Medicare Part A (Hospital Coverage) covers hospital inpatient care, skilled nursing facility (not custodial or long-term care), home health care, hospice care, blood transfusions, and in-patient care in a religious non-medical health care facility.
The majority of people over 65 years old automatically get enrolled into Medicare Parts A and B if you paid into Social Security for 10 years or more. If you contributed for fewer than 10 years to Social Security, then Medicare is still offered, though, at a premium fee.
Hospital Care
Medicare covers your costs when admitted to the hospital (minimum one overnight stay), including semi-private rooms, meals, nursing, and medications as part of in-patient care. If you have Medicare Part B, then your doctor(s) services are covered while you’re in the hospital.
Deductible: $1,184 deductible must be met before Medicare will pay any expenses for year 2013.
Coinsurance: 20% of each benefit is to be paid by the insured for 2013.
Max Length Stay:
- Days 1–60: $1,184 deductible must be met prior to coverage being covered. Coinsurance is 80%Covered, 20% your cost for each benefit period in 2013.
- Days 61–90: $296 coinsurance per day + 20% of each medical benefit for period in 2013
- Days 91 and beyond: $592 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime) in 2013.
- Beyond lifetime reserve days: 100% are at your expense.
- Once you have reached lifetime reserve the copayment is ($592/per day). Lifetime reserves has a max of 60days available through the lifetime
- 100-day clock can be reset with a 60-day break in receiving facility-based skilled services.
- If contiguous service is used without any breaks throughout the initial 90 days and followed into lifetime reserves then you will be required to cover 100% of all remaining cost incurred.
Blood
The first three (3) vials of blood are at the patient’s cost unless the blood you are provided is from a blood bank, in which case the savings are passed on to you at no additional cost. If the hospital is paying for the blood, then you will pay for the first three (3) vials. Any additional vials needed on a calendar basis, Medicare covers 80%.
Skilled Nursing Facility
After a minimum stay of three (3) days in the hospital, if a doctor requires a continued daily skilled service or daily intravenous injections or physical therapy, then Medicare will cover semi-private rooms, meals, nursing and rehabilitation services.
Benefits include:
- 1-20 days covered by Medicare
- Days 21-100 - $148/per day payment by the patient
- After 100 days, patient is responsible for 100%
Home Health Care
If a Medicare doctor certifies that you need additional assistance that involves skilled nursing care, physical/speech therapy or occupational therapy, then a Medicare-certified provider agency must be used to provide continued service. Medical social services or intermittent home health aids services and medical supplies for use at home may also be covered. Medicare covers 80% of Medicare approved services.
Hospice Care
A patient must be deemed terminally ill and have expectancy of 6 months or less to live to be covered for hospice care. Services include related symptom and pain management such as: prescriptions; medical, nursing and social services; approved medical equipment; and other services. Also includes respite care for up to five (5) days each time respite is used.
Coverage does not include room and board unless hospice medical staff determines that short-term inpatient stays are needed because pain and symptom management is not enough at home.
- Hospice care is covered 100%
- Co-payment of $5 per prescription for outpatients needing prescriptions for pain and symptom management
- You pay 5% for inpatient respite care