Medicare is an insurance program that is offered and run by the Federal Government, primarily intended for those over 65, although people with certain medical conditions, like acute renal failure, are also covered. Medicare Benefits are divided into 4 Parts, with Part A covering hospital related costs.
Part A Medicare Benefits are primarily intended to cover the cost of overnight hospital stays. The amount of the cost that is covered varies, depending on the length of the hospital stay and will also sometimes cover the cost of temporary stays at a nursing home.
While I the hospital, Part A Benefits extend to all costs, including medical tests, doctors costs, and incidentals, like food and board.
Requirements for Coverage of Semi-Long Term Care
In order for an extended stay at a nursing home or assisted care facility to be covered, it is necessary for the patient to have had a previous hospital stay for the same problem, which lasted at least full days, not including the day the patient was released. Also, the treatment must be for rehabilitation or to help manage a disease in order to be covered. Further, it is imperative that the assisted living facility offers skilled care, meaning that the workers must be registered nurses.
Length of Stay Covered By Medicare
Medicare will usually cover stays of up to 100 days, providing the above requirements have been met. The first 20 days are paid for by Medicare, with the following 80 days requiring a copay of around $134 per day.
If the patient uses their Part A Benefits, even partially, they must wait 60 days before they ca receive another full 100 day hospital stay.
Premiums and Deductibles
Providing the Medicare Recipient has paid payroll taxes for more than 13 years, there is monthly premium to receive Part A Benefits. However, those who have only paid in between 10 and 13 years will need to pay a deductible of $233 and those with less than 10 years paid into Medicare must pay $423 a month to receive Part A Benefits.
The required deductible, however, is the same for both and depends on how long the senior is in the hospital. For example, hospital stays between 1 and 60 days require a deductible of around $1000. After that, it drops down to about $260 per-day for the next 30 days. Then, stays between 91 and 150 days require a $534 deductible per-day. After 150 days, the patient will no longer be able to receive benefits.
If a stay at a skilled nursing facility is required, the patient’s first 20 days are covered by Medicare and there is a $133 deductible after that. Stays must be no longer than 100 days at a skilled-nursing home.
Determine Eligibility for Part A Benefits
To determine if you are eligible for Part A Benefits, you can visit Medicare Site and use their Part A Benefits Eligibility Tool