On a Medicare card Part A will have the word “Hospital” beside it. Because of that Medicare Part A is most commonly known as the inpatient or hospitalization part of Medicare. This means when a Medicare beneficiary is admitted into the hospital most of the services that are received are filed under Medicare Part A. This sounds simple but sometimes it’s not.
Medicare Part A has a deductible of $1,556 per benefit period. Notice two things here. First is the deductible of $1,556. If you are admitted into the hospital and had Original Medicare only, you would owe the first $1,556 of your stay. This deductible covers hospital services, including semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies.
The second thing to notice is the term “benefit period”. This tells you the deductible is not an annual deductible but could hit you more than once in a calendar year. A “benefit period” begins when you are discharged from a hospital or skilled nursing facility and ends when you haven’t received any inpatient care for 60 consecutive days. If you are admitted as an inpatient after the 60 days of no inpatient care a new benefit period begins, meaning another $1,556 deductible. Also if you are confined to the hospital for 60 consecutive days your deductible will cover you but on the 61st day you will begin paying a coinsurance.
The good news is for most Medicare beneficiaries Part A is free. Free meaning you don’t pay a premium for it. The reason for this is while you are working you pay 1.45% of your pay check into Medicare. If you did that for 40 quarters you’re entitled to Part A for free. Next week will discuss the other benefits of Medicare Part A.
Last week we discussed how Medicare Part A will cover you if you are admitted into the hospital. A hospital, under Medicare, can be acute care hospitals, critical care hospitals, inpatient rehabilitation facilities, long term care hospitals or mental health care.
The one aspect of Medicare Part A we get the most questions about is coverage at a skilled nursing facility (SNF). To be covered by Medicare at a SNF certain criteria has to be met. First, of course, is you must have Medicare Part A. Next your doctor has determined that you need daily skilled care given by, or under the supervision of, skilled nursing or therapy personnel. Your skilled nursing care will have to be in a SNF that is certified by Medicare.
What a lot of people don’t know is that you must have a “qualifying” hospital stay to be covered at a SNF. Under Medicare a “qualifying” hospital stay is at least a 3-day inpatient stay prior to being admitted to the SNF. If you go to the ER and are held one day for observation and are admitted into the hospital for two days this does not constitute a “qualifying” hospital stay. If you are admitted on a Monday and discharged the following Wednesday this is not a “qualifying” hospital stay. In the two examples above those are 2-day inpatient stays. A good rule of thumb is you must be admitted as inpatient for at least three midnights.
You also need to know that Medicare Part A will only cover you for 100 days at a SNF and only 20 of those days are at 100%. In other words days 1-20 are covered at 100%. Days 21-100 you will pay the first $200.00 per day and Medicare pays the rest of the cost. Starting with day 101 you will pay 100% of the bill.
If you have questions regarding any aspect of Medicare or Medicare health plans feel free call us at Alabama Health Guidance (256-648-5710), stop by our office at 885 Florence Blvd (Four Lane Shopping Center) or email me at ikey@alabamahealthguidance.com.