’s coverage.

With Medicare Advantage, you still receive your Medicare Part A and Part B benefits, however, you can also obtain additional coverage, such as dental, vision, and / or wellness options. These plans are offered by private insurance companies, so the premiums and the additional benefit options can differ by location and by the insurer that is offering the plan.

How to Help Pay for Medicare Part A Expenses

While Medicare Part A covers a variety of services, the out-of-pocket charges such as copayments and deductibles do tend to add up. Because of that, enrollees can turn to a Medicare Supplement insurance plan to assist them in paying some of these costs.

Medicare Supplement insurance, also known as Medigap, is a type of insurance coverage that is intended to fill in the gaps in coverage where Medicare leaves off. There are ten different Medicare Supplement plans to choose from – starting with Plan A that provides a basic core set of benefits, to Plan F that offers a highly comprehensive set of coverages. There are also additional plans that provide insureds with other low-cost options to fit their needs.

As an example, Medicare Supplement Plan A provides the following coverage:

  • Part A coinsurance and hospital costs – up to an additional 365 days after Medicare benefits have been used up.
  • Part B coinsurance or copayment.
  • First three pints of blood.
  • Part A hospice care coinsurance or copayment.

Medicare Supplement insurance is offered through private insurance companies across the country – and, while all insurers are required to offer identical coverage for plans of the same corresponding letter, the premiums can differ a great deal from one insurer to another. For this reason, it is always a good idea to compare several different Medicare Supplement insurance plans before making your final purchase choice.

Where to Get the Best Premiums on Medicare Supplement Insurance Coverage

If you’re seeking a Medicare Supplement insurance plan to help pay the high out-of-pocket coinsurance and deductibles left by Medicare, it is a good idea to work with a company or an agency that has access to more than just one insurer. That way, you will be able to more directly compare the policy prices. When you’re ready to begin, we can help.

Should you find that you still have any questions regarding Medicare Supplement, Medicare Part A or Part B, or even Medicare in general, please feel free to give us a call. We can be reached directly, toll-free, by calling 800-376-0824.

Finding the right Medicare Supplement plan doesn’t have to be confusing – and it’s not when you have an ally on your side. We’ll walk you through the plans, the benefits, and the premiums so that you know exactly what you’ll be getting. So, contact us today – we’re here to help.

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