The Basics of Medicare Part A
When Medicare was signed into law, the publicly funded health insurance program had just two parts to it, Medicare Part A and Part B. While Medicare coverage has expanded in recent decades, Part A and Part B are still the focal points of the insurance program. Medicare Part A provides senior citizens and other eligible beneficiaries with health benefits related to hospital stays and/or stays in skilled nursing facilities. While it may seem simple, Medicare Part A can be difficult to fully understand.
Medicare Part A is available to all senior citizens 65 years of age and older who have paid into the Medicare program through payroll taxes over the course of their life. Individuals who did not work are still eligible as long as a spouse paid into the program while employed. Individuals, who have paid into Medicare through their payroll taxes, or those of their spouse, can have Medicare coverage without paying a premium. However, individuals 65 years of age and older who did not pay into the Medicare program must pay a monthly premium to have Medicare Part A coverage. There are a few other individuals who are also eligible for Medicare and they include:
• Individuals receiving Social Security Disability Insurance for more than 24 months
• Individuals suffering from End-Stage Renal Disease who are in need of dialysis or kidney transplant.
• Individuals afflicted with Amyotrophic Lateral Sclerosis (known as ALS or Lou Gehrig’s disease)
The overall purpose of Medicare Part A coverage for senior citizens and other eligible individuals is to help cover the costs associated with inpatient medical services. These services include:
• Hospital Stays
• Stays in a Hospice or other Skilled Nursing Facility
• In home medical care
In each of these situations, Medicare Part A will cover only certain expenses for a pre-determined amount of time, with the remaining expenses left to the individual to pay for out of pocket.
Medicare Part A will cover the expenses of an individual who is admitted to the hospital for a period of 150 days in a given benefit period. Typically a benefit period begins when a person is admitted and ends when they have either reached 150 days or left the care of the hospital. An individuals’ 150 day benefit period only resets if they go 60 days without receiving inpatient care at a hospital between visits. Part A coverage will pay for some of the hospital expenses an individual incurs, but not all of them. Individuals can count on Medicare to help cover the cost of food, nurse and physician services, a semi-private room, and other services and supplies necessary for their treatment. Medicare will not cover things such as private-nurse care, a private room, televisions in a room, or toiletries unless these items are necessary as part of an individual’s treatment. Beneficiaries must pay a deductible for the duration of their stay, and then face daily premium expenses depending on the length of their stay. The daily premiums don’t begin until the 61st day of treatment and increase with the length of the stay.
Hospice/Skilled Nursing Facility
Medicare Part A will cover an individual’s expenses for a stay in a skilled nursing facility as long as it is ordered by doctors or deemed necessary after a hospital stay of at least three days. Individuals will receive many of the same services they would in a hospital, plus Part A coverage will pay for rehabilitative services and supplies. Medicare will cover the full cost of the first 20 days of an individual’s stay, but after that premiums begin on a daily basis with the individual assuming the full burden of the cost after 100 days.
Patients who are terminally ill and need the services of a hospice will receive full coverage from Part A to pay for medications for relief of pain and control of symptoms as well as nursing services, social services, and grief counseling. As long as a patient’s physician verifies an individual is terminally ill they will receive coverage for a hospice stay.
In-Home Health Services
Finally, Medicare Part A covers an individual for necessary medical services in their home only if they are home-bound, a doctor orders the care, and a Medicare-approved health agency provides the treatment. Part A will cover the cost of a variety of services including part-time nursing services, physical therapy, and medical social services. There is no deductible and no premium involved, however individuals will have to make an insurance co-pay covering 20% of the cost of any durable goods ordered by a doctor.
Medicare Part A provides valuable and life saving medical coverage to millions of Americans each year that otherwise might not be able to afford decent health care or any health care at all. The publicly funded insurance program currently covers over 45 million individuals, 38 million of whom are senior citizens.