Medicare Part A Coverage Continued

Skilled nursing facility care, home health care, hospice & psychiatric hospitalization

In addition to inpatient hospitalization, Medicare Part A also provides medical coverage for skilled nursing facility care, home health care, and hospice & psychiatric hospitalization.

Skilled Nursing Facility Care

Medicare defines a skilled nursing facility as, “A nursing facility with the staff and equipment to give skilled nursing care and, in most cases, skilled rehabilitative services and other related health services.”

In order to be covered by Medicare Part A, stays at nursing homes or skilled nursing facilities must be related to the diagnosis made during a hospital stay. For instance, if your hospital stay was for a stroke, then a nursing home or skilled nursing facility stay for rehabilitation would be covered. A nursing home or skilled nursing facility stay coverage includes charges for a semi-private room, meals, and rehabilitative and skilled nursing services and care.

The coverage is limited to a maximum of 100 days in a 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. If you go back into a hospital or skilled nursing care facility after one benefit period has ended, then a new benefit period begins. You must pay the deductible for each benefit period, and there is no limit to the number of benefit periods. The first 20 days of a benefit period are paid in full (after the deductible), and the remaining 80 days will require a co-payment. As of 2011, this is $141.50 per day. Medicare Part A will not cover long-term care, non-skilled care, daily living, or custodial activities.

Home Health Services

Home health services are described by Medicare as health care services and supplies that a doctor decides you may receive in your home, under a plan of care established by your doctor. Medicare only covers home health care on a limited basis, as ordered by your doctor. It includes limited reasonable and medically necessary part-time care and services, such as skilled nursing care, physical or occupational therapy, home health aide service, speech language pathology, and medical social services. It also includes certain home-use medical equipment (wheelchairs, hospital beds, walkers, oxygen), and other medical supplies.

Hospice Care

Hospice care is for the terminally ill who have six months or less to live. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional, and spiritual needs of the patient. Hospice also provides support to the patient’s family or caregiver as well. Coverage includes drugs for relief of pain and to control symptoms, medical, nursing, and support services, grief counseling, and other services. Care is to be provided by a nearby, Medicare-approved hospice caregiver who will visit you at your home. Medicare also provides additional care for a hospice patient in an approved facility, so that the usual caregiver can get a respite. These respite care stays are covered for up to 5 days.

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