Open enrollment for Medicare brings about several questions, including what costs and services each part covers. Seniors who are considering Medicare enrollment should understand what each section covers, including the costs associated with Medicare Part A.
Medicare Part A is the primary coverage that Medicare recipients receive, and it covers a variety of services, including skilled nursing facility care, hospice, home health services, nursing home care and hospital care. It works like an insurance for hospital care and services. But Medicare Part A does not cover every hospital-related cost. Here are a few factors to consider:
Hospital Care
When it comes to hospital care, Medicare Part A primarily covers the costs associated with hospital care. Hospital care under Medicare Part A includes long-term care hospitals, inpatient hospital care, and skilled nursing facility care.
- Long-Term Care Hospitals. When patients have multiple serious conditions, long-term care hospitals serve as a key component of providing patients with specialized care. If a Medicare policyholder receives care while staying in a long-term care hospital, they can have peace of mind that it is covered. However, Medicare policyholders are still required to pay a deductible during the benefit period — the period the patient is admitted in the hospital and receiving inpatient care until 60 days following the time the patient no longer receives inpatient care. This deductible only needs to be paid once during the benefit period.
- Inpatient Hospital Care. Medicare Part A covers hospital services and amenities, including meals, semi-private rooms, and inpatient treatment medications. This care also covers inpatient mental health care and inpatient care even when Medicare policyholders are taking part in a qualified clinical research. The care that Medicare policyholders receive at long-term care hospitals, psychiatric hospital, inpatient rehabilitation facilities, critical access hospitals and acute care hospitals are covered under Medicare Part A. But keep in mind that inpatient hospital care does not cover amenities, such as a phone or TV, in the room if these amenities are not inclusive of the charge. It also does not cover personal care items, such as shaving cream or razors. Other services that are not included are private-duty nursing and private rooms that are not medically necessary. Inpatient hospital care also requires Medicare policyholders to pay deductibles and make coinsurance payments depending on the length of stay in the hospital. For instance, patients do not have to pay a coinsurance payment for inpatient care that does not last longer than 60 days. However, a $335 coinsurance payment is required in 2018 for patients who receive inpatient care and services between days 61 and 90.
- Skilled Nursing Facility Care. When Medicare policyholders require skilled nursing care, they can take advantage of the coverage benefits received under Medicare Part A. This hospital insurance also covers this specialized care when patients receive it at a skilled nursing facility. For instance, Medicare policyholders can receive coverage for services, such as dietary counseling, medications, skilled nursing care, a semi-private room, and required occupational or physical therapy, when these services are provided in a skilled nursing facility. However, there are limitations to this benefit. For example, patients who break their skilled nursing facility care for more than 30 days must receive three days of inpatient care before they can receive extra skilled nursing facility care coverage. No coinsurance is required for 20 days, but starting on day 21, patients can expect a coinsurance payment of $167.50 in 2018, and any service or cost beyond the 100th day must be paid by the patient.
Nursing Home Care
If nursing home care is medically necessary, Medicare Part A may cover nursing home care services. Some services that may be covered under this benefit may include, such as changing sterile dressings. However, if it only covers custodial care, such as getting dressed or bathing, these services are not covered by Medicare.
Home Health Services
Home health services, such as speech-language pathology services, skilled nursing care that is intermittent and physical therapy, are covered by Medicare Part A. Under Original Medicare, these services are covered at no cost to the patient, with the exception of durable medical equipment, which patients will have to pay a partial cost. Other home health care services may include part-time home health aide services and medical supplies intended for use at home. However, home health services under Medicare Part A do not cover personal care, home-delivered meals, round-the-clock home care or homemaker services, such as cleaning and shopping.
Hospice
Seniors who qualify for hospice care can expect a variety of services and amenities covered under Medicare Part A, such as grief and loss counseling, social work services, dietary counseling, doctor services, and prescription drugs for pain relief. Hospice care is completely covered under Medicare Part A. However, policyholders are expected to pay a $5 copayment per medication for pain relief or a similar prescription drug. What is not covered under Medicare Part A includes room and board at the patient’s residence or a nursing home where the patient lives if these places are where hospice care services will be rendered.
Final Thoughts
Understanding the fundamentals of what Medicare Part A covers is important for deciding which healthcare policy best meets senior healthcare needs. It’s also key to use providers who accept Medicare coverage to effectively leverage benefits. Consider using healthcare professionals who understand Medicare and who can help with a variety of healthcare options that seniors can leverage, such as Gonzaba. Take advantage of Medicare benefits, and schedule an appointment with Gonzaba for vital senior healthcare services.