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Part A Medicare Benefits

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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

What is Medicare?

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Medicare is a health insurance program that was established by the federal government in 1965. It was part of the Social Security Act of 1965, which was signed by President Lyndon Johnson on 30 July, 1965. Arguably, Medicare is a type of socialized medicine, which is administered by the Government, but since the actual medicine and treatment is preformed by private doctors and the governments role is more of as a supervisor, Medicare would technically be a Social Insurance Program.

Those that qualify for Medicare are able to receive reimbursement for their medical costs, including doctors visits and medical equipment, but as of recently, also prescription medication.

How is Medicare Funded

Medicare is paid for by taxes, which are taken out of workers paychecks. Currently, 2.9 percent of a persons income is taken for Social Security taxes, with the employee paying half of this and the employer paying the other half.

Part of the requirements for participating in Medicare, or at least participating without paying extra fees, is that the person has paid enough money into Medicare throughout their life.

Requirements for Medicare Coverage

Medicare is designed primarily to help cover the medical costs of those who are over 65, legal residents of the United States, and have been paying taxes for at least 10 years. However, in certain cases, usually due to disability, Lou Gehrig’s Disease, or renal failure, it may be possible to receive Medicare Benefits before the age of 65.

Currently, congress is discussing allowing those who are over 55 to buy into Medicare Early, as part of the current health care reform that is taking place in Congress. This is, however, still under wraps, so it remains to be seen if this will make it into the final bill and what the buy in cost will actually be.

What is Covered By Medicare?

This is something that I will go into further in my later posts and will update this one as well, but Medicare covers doctors visits, certain hospital stays, many types of home medical equipment, as well as prescription medicine.

However, when you sign up for Medicare, you are given the opportunity to decide what type of coverage you would like to receive. The different types are decided into Parts, such as Part A Medicare and Part B Medicare, and you will usually be given the opportunity to enroll in whichever parts you qualify for.

Those who have insurance through an employer can usually wait on deciding without penalty, but otherwise, adding on coverage later, especially prescription medicine coverage, will have a few hurdles.

In addition to Government Run Plans, it is also possible to sign up for a Medicare Advantage Plan, which is actually run by a private insurance company, but because these are allowed to be slightly different from traditional Medicare, it is imperative to carefully read the plan and compare it to regular Medicare.

How can I Find Out More Information About Medicare?

I would encourage you to check back at this blog regularly, as we will be updating it with more information about how Medicare Works, what Medicare Covers, and current news events.

With that said, one of the best places to find out about Medicare is to visit the official Medicare site. They have a tremendous amount of information for those on Medicare or curious about how it works, including sections to find out Your Medicare Coverage.