We are continuing on with our series of blogs on Medicare. Again, Senior Providers Network is not trying to make experts out of anyone, just give you a better understanding. In our last blog, we discussed that original or traditional Medicare is made up of 2 main parts “A & B”. In this blog we are going to discuss Medicare Part A, the “hospital insurance” side of things. Part A covers hospital or inpatient care, a skilled nursing facility and, in limited circumstances, at home, but we will discuss this later.
When do I sign up for Medicare Part A? You can enroll three months before your birth month, during your birth month or three months after your birth month.
What if I’m still working and have healthcare insurance through my employer? You can still sign up and have Medicare Part A be a secondary coverage. More on this down below…
What does Medicare Part A cover?
- Medicare Part A beneficiaries receive coverage for hospital expenses that are critical to your inpatient care:
- Semi-private room (does not cover the costs for a private room unless medically necessary)
- Nursing services (does not cover private-duty nursing)
- Only medications that are part of your inpatient treatment
- Other services and supplies from the hospital (does not cover items like shampoo or razors, or other items like telephone and television charges.
Home health care services are covered only when deemed medically necessary and ordered by your doctor. These services could include:
- Part-time or intermittent skilled nursing care and/or home health aide services
- Physical therapy
- Speech-language pathology services
- Occupational therapy
- Medical social services
These services must be provided by a Medicare-certified home health agency. Doctors must certify that you are home-bound. Homebound is defined as: under normal circumstances, you cannot leave home and doing so would require substantial effort.
Skilled nursing facility (SNF) has to be a Medicare-certified facility. To qualify for SNF care, the hospital stay must be a minimum of three days, (starts the day you are admitted)
If your doctor has certified that you have a terminal illness with an estimated six months or less to live, you may be eligible for hospice care coverage. In hospice care, the focus is on palliative care, not curing your disease. The goal is to relieve pain and make the patient as comfortable as possible.
What's not covered by Part A?
Medicare doesn't cover everything. You will need to pay out of pocket or have other insurance that covers the items that are not covered. Keep in mind that even if Medicare covers a service or item, you still may have to pay a deductible.
Services that Medicare doesn't cover include:
- Long-term care (also called non-medical care)
- Most dental care
- Eye exams related to prescribing glasses
- Cosmetic surgery
- Hearing aids and exams for fitting them
- Routine foot care
What happens if I don't sign up for Medicare Part A?
Medicare's general enrollment period runs from Jan. 1 through March 31 every year. If you missed the initial enrollment window, it could end up costing you a higher Part B premium -- for life. You can still sign up later but, you could face a 10% increase in your Part B premiums for every year-long period you're eligible for coverage but didn’t enroll. Remember from our first blog “Medicare Basics”, that in most cases Part A is free, so it would be beneficial to sign up on time and avoid the increased cost of Part B.