Medicare Part A (Hospital Insurance) Original Medicare

hospice eligibility

Hospice care is available under Medicare only if the patient meets the following requirements: Is eligible for Medicare Hospital Insurance (Part A); Signs a statement choosing hospice care instead of standard Medicare benefits for the terminal illness; Receives care from a Medicare-approved hospice program; and The patient's doctor and the hospice medical director certify that the patient is terminally ill with 6 months or less to live if the disease runs its expected course.

covered expenses

Medicare covered hospital services include a semiprivate room, meals, general nursing, and other hospital services and supplies. This includes care received in critical access hospitals and inpatient mental health care

SNF Days 1-20

Medicare pays all cost for days 1 through 20 in a skilled nursing facility

Respite coinsurance

Medicare pays the Hospice directly at specified rates depending on the type of care given each day. There is no cost to the insured for hospice care. The patient is responsible only for the following: No more than $5 for each prescription drug and other similar products. The hospice can charge up to $5 for each prescription, outpatient drugs, or other similar products for pain relief and symptom control. 5% of the Medicare payment amount for inpatient respite care

days 1-60

Medicare will pay all charges for covered hospital services during the first 60 days of a benefit period except for a deductible. The inpatient hospital deductible for 2019 is $1,364 and is paid by the beneficiary when admitted as a hospital inpatient. The Part A deductible is the beneficiary's only cost for up to 60 days of Medicare-covered inpatient hospital care in a benefit period.

Home health care eligibility

A doctor decides medical care at home is needed, and makes a plan for care at home; The patient needs at least one of the following: intermittent (and not full time) skilled nursing care, physical therapy or speech language pathology services, or a continued need for occupational therapy; The patient is homebound, which means the patient is normally unable to leave home or that leaving home is a major effort. When the patient leaves home, it is only for a short time and not very frequently (for example, to attend religious services or to get medical treatment). Care can be provided in an adult daycare program that is licensed or certified by a state; and The home health agency providing the care must be approved by the Medicare program.

days 61-90

For days 61 through 90 of hospitalization in a benefit period, Medicare Part A will pay all covered expenses after the patient pays a daily copayment amount that changes annually. Beneficiaries must pay an additional $341 per day for days 61 through 90

exclusions

Inpatient hospital care does not include private nursing or a telephone or television in the patient's room. It does not include a private room, unless medically necessary

SNF covered services

Medicare Services in a Skilled Nursing Facility include the following:Semi-private room, Meals, Skilled nursing care, Physical therapy*, Occupational therapy*, Speech-language therapy*, Medical social services, Medications, Medical supplies, and equipment used in the facility

days 91-150

Patients must pay all cost beyond 150 days. The patient has a lifetime reserve of 60 days for inpatient hospital care. These lifetime reserve days may be used whenever the patient is in the hospital for more than 90 consecutive days. For days 91 through 150 (lifetime reserve days) of an inpatient hospital stay, coinsurance amount is $682 per day.

Hospice covered services

Physicians' services Nursing care (intermittent with 24-hour on call) Medical appliances and supplies related to the terminal illness (such as wheelchairs or walkers) Medical supplies (such as bandages and catheters) Outpatient drugs for symptom management and pain relief Short-term acute inpatient care, including respite care Home health aide and homemaker services Physical therapy, occupational therapy and speech/language pathology services Medical social services Counseling, including dietary and spiritual counseling Grief and loss counseling for the patient and the patient's family Short-term inpatient care Short-term respite care (patient pays a small copayment)

SNF staff

Registered nurses Licensed practical and vocational nurses Physical and occupational therapists Speech-language pathologists, and Audiologists.

Skilled Nursing Facility (SNF)

The Original Medicare Plan Part A covers skilled care in a skilled nursing facility (SNF) under certain conditions for a limited time. Skilled care is health care given when the patient needs skilled a nursing or rehabilitation staff to manage, observe, and evaluate care, when given in a Medicare-certified SNF. Examples of skilled care include changing sterile dressings, intravenous injections and physical therapy. Medicare covers certain skilled care services that are needed daily on a short-term basis (up to 100 days)

SNF days 21-100

The coinsurance rate for days 21 through 100 in a skilled nursing facility is $170.50 per day for 2019. This amount can change each year. Patients who have a Medicare Advantage Plan may have a different cost or additional coverage. Beyond 100 days, Medicare will not pay for any covered services. The patient must pay full cost.

hospice benefit period

The patient can get hospice care as long as the doctor and the hospice medical director or other hospice doctor certifies that the patient is terminally ill and probably has 6 months or less to live if the disease runs its normal course. If the patient lives longer than 6 months, the patient can still get hospice care, as long as the hospice medical director or other hospice doctor recertifies that the patient is terminally ill. Hospice care is given in periods of care. The patient can get hospice care for two 90- day periods followed by an unlimited number of 60-day periods. At the start of each period of care, the hospice medical director or other hospice doctor must recertify that the patient is terminally ill, so the patient may continue to get hospice care. A period of care starts the day the patient begins to get hospice care. It ends when the 90-day or 60-day period ends.

blood deductible

The patient will be billed for the first 3 pints of unreplaced blood furnished to the patient in a calendar year. Additional blood is fully covered by Medicare.

SNF Benefit Period

There is no limit to the number of benefit periods a patient can have in a skilled nursing facility, provided all the conditions are met. Medicare uses a period of time called a benefit period to keep track of how many days of SNF benefits are used, and how many are still available. A benefit period begins on the day the patient uses hospital or SNF benefits under Part A of Medicare. The patient can get up to 100 days of SNF coverage in a SNF benefit period. Once the patient uses up those 100 days, the current benefit period must end before the patient can renew the SNF benefits. The benefit period ends when the patient has not been in a SNF or a hospital for at least 30 days in a row, or, if the patient remains in a SNF, when the patient has not received skilled care there for at least 30 days. There is no limit to the number of benefit periods the patient can have. However, once a benefit period ends, the patient must have another 3-day qualifying hospital stay and meet the Medicare requirements before the patient can get another 100 days of SNF benefits.

home health care requirements

covers home health services for as long as needed. However, the skilled nursing care and home health aide services are only covered on a part-time or "intermittent" basis. This means that there are limits on the number of hours per day and days per week that skilled nursing or home health aide services are received. Therapy services do not have to be part-time or intermittent. To decide whether or not the patient is eligible for home health care, Medicare defines part time or "intermittent" as skilled nursing care that is needed or given on fewer than 7 days each week or less than 8 hours each day over a period of 21 days (or less) with some exceptions in special circumstances

Part A psychiatric

covers inpatient mental health care services. These services can be given in a general hospital or in a specialty psychiatric hospital that only cares for people with mental health problems. Medicare helps pay for inpatient mental health services in the same way that it pays for all other inpatient hospital care. If the patient is in a specialty psychiatric hospital, Medicare Part A only pays for a total (lifetime limit) of 190 days of inpatient care in a Medicare certified psychiatric facility. There is no lifetime limit on inpatient care given in general hospitals. The patient may get care in general hospitals after the patient reaches the 190 day lifetime limit in specialty psychiatric hospitals.

home health care exclusions

home health care does not cover the following: 24-hour-a-day care at home; Meals delivered to a home; Homemaker services like shopping, cleaning and laundry; or Personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care needed.

Part A

hospital and skilled nursing facility benefits are paid on the basis of benefit periods. A benefit period begins the first day an individual receives a Medicare covered service in a qualified hospital. It ends when that individual has been out of a hospital or skilled nursing facility for 60 consecutive days. If the patient enters a hospital again after 60 days, a new benefit period begins.

hospice care

is a special way of caring for people who are terminally ill. People of all ages who are terminally ill can get hospice care. Families of people who are terminally ill may also benefit from hospice care and can receive counseling services. Hospice care for people who are terminally ill includes physical, psychological, social, and counseling services. The goal of hospice is to provide care for people who are terminally ill to manage their pain and other symptoms, not to cure their illness. A public agency or private company can provide hospice services.

Respite care

is care given to a hospice patient by another caregiver so that the usual caregiver can rest. As a hospice patient, the patient may have one person that takes care of the patient every day. That person might be a family member. Sometimes the family member needs someone to take care of the patient for a short time while the caregiver does other things that need to be done. During a period of respite care, the patient will be cared for in a Medicare-approved facility, such as a hospice facility, hospital or nursing home.

Home health care

is skilled nursing care and certain other health care services the patient receives at home for treatment of an illness or injury.

First dollar coverage

means there is no deductible. Medicare pays all cost for home health care visits Coinsurance Generally, the patient's cost in Original Medicare is $0 for home health care services and 20% of the Medicare-approved amount for durable medical equipment.

provider file claiming

providers are required to file a claim with a Medicare Intermediary. The intermediary pays the claim and sends a Medicare Summary Notice (MSN). The Medicare Summary Notice is also referred to as an Explanation of Medicare Benefits (EOMB or EOB). The Medicare Summary Notice is an easy-to-read monthly statement that clearly lists the health insurance claims information. It replaces the Explanation of Your Medicare Benefits (EOMB). The MSN lists all the services or supplies that were billed to Medicare for a 30-day period of time. It is important to check this notice to be sure the patient received all the services, medical supplies, or equipment that providers billed to Medicare. Patients who disagree with a claims decision have the right to file an appeal.