Medicare: Part A, Cost and Benefits
As previously discussed, [Medicare: Do you know Part A, Enrolling] Original Medicare consists of Part A (hospital Insurance) and Part B (Medical or Outpatient Insurance)
You are required to individually apply for Medicare unless you already receive Social Security and enrollment is automatic. Most individual should enroll for part A as soon as qualified other than those with HSA health savings plans through their employer and who want to remain on the group HSA plan. {If you enroll or are enrolled automatically, you cannot continue contributing to you Health Savings Account}
Benefits provided by Medicare part A is not without cost. As with your Health Insurance before going to Medicare there are deductibles and copayments when receiving care.
Medicare part A benefits are measured in benefit periods as opposed to the annual deductible of your current health insurance. Unlike you private or group health insurance it is possible to have more than one deductible during the year. The hospital deductible for 2012 is $1,156 and covers most (not all) cost during the first through sixtieth day of treatment as an inpatient. {Not all overnight stays are classified as inpatient, so check with your doctor.} Day 61 to 90 require a copay of $289 (2012) per day and day 91 through 150 requires a copay of $578 per day. (Day 91 through 150 is reserve days and you only have 60 of these, lifetime.)
Cost is based on benefit periods and periods start on the 1st day coverage is provided ending when you have not received skilled impatient care in any facility for a consecutive 60 days. If you return for skilled inpatient care after the 60th day a new deductible is required and the period starts anew. However, if you return for skilled inpatient care during the 60 day period after release, you continue under the former claim and no new deductible is required, but you may be required to pay copays.
Part A covers Skilled Nursing care Facilities but requires 3 days (72 hours) of prior inpatient hospitalization. Medicare pays 100% of cost for the first 20 days, followed by a copay of $144.50 per day for any additional day up to 100. {Medicare does not cover custodial care}
Part A provides Home Health Care: If a person requires post-institutional skilled health care at home, Medicare will cover some of the cost on a limited bases. Part A Hospital Insurance covers a maximum of 100 home health visits made on an intermittent basis. Care must be certified as needed, skilled nursing or therapy services are required and services are provided by a Medicare certified home health agency.
Hospice or end of life care is the last function of Part A Hospital Insurance: Medicare through Part A Hospital Insurance recognizes the care required by the impending death of an individual. Hospice is not considered treatment but care to make the patient as comfortable as possible with the goal of maintaining continued life with minimal disruption to normal activities while remaining in the home.
Hospice benefit periods consist of two 90-day periods followed by an unlimited number of 60-day periods. The patient must be re-certified that he/she is still terminally ill at the beginning of each 60-day period. During Hospice care there are no deductible and patients do not pay for Medicare covered services except for a 5% or $5 (whichever is less) copay for cost of outpatient prescriptions.
Impatient respite care is also provide, the patient is charged 5% of the amount paid by Medicare per respite care day.
Having a Medicare Supplement policy sold by a private insurance company fills in the out of pock cost gaps of Medicare part A.
If you would like to have a conversation concerning your current health care coverage, Medicare or Medicare Supplements, call (888 270 9870 or email ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it. ).
