Know What Medicare A Covers

I have known veterans who only took Medicare A because it was free, and they opted out of  Medicare Part B for doctor and outpatient services because it cost something.  They thought Medicare A was enough because they could rely on the VA hospital.  The VA, however, changes what it will cover or reimburse, depending upon Congress’s budget and who is in the White House.  I had another gentleman in my office recently who thought Part B was unnecessary waste of money because he had been healthy all of his life.  While Medicare A is good insurance and covers some things, it is very limited if you understand how Part A works.  You should never guess about health insurance.  You need to know what Medicare A covers and doesn’t cover.

Medicare A was the first Medicare plan in 1965.  It covers hospital services.  Hospital stays are the most devastating and costly part of health care.  Medicare A covers five areas: inpatient hospital stays, blood, skilled nursing facilities, home healthcare, and hospice.  It does not cover these services completely.  There are deductibles, copayments, coinsurance, and limitations on days of service.

Medicare A Covers 60 Days In the Hospital

The deductible for Medicare A is currently $1,484 for 2021.  It has increased with a definite consistency over the years.  After the deductible is met, the patient is covered 100% for the next 60 days.   After a continuous 60 days as an inpatient in the hospital, the copay is $371 per day for Medicare A coverage.  The copay runs from days 61-90.  (This cost is assuming you have no other coverage, like a Medicare supplement.)

Lifetime Reserve Days for Medicare

Each Medicare beneficiary has 60 lifetime reserve days for Medicare A coverage.  This means the patient may dip into this limited number of days when they go past the 90-day mark.  If they use up those 60 days, they are not replaceable.  “Lifetime” means lifetime.  Even then, the 60 lifetime reserve days for Medicare have a copay of $742 for each day.  After the 150 consecutive days, the patient assumes ALL costs.  Of course, this is a rare event.

Hospital Stay Coverage Depends on the Day

Staying as an inpatient in a hospital for 60, 90, or 150 days is a very rare event.  The more likely occurrence is being admitted to the hospital, discharged, then readmitted for the same thing.  That is a number game in itself.  Once you are discharged, you need to be out of the hospital for 60 consecutive days.  If you are, then the clock starts over again when you are admitted, even if it is for the same reason.

The count starts back up where you left off if you return to the hospital within those initial 60 days.  If you left day 15 and are readmitted 30 days later, your second period in the hospital starts with day 16.  This is assuming the readmittance is for essentially the same reason. Hospital stay coverage depends on where you fall in the sequence of days.

Does Medicare Cover Blood Transfusions?

Medicare A covers blood and Medicare B covers blood, but in two different circumstances. Medicare does not cover the first three pints of blood. They wait until the fourth pint before they kick in. 

If the hospital gets the blood for the transfusion from a blood bank then you may not pay, other than donating blood afterward. Someone else may also donate blood in your name. If the hospital purchases blood, you will either pay or give you the option to donate.

Medicare A Covers Hospice Care

Hospice is for the terminally ill. Terminally ill means the medical prognosis is an expectation of six months or less of life, assuming the illness runs its usual course. Only a Medicare-certified hospice program may take a patient, and the program director, together with the attending physician, determines admittance to the hospice program. Medicare A covers the care totally except for some minor copays for medications.

What hospice provides is PAIN RELIEF. Everything—drugs, medical equipment, nursing, homemaker services—are all designed to reduce pain and maintain some reasonable level of comfort for the dying person. Hospice is generally administered at home.

Some people believe hospice will cover room and board and other housekeeping items in a hospice or nursing home facility. The individual and/or family will bear those costs, not Medicare.

Does Medicare Cover Skilled Nursing Facilities?

Skilled nursing is not nursing home insurance. I get this question almost every week. ‘What happens to me if I have to go to a nursing home?’ If it is not tied to a medically necessary reason for full-time rehabilitation, the nursing home will be on your dime unless you have long-term care insurance.

Skilled nursing care is not custodial care, which means bathing, transporting, feeding, etc. That is what most people imagine when they think of a nursing home. Skilled nursing is something else.

There are five criteria a person must meet to be admitted to the skilled nursing facility that Medicare A covers. The first criteria is a minimum 3-day inpatient hospital stay for a related illness. Then the doctor discharges you to a facility because you cannot continue your treatment on your own. For example, if you need injections or physical therapy. 

Second, you must enter the facility within 30 days of dismissal. Third, you can only receive the medically necessary treatment in a skilled nursing facility. You cannot receive the same or similar treatment through home health care or office visits. 

Fourth, the skilled nursing facility must be a Medicare-approved facility. Finally, the reason for the stay must be the same reason the patient was in the hospital.

Medicare A covers skilled nursing at zero cost for the first twenty days. However, on days 21-100, the patient pays $185.50 per day unless they have a Medicare supplement or other insurance. Like the hospital stay, there is a formula for starting and stopping the days and how they are counted.

Medicare A Covers Home Health Care

Medicare A covers home health care in much the same way as it covers skilled nursing facilities. There is a list of criteria the patient must meet. 

Home health care is like skilled nursing in that it provides skilled care–not custodial. The patient must be certified to receive it. They must be homebound. In other words, they cannot easily go to an office to receive treatment. Medicare will cover home health care completely under Part A for as long as medically necessary and can be verified as necessary. It will be at no cost to the beneficiary.

What Does Medicare Part A Not Cover?

Medicare A does not include Medicare B. Part B is doctor and outpatient procedures, which is the bulk of what most people need. Those are also doctor visits in the hospital.

Medicare Part B does cost something. The Part B premium is currently $148.50 per month per person unless your income is in the top 6%.

Some people who do not take Part B. Maybe they have VA benefits or some other coverage. That can be a mistake. 

Medicare A does not cover prescription drugs. Part D covers medications. Part A does not cover dental, vision, hearing, transportation. Those are all medically important services covered in other places and ways.

Medicare Part A Doesn’t Cover All Medical Costs 

You paid for Medicare A coverage during your working years. Your payroll taxes included a 1.45% tax for Medicare Part A. It was and is strong protection for seniors against the devastating cost of hospital stays. 

Skilled nursing is an important service, and Medicare A comes in to cover it. Home health care is vital for a person’s recovery and getting back to self-sufficiency, and hospice is a tremendously humane ministry Medicare A provides. But alone, Medicare Part A does not cover the medical care that most people need.

I recommend you seriously consider whether you need additional protection. Know your costs and coverage limitations.

Call 402-614-3389 and email us at info@omahainsurancesolutions.com for a free consultation and quote. We will confirm whether you’re covered and if additional protection is right for you.

 

Like most children, I learned to sing the alphabet before I learned to read it. From that humble beginning, language opened up to me. Why does that matter when we’re talking about Medicare? You can’t understand language without first understanding the alphabet. Medicare has a language and an alphabet all its own. 

 

Medicare Part A is the first letter in the alphabet and language of Medicare. A isn’t for apple, however. Part A is for hospital insurance, so how much is Medicare Part A deductible for 2021?

First, we let’s discuss what Part A is and what it covers. 

What Is Medicare Part A?

Medicare Part A covers four areas of care: inpatient hospital stays, skilled nursing facility stays, home healthcare, and hospice.

Inpatient hospital covers, as you might expect, when patients go to the hospital. Patients can go to the hospital for treatment, they may even stay overnight, but they may not necessarily have been admitted as an inpatient. Inpatient hospital is its own category, billing codes, and Medicare costs. A patient is generally not admitted for an inpatient hospital stay unless the condition is serious enough to warrant at least a two-day hospital stay.

Observation in the hospital is not admittance. You are under hospital observation, but you are not an inpatient. Medicare Part A deductible will not cover observation in 2021, and most Medicare Advantage plans (MA plans) will not cover hospital observation, either. However, some MA plans are starting to. 

Check your MA plan’s evidence of coverage before proceeding. Note that a doctor must sign an order for a medically necessary service in the hospital for a person to be admitted as an inpatient.

What Is The Medicare Part A Deductible in 2021?

Part A hospital insurance covers everything during the hospital stay–except doctor’s visits– completely for 60 days, but only after you pay a $1,484 Medicare deductible out of your pocket in 2021, assuming you have no other health insurance coverage.  

Medicare Part A does not have a premium. The 1.45% FICA taxes you paid for Medicare during your working years covers your Part A cost. There is only a deductible, no co-insurance. 

This applies to each 60 days per event benefit period. Note, that it is possible to have multiple unrelated events overlapping within a 60 day period. In that case, you’d pay multiple deductibles. Ouch!

What Is The Medicare Part A Benefit Period?

The Part A benefit period begins the day of admittance and ends when the treatment stops. A new benefit period does not start until you are without inpatient treatment for 60 consecutive days. 

If you are readmitted to the hospital within the 60 days following, the countdown starts again where you left off until you use 60 days.

Medicare Part A Coinsurance Payments Are Covered By?

Once you exceed the first 60 days, you have a co-insurance of $371 per day from day 61-90.  Medicare coinsurance is different from Medicare deductible in 2021.  Again, this is assuming you have no Medigap policy or other health insurance.

Paying the Part A co-insurance amount is rare because most hospital stays end well before the 61st day.

Medicare Deductibles Affect Insurance Costs

It is important to note for those on Medigap policies or even Medicare Advantage that Medicare deductibles impact insurance costs. This extended coverage is the obligation of your Medigap policy or MA plan. Consequently, the insurance company actuaries must factor in the probability of occurrence and cost. 

The cost is transferred to the price of the Medigap plan or co-pays on the MA plan. Many clients wonder why their Medigap plan premium is going up? There are many factors, but when Medicare lowers the amount it will cover, the insurance companies pass on the cost to the consumer.

What Are Lifetime Medicare Reserve Days?

Medicare lifetime reserve days refers to the 60 days a Medicare beneficiary may use once they exhaust the first 60 days of Part A and the additional 30 days with the $371 co-insurance. 

The patient dips into the lifetime reserve days Medicare provides. These days, however, are not free. The coinsurance is $742 per day. Once these 60 lifetime reserve days are exhausted, the patient assumes all costs in the hospital, assuming there is no other insurance.

What Does Part A Cover Besides Hospital?

In 2021 once you have paid the Medicare deductible, Medicare Part A covers hospital stays virtually completely: semi-private room, general nursing, drugs prescribed while in the hospital, supplies, and treatments while an inpatient.  The various areas within the hospital are also covered life ICU (intensive care units), inpatient rehabilitation, inpatient psychiatric facilities, long-term care hospitals.

Does Part A Cover Skilled Nursing Care?

Most people understand Part A is for the hospital. On the Medicare card itself, the card says “Part A Hospital.” However, many people don’t realize skilled nursing care falls under Part A, as well. The rules of coverage and payment are very similar to the inpatient hospital stays. I discuss skilled nursing in another blog. 

Is Home Health Care Covered Under Medicare Part A or Part B?

Home Health Care can fall under Part A. Many people assume it is exclusively under Part B, but there are circumstances when Part A may pay for home health care. 

Generally, beneficiaries and doctors approach home health care from the Part B side of Medicare to avoid the high Medicare Part A deductible and the more restrictive rules of hospital confinement.

What is the Medicare Deductible For Hospice 2021?

Part A covers hospice completely with no deductible. Hospice includes hospice nurses, medications, and counseling. Medicare Advantage plans actually do not cover hospice, rather the beneficiary reverts back to Original Medicare, at least for the hospice care. The Medigap policy likewise does not cover the cost. Medicare picks up the entire tab. 

That being said, there is some confusion about what hospice covers. I had a client’s family member call to cancel her mother’s supplement. Someone in hospice told her because hospice was paying for everything, she could save money by canceling the Medigap policy. But hospice will not cover things like your primary care physician visiting you, a special hospital bed, or other medical treatments that are not life-sustaining but you might prefer. 

Those services fall under Original Medicare and your supplement or your Medicare Advantage plan. For the short time someone is on hospice, I would focus on them rather than a few dollars.

Medicare Part A Deductible Conclusion

I have discussed Medicare Part A as Part A without a supplement or referring to Medicare Advantage. Many Medicare beneficiaries have only Medicare Part A or Part A with Part B. They do not have a supplement, advantage plan, or other insurance. So this speaks to them. 

However, to understand Part A and how it fits within the bigger picture of Medicare health insurance, it is important to understand what it is, what it covers, and what it costs in its various iterations.

If this is confusing–and I don’t blame you for feeling that way–give us a call. Medical expenses can be astronomical. If the correct insurance is not in place with sufficient coverage, costs may surprise and overwhelm you. Not following the eligibility requirements could result in surprise penalties and permanent premium hikes from Medicare. 

Call 402-614-3389 or email [email protected] for a free consultation to make sure all letters of your Medicare alphabet are in place.

The Affordable Care Act (ACA) has left many Americans with questions, especially lately with many of the regulations going into effect for 2015. The ACA provides a Health Insurance Marketplace, designed to assist people who don’t otherwise have health coverage through their employer or otherwise. How does this all affect Omaha Medicare Recipients? The short answer is; nothing changes. If you currently receive Medicare, your choices and benefits remain the same. How so?

You can get more, for less. That’s right; if you are a Medicare recipient, you’ll be able to receive many types of preventive care at no additional cost, including services such as mammograms or colonoscopies. In addition, you’ll be able to receive one free wellness exam per year.

You’ll save money on prescription drugs. The “donut hole” that is part of the Medicare Part D program is a gap in your drug coverage that gives recipients 55% off of Part D-covered brand-name prescription drugs. This donut hole is steadily shrinking, and is expected to be closed by 2020, meaning recipients will only pay for 25% of their covered brand-name and generic prescription drugs.

Your Doctor will receive more support. The ACA has created new initiatives that support care coordination, ensuring that patients get the right care at the right time. As a result, your doctors will likely receive additional resources to ensure that your treatments are consistent.

Whether you receive Medicare through Original Medicare or an Omaha Medicare Advantage Plan, you will have the same benefits and security that you do now as a Medicare Recipient. Interested in learning more? Please contact Omaha Insurance Solutions at (855) 367-3631 to speak to a licensed insurance agent today.