Part A – Overview and Hospitalization Benefits/Requirements

Our continued discussion of Medicare Insurance will now focus on Part A, which is Medicare’s hospitalization insurance. According to Medicare.gov, the official U. S. government site for Medicare information, Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facilities, hospice care, and home health care. This is called “premium-free Part A,” because most people have paid Medicare taxes while they were working. As long as you have paid Medicare taxes for 10 years, your Part A will not require a monthly premium.

If you aren’t eligible for premium-free Part A, you may be able to buy Part A if you meet one of the following conditions:

v  You’re 65 or older, and you have (or are enrolling in) Part B and meet the citizenship and residency requirements.

v  You’re under 65, disabled, and your premium-free Part A coverage ended because you returned to work. (If you’re under 65 and disabled, you can continue to get premium-free Part A for up to 8 1/2 years after you return to work.)

The Kaiser Foundation states that Part A is funded mainly by a 2.9% payroll tax on earnings paid by employers and employees (1.45% each), which is deposited into the Hospital Insurance Trust Fund. Beginning in 2013, the Medicare payroll tax will increase on earnings for higher?income taxpayers, meaning those with an annual income over $200,000 per individual and over $250,000 per couple. It will increase by 0.9 percentage points, from 1.45% to 2.35%. The Part A Trust Fund is projected to be solvent through 2024.

In general, Part A covers:

v  Inpatient care in hospitals (such as critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals)

v   Inpatient care in a skilled nursing facility (not custodial or long term care)

v  Hospice care services

v   Home health care services 

v  Inpatient care in a Religious Nonmedical Health Care Institution

What does Part A Cover?

Medicare does not cover everything, nor does it cover the total cost for many of the covered services or medical supplies. This means that you will need to pay for some of the costs out of your own pocket. Coverage amounts are based on which Medicare plan you have – Medicare Part A, or Part A through a Medicare Advantage Plan (which we will discuss in later articles). Part A helps to cover only the medically necessary services listed below:

Blood Transfusions

This is blood (pints) that you receive during a covered stay in a hospital, critical access hospital, or a skilled nursing facility.

Hospital Stays

Part A covers inpatient hospital stays, which include a semi-private room, meals, general nursing, and miscellaneous hospital services and supplies. Inpatient care in critical access hospitals and mental health care (up to a 190 day lifetime maximum) are also covered. Hospital stays must last for at least 3 days (72 hours). The time begins the first midnight after admission and does not include any hours on the discharge date.

  • You pay a deductible and no copayment for days 1–60 of each benefit period. (A benefit period is defined by Medicare as beginning the day you go into a hospital or skilled nursing facility, and ending when you haven’t received any hospital or skilled nursing care for 60 days.)
  • You pay a copayment for days 61–90 of each benefit period.
  • You pay a copayment per “lifetime reserve day” after day 90 of each benefit period (up to 60 days over your lifetime).
  • You pay all costs for each day after the lifetime reserve days.
  • Inpatient mental health care in a psychiatric hospital is limited to 190 days in a lifetime.

 

Sources used:

http://www.medicare.gov/publications/pubs/pdf/10050.pdf

http://www.kff.org/medicare/7067/ataglance.cfm

http://www.medicareconsumerguide.com/medicare-part-a.html

 

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