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WHAT DOES MEDICARE PART A COVER?
Medicare Part A is one of four components of the federal governments health insurance program for senior citizens that are eligible to receive such healthcare benefits. It basically covers Hospital care, that is, care received while in the hospital, a skilled nursing facility, and in limited circumstances, special home care which is mostly needed after being hospitalised for a stroke, a major fracture or other episodes that require rehabilitation.
Once you apply for Medicare, you automatically get enrolled in Part A. For most persons, they do not have to pay a premium for Part A as they’ve already paid into the system in the form of Medicare tax deductions from their paycheck.
On the whole, Medicare Part A covers the following:
- Hospital Care (Inpatient)
- Limited Home Health Services
- Skilled nursing Facility care
- Hospice Care
Some of the above benefits can only be covered in limited situations and when certain requirements are met.
Medicare Part A beneficiaries are liable to receive coverage for hospital expenses that are critical to their inpatient care, such as semi-private room, nursing services, meals, medications needed for inpatient treatment, hospital supplies and services that are critical to inpatient care.
Inpatient care can further be received through:
- Acute care hospitals
- Critical access hospitals
- Inpatient rehabilitation facilities
- Long term care hospitals
- Mental health hospitals
- Participation in a qualifying clinical research study
Things not covered for by Medicare Part A hospital insurance are: cost for a private room (unless it is medically necessary), private duty nursing, cost for blood and personal care items.
Home Health Care:
Home health care benefits under Medicare Part A can only be covered if its deemed medically necessary by a care doctor. It has to be provided by a Medicare-certified home health agency and an eligible beneficiary must be certified homebound by his or her doctor.
A patient is certified homebound if; he or she cannot leave home and would require extra effort or special equipment to do so.
Services covered by home health care includes:
- Part-time skilled nursing care,
- Physical therapy,
- pathology services,
- occupational therapy,
- medical social services,
- part-time home health aide services,
- durable medical equipment, when ordered by your doctor.
The cost for durable medical equipment that meets the eligibility requirements is covered separately under Medicare Part B.
Things not covered for by Part A Home Health Care benefits include: 24 hour home care, meals, homemaker services that is unrelated to your treatment and personal care services such as help with bathing and dressing.
Skilled Nursing Facility Care:
Costs for Skilled nursing facility care are covered under Medicare Part A after a qualifying impatient stay for a related illness or injury.
This mostly depends on if a beneficiary has Medicare part A and has days (3 days) left in his or her benefit period; if your doctor has decided that you need daily skilled care which must be given by or under the supervision of, skilled nursing or therapy staff.
Skilled nursing care should be provided at a Medicare-certified facility and it covers the following: semi-private room, meals, skilled nursing services, rehabilitation services that are medically necessary to treat specific ailments, medical social services, medications received while in SNF care, medical supplies and equipment used in SNF, ambulance transportation to the nearest healthcare provider if needed services are not provider at the facility, dietary counseling, and others.
Medicare Part A skilled nursing facility care does not cover long-term care or constant personal care.
Hospice care is only covered for Medicare if the hospice provider is Medicare-approved. Beneficiaries can ask their doctor, state health department, or hospice provider if their hospice provider is Medicare-approved.
Hospice care depends on your preferred health care plan. If you qualify for hospice care, you and your family will work with your hospice team to set up a plan of care that meets your needs.
Hospice care is reserved for those with terminal illness who have six months or less to live. To qualify for hospice care, the following conditions must be met:
- Patient must be enrolled in Medicare part A
- Must be certified terminally ill with 6 months or less to live by a doctor
- Must agree to give up curative treatment on terminal illness and focus on palliative treatment. Patient can, however, go back to curative treatment if they so decide.
- Must receive hospice care from a Medicare-approved hospice facility.
Hospice is mostly received in the patient’s home and includes the following services;
- doctor services,
- nursing care,
- pain relief medications,
- social services,
- durable medical equipment,
- medical supplies,
- hospice aide services,
- homemaker services,
- dietary counseling,
- physical and occupational therapy,
- short term inpatient care and respite care.
DO I HAVE TO PAY FOR MEDICARE PART A?
Medicare Part A isn’t entirely free. Medicare often charges a huge deductible each time a beneficiary is hospitalized. This deductible is reviewed on a yearly basis and for 2020 the deductible is placed at $1,408.
For those who need additional coverage, they can buy a supplemental or Medigap policy to cover such deductible or some out-of-pocket costs for the other parts of Medicare.
However, those who paid Medicare taxes for a certain amount of time while working don’t get to pay a monthly premium and there’s extra coverage for the beneficiary’s spouse. This is sometimes called premium-free Part A.
PREMIUM-FREE PART A & PART A PREMIUM
Those who have clocked 65 can get premium-free Part A if:
- They already get retirement benefits from social security or the Railroad Retirement Board.
- They are eligible to get Social Security or Railroad benefits but haven’t filed for them yet.
- A beneficiary or their spouse had Medicare-covered government employment.
Those under the age of 65 an get premium-free Part A if:
- They have Social Security or Railroad Retirement Board disability benefit for 24 months
- They have End-Stage Renal Disease (ESRD) and meet certain requirements.
PART A PREMIUM
Those who do not qualify to buy premium-free part A can afford to get Part A premium.
If you get Part A, you’ll pay up to $458 each month. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $458.
However, if you paid Medicare taxes for more than 30 quarters, the standard part A premium only cost $252.
In most cases, if you chose to purchase Part A, you must also get Medicare Part B and, monthly premiums for both Part A and Part B.
WHEN AM I ELIGIBLE FOR MEDICARE PART A
Most people are eligible for Medicare Part A at age 65 if they are already collecting retirement benefits from the Social Security Administration or the Railroad Retirement Board. Some persons may qualify for Medicare Part A before 65 if they have disability, End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).
Also, only United States citizens or those who are Legal Permanent resident for 5 straight years are eligible.
Most beneficiaries do not pay a premium for Medicare Part A if they have worked at least 10 years (40 Quarters) and paid all Medicare taxes during their active years. Those who aren’t eligible for premium-free Medicare Part A can still enroll in part A and pay a premium.
Beneficiaries who become eligible for Medicare part A, but then delay enrollment may be subject to an enrollment penalty once they sign up.