Medicare Part A (2011)
Medicare Part A is hospital insurance. It is free for those who qualify.
To qualify, one must have worked at least 10 years and paid FICA taxes during that time, or be the spouse of a qualified individual.
If you don’t qualify, you may buy into the program, but it is quite expensive.
Part A provides benefits for inpatient hospital care, skilled nursing care, hospice care and medically necessary home health care.
Custodial, or extended, care is not included in Part A coverage.
In 2011, the deductible is $1132. This deductible is not a calendar year deductible, but a benefit period deductible. A benefit period is defined as beginning the first day one enters a hospital, and ends 60 days after their release date (i.e. Assume one enters a hospital on January 1, and is released on January 4. If that individual reenters a hospital for any reason in January, February or the first few days of March, they will not have to pay another deductible. However, if they were readmitted after March 5, they would again be assessed the deductible). It is mathematically possible the one could pay the deductible five times in a calendar year.
Once you meet the deductible, Medicare will pay 100% of your hospital costs for the first 60 days.
From the 61st through the 90th day, one must pay a co-pay of $283 per day.
From the 91st through the 150th day, the co-pay is $566. This period is known as the lifetime reserve days and may only be used once during one’s lifetime.
After 150 days, Medicare pays nothing.
The majority of people never stay in the hospital beyond the initial 60 days. The reason for the is the DRG program. DRG stands for Diagnostic Related Groups. Medicare pre-determines what it will pay for a given diagnosis, and hospitals release people based upon this reimbursement.
If a person no longer meets Medicare’s requirements to stay in a hospital, but is not quite ready to return home, they may qualify for Skilled Nursing Facility Care.
In order to qualify for Skilled Nursing Facility Care, an individual must have been in the hospital at least 3 days, must enter a Skilled Care Facility within 30 days of hospital discharge. The facility must be Medicare approved, and the individual must show daily signs of improvement.
Provided one meets (and continues to meet) all of the above criteria, Medicare will pay 100% of the cost for the first 20 days. From days 21 to 100, one must pay a co-pay of $141.50 per day. After 100 days, Medicare will pay nothing.
Normally, Medicare ends up paying for about 20 days of Skilled Nursing Facility Care.
Medicare Part A also provides benefits for blood. Medicare will pay 100% of the cost after the first three pints (this benefit may also be covered under Medicare Part B).
Medicare Part A will also cover 100% of medically-necessary skilled home nursing care services, as well as 80% of the Medicare-approved durable medical equipment.
Hospice services are also available. In order to receive hospice benefits, one needs to be certified as terminally ill, by their doctor with a life expectancy of less than six months.
