Medicare Part A Coverage and Eligibility Requirements

Basic Days

are the first 60 days of ACUTE Inpatient care provided to a beneficiary during a benefit period

Medicare Part A Coverage aka ?

Hospital Insurance

Coinsurance

Medicare patients hospitalized for more than 60 days in a benefit period must pay coinsurance if they remain in hospital

Medical Part A, A benefit Period

Starts the day a patient enters the hospital if the patient has not been in inpatient or an SNF pt in the last 60 days Ends when the patient has not been in inpatient or SNF for the 60 consecutive days.

Part A provides services for who?

provided in hospitals and SNF ( Skilled Nursing Facility )

Medicare Part A Criteria for basic days are?

1. The beneficiary financial responsibility is limited to the benefit period deductible 2. there is no coinsurance 3. if exhausted, these days are recycled once a new benefit period begins

What are the requirements for Medicare?

1. must be 65 or older 2. adults with disabilities 3. Individuals who become disabled before age 18 4. Spouses of entitled individuals 5. Retired Federal Employees enrolled in the Civil Service Retirement System ( CSRS ) 6. Individuals with ESRD 7. Permanent Residents

SKN Skilled Nursing Home

A patient is eligible for 100 days of care in SNF during a benefit period as longs as MN for for the admission and days of been proven. Covered: semiprivate room, meals, skilled nursing, rehabilitation services (after a related 3-day inpatient hospital stay ) are also covered

Organ Transplant

All organ transplants must be located in a hospital that has Medicare provider agreement Must comply with hospital conditions of Participation

Transplant Program

Defined as a component within a transplant hospital that provides transplantation of a particular type of organ

Intermediary determines What?

Determines Payment and process claims for Part A Facilities for covered items and services provided by the facility

Blood

If hospital has to buy blood for the pt. the pt must either pay the hospital for the first 3 units of blood received in a calendar year or have the blood donated

Inpatient Hospital Care

The pt. also has a lifetime reserve of 60 days that may be used once the 90 days haven been exhausted. Once the reserve days have been used, they are not replenished

Hospice Care

for individuals with a terminal illness and includes drugs for symptom control and pain relief. Medical and support services from a Medicare-approved hospice and other services not otherwise covered by Medicare Given in the home. Medicare covers short term hospital and inpatient respite care

Inpatient Hospital Care

hospital insurance helps pay for up to 90 days in a participating hospital in any benefit period, subject to a deductible Includes:Semiprivate room meals general nursing televison telephone Not Includes: private duty nursing T.V or Phone in the room, private room unless MN

Home Healthcare

part-time or intermittent skilled nursing care or home health aide services, physical therapy, occupational therapy, speech language therapy medical social social services ( wheelchairs, hospital beds, oxygen, walkers ) No time limit as long as MN

LTR LifeTime Reserve Days

once a patient has used their 90 days in one benefit period ( 60 basic days, 30 coinsurance days) they become eligible for 60 Lifetime reserve days for the 91st through 150th day of ACUTE inpatient care during same benefit day

LTR

once the reserve days are used, they cannot be reused charge to the beneficiary for using reserve days in one-half of the Current Part A Deductible

Benefit Period

time during which medical benefits are available to an insurance beneficiary