GET THE MOST OUT OF YOUR COVERAGE!
Medicare Part A covers hospital care if you are formally admitted and you need care for more than two nights. Your treatment must be medically necessary and must require in-patient care. In 2015 there is a deductible of $1,260 per benefit period for Part A. There is no premium for Part A if you meet the above criteria. If you do not qualify, you may obtain coverage by paying a monthly premium.
Hospital Care – Part A covers your first 60 days in a hospital each benefit period. For days 61-90 there is a $315 per day copay. After 90 days in a benefit period, you are entitled to 60 ‘Lifetime Reserve Days.’ These have a copay of $630 per day. Beyond your ‘Lifetime Reserve Days,’ the patient is responsible for all costs.
Long-Term Care is subject to the same limitations and charges as acute care. The number of days listed is a total of your combined stay in either of these facilities. If you have a serious condition that requires medically-necessary, long-term care and you are expected to recover, you may be eligible for long-term care. Your deductible is per benefit period. You do not pay an additional deductible, if you change facilities.
Skilled Nursing Services – Medicare Part A covers skilled nursing services provided in a ‘skilled nursing facility.’ This would include physical and occupational therapy and speech pathology services. Medication, medical supplies and equipment needed while an in-patient are also covered. For the first 20 days per benefit period are covered 100% for covered services. For days 21-100 there is a charge of $157.50 copay per day. Days 101 and after are the full responsibility of the patient.
Benefit Period – The Part A ‘benefit period’ is not a calendar year. It begins when you are admitted as an inpatient to a hospital, long-term care facility, or skilled nursing facility.
It ends when you have not received in-patient care for 60 consecutive days. After the 60 days, a new benefit period begins and you are subject to another $1,260 deductible. You also begin at day 1 for hospital coverage and have 60 days of care without a copay. You may have more than one benefit period per year and there is no limit.
Homecare – Medicare Part A and Part B together cover homecare if your doctor has certified that you are homebound and that your treatment is medically necessary. Physical therapy, speech-language pathology or occupational therapy may be covered. Your condition must be expected to improve within a certain period of time. The services provided must require a skilled therapist and the associated agency must be Medicare-certified. Medicare does not cover 24-hour care.
Hospice is provided for patients who are terminally ill and have opted not to seek curative care. The focus is on comfort, not curing an illness. Drugs, counseling and medically necessary supplies and equipment are covered. Most services are provided in the home.
Medicare Part A will cover hospice care if your hospice doctor and regular doctor certify that you are terminally ill and have a life expectancy of six months or less. You must sign a statement that you are accepting palliative care instead of treatment for your illness.
Your hospice medical team must arrange for any services outside of palliative care including short-term, in-patient care, medications other than for symptoms or pain relief, visits to other physicians for conditions not related to your terminal illness, and emergency care.
Hospice care can be extended past six months with recertification from your physicians.