Medicare Part A
When you look at your Medicare options, it can quickly become confusing. However, once you have the help of the professionals and a basic understanding of what you require, it isn’t as bad as it first appears.
They compose the original Medicare of two components:
- Medicare Part A - Hospital Insurance
- Medicare Part B - Medical insurance
Part A of your Medicare provides coverage for in-patient care and treatment while in a hospital, or in a specialist nursing center and, in some limited circumstances, at your home.
Medicare Part A Eligibility
You will find most individuals will be automatically eligible for Medicare Part A upon reaching the age of 65 if they happen to be receiving retirement benefits from the Social Security Administration or the Railroad Retirement Board.
You may find you qualify for Medicare (Part A) before the age of 65 if you suffer from any of the following:
- You have a disability and receive disability benefits
- You are receiving retirement benefits
- End-stage renal disease (ESRD) – dialysis required
- Amyotrophic lateral sclerosis (ALS)
Furthermore, you are required to be a United States citizen age 65 or over, or you are a legal permanent resident with five continuous years in the country.
A majority of beneficiaries will not pay a Medicare Part A premium when they have worked a minimum of 10 years (or 40 quarters) while paying Medicare dues for that period.
Those individuals who are non-eligible for Medicare Part A without paying premiums may still enroll in Part A and pay a dividend instead.
Recipients who are late in enrolling once they first qualify for Medicare Part A may be liable for late enrollment penalties after registering.
Here you can see a summary of what Medicare (Part A) covers:
- Hospital care if you are an in-patient
- Care when in a Hospice
- Skilled nursing facility care (available if custody care is not the sole care requirement)
- Partial services for home health
Note: Be aware that some benefits above will only be met in certain situations and under certain conditions.
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Medicare Part A benefits begin on the first day of the month in which you turn 65.
If your birthday falls on the first day of the month, your benefits will start in the month preceding your 65th birthday.
If you enroll in Medicare Part B at the same time as you apply for your pension, your coverage in Part B will start on the same date. Your red, white and blue Medicare card should arrive about three months before your 65th birthday.
Suppose you suspect that you may not qualify for Social Security pension benefits, or any other benefits from the Railroad Retirement Board (RRB). In that case, you must register for Part A Medicare.
You will do this manually through your IAP (Initial Enrolment Period), and you may do so via the Social Security website. Alternatively, you can go to your local social security office.
The seven-month Initial Enrollment Period begins three months before your 65th birthday and includes the month of your 65th birthday. It also continues for the next three months.
Your coverage starts depending on the month you enroll in your IEP. Should you wait until the last minute to enroll, or you forget, you will have to wait until the following general enrollment period which falls January 1 to March 31 in the next year.
If you are disabled, your enrollment in Medicare Part A hospital insurance (and Medicare Part B medical insurance), starts once you have received Social Security disability benefits for 24 months.
Coverage starts in the 25th month which is two years. Again, you will see your card show up three-months before your birthday and coverage begins.
Suppose you have delayed your registration for Part A of the Medicare program. In that case, you can register at the next available general registration period, except if you are eligible for a special registration period.
The general registration session takes place each year from January 1 to March 31. If enrolling in the General Enrolment Period, coverage starts on July 1 in that year, and your health card will be sent to you about three months before your coverage begins.
If you are not eligible for premium-free Medicare Part A and did not enroll when you were first eligible, you may be subject to a late-enrollment penalty when you sign up.
Should you or your spouse lose your employer, or union-sponsored group hospital insurance. Or in the event you are a volunteer in a foreign country or serving your country, you can enroll in Part A of Medicare right away or during a special enrollment period (SEP).
A Special Enrolment Period (SEP) covers eight months starting the month after your employment or other group coverage ends.
Should your employment end within the period of what would be your IAP, you must follow the standard rules for initial enrollment in Part A of the health insurance plan.
You have to pay the late enrollment penalty if you qualify for an IAP. Your Part A health insurance coverage begins on the first of each month following your registration, and your health insurance card should reach you within 30 days of your registration.
As a benefactor of Medicare Part A, it entitles you to coverage of critical hospital expenses for hospital care, including a semi-private room, nursing services, medications forming an integral part of your hospital treatment, and any additional hospital services or supplies.
This will cover your hospital in-patient care received through:
- Acute care hospitals – short term secondary health care
- Critical access hospitals – facilities offering limited outpatient care in rural areas
- In-patient rehabilitation facilities – facilities for strokes, brain injuries or similar
- Long-term care hospitals
- Mental health care
- Participation in qualifying clinical trials and studies
One thing to note is that your Part A Medicare hospital insurance will not cover costs for private rooms unless it is there is a medical necessity for doing so.
Furthermore, there is no cover of costs for private-duty nursing, shampoo, razors and other personal care items you may require. Also, if you need things such as television or a telephone, Medicare Part A won’t offer any coverage for these items.
One area you need to understand is that Medicare Part A will not cover the cost of any units of blood.
Besides this, you won’t pay for any units if the hospital receives its blood from a blood bank at no charge to them.
If the hospital has to purchase units of blood, you will need to pay only for the initial three units, which you receive each calendar year.
The above will differ if you have a blood donation from another person or yourself.
Benefits of Part A of Medicare for home-based health services apply when determined as medically necessary and prescribed by your physician.
You may find health care services comprising:
- Physical therapy
- Occupational therapy
- Medical social services
- Speech-language pathology services
- Part-time or alternating skilled nursing care
- Part-time or alternating home health care services
Note: Another addition can be any durable medical equipment your doctor has prescribed. If your doctor requests durable medical equipment for care and your equipment complies with eligibility requirements, this is covered separately in Part B of Medicare.
If you qualify for coverage, Medicare will ordinarily cover 80% of the Medicare-approved amount for durable medical equipment.
Medicare Part A will not cover round-the-clock home care, meals, or homemaker services unless related to your therapy or treatment.
Neither will it cover your personal care services, including help with bathing or dressing, should it be the only care required.
Medicare Part A will cover the total cost of covered home health care services. As stated above, if any durable medical equipment is required and ordered by your doctor, Medicare Part B covers it up to 80%, and you will be responsible for the remaining 20% of the Medicare-approved amount.
Your home health care services are to be provided through a Medicare-certified home health agency, with a doctor to certify you as being a home-bound individual.
Under Medicare’s terms, they will categorize you as “home-bound” if both the following are true:
- You cannot leave your home under ordinary circumstances, and it would require immense effort to do so.
- You are medically advised against leaving your home unless accompanied by another person, transportation, or specialized equipment.
Suppose your doctor certifies you as having a terminal illness that has an estimated life-span of no more than six months. You may be eligible for hospice care cover.
The focus for hospice care lies in palliative care, as opposed to curing your illness. Instead, the aim is to alleviate pain by making you as comfortable as humanly possible.
To be eligible for Medicare-covered hospice care, you need to meet all the following criteria:
- You must have Medicare Part A enrollment.
- You have to receive hospice care through a Medicare-approved hospice facility.
- Your physician or health care provider has to certify you as terminally ill and having only six months to live.
- They require you to agree to forego remedial treatments toward your terminal illness. However, Medicare continues its coverage of palliative and comfort-focused care for your terminal illness care with related symptoms or disorders.
Medicare Part A hospice care is generally performed in the patient’s home, and may include, and is not confined to, the following:
- Doctor Services and Nursing care
- Pain Relief Medications or Durable Medical Equipment
- Social and Hospice Support Services
- Medical Supplies and Physical/ Occupational Therapy
- Dietary counseling
- Homemaker Services
- Short-term hospital care as necessary for pain or symptom control
- Short-term respite care
When patients are receiving hospice care, Medicare Part A may also meet individual costs which Medicare rarely includes, like grief and spiritual counseling.
Medicare Part A only covers hospital room and board if the hospice medical staff requests short-term in-patient care for pain or other treatment of symptoms.
While you must forgo any remedial treatment for a terminal illness to qualify for Medicare coverage, it entitles you to discontinue hospice care anytime. If you plan on reverting to curative therapies, speak with your physician.