medicare part A
eligibility 1
a citizen or a legal resident of the united states age 65 and qualified for social security or railroad retirement benefits
special enrollment period
at any time during the year if the individual or their spouse is still employed and covered under a group health plan
general enrollment period
between january 1st and march 31 each year
home health care
for an individual confined to the home and meeting certain other conditions, hospital insurance can pay the full approved cost of home health visits from a participating home health agency. there is no limit to the number of covered visits. covered services include part time skilled nursing care, physical therapy, and speech therapy. hospital insurance also covers part time services of home health aides, occupational therapy, medical social services and medical supplies and equipment.
eligibility 5
has ALS (amyotrophic lateral sclerosis, or lou gehrigs disease) - automatically qualifies for part A of the month disability benefits begin
eligibility 4
has end stage renal disease - permanent kidney failure that requires dialysis or a transplant - "ESRD"
inpatient hospital care
hospital insurance helps pay for up to 90 days in a participating hospital in any benefit period, subject to a deductible. the first 60 days are covered at 100% of approved charges after the deductible is met. the next 30 covered days are paid, but they are paid with a daily copayment. every part A insured has a lifetime reserve of 60 days in hospital care. the lifetime reserve days have a copayment that is twice that of days 61 through 90, and they are nonrenewable.. covered services include semi private room, meals, regular nursing services, operating and recovery room costs, hospital costs for anesthesia, intensive care and coronary care, drugs, lab tests, x rays, medical supplies, appliances, rehab services, and preparatory services related to kidney transplant surgery. blood is also covered, except for the first 3 pints. - under the inpatient hospital stay, part A does not include private duty nursing, a television or telephone. it also does not include a private room unless medically necessary. in addition, inpatient mental health care in a phychiatric facility is limited to 190 days in a lifetime. - 60 days of non- use of the inpatient hospital benefit starts a new benefit period and a new deductible
eligibility 2
is 65 years old or over and entitled to monthly social security benefits based upon the spouses work record and the spouse is at least 62
eligibility 3
is younger than 65 but has been entitled to monthly social security benefits for 24 months "disabled"
skilled nursing facility care
part A helps pay for up to 100 days in a participating skilled nursing facility in each benefit period, following a 3 day inpatient hospital stay for a related illness. to get this type of care, the insureds doctor must certify that daily skilled care is necessary. covered expenses include semi private room, meals, regular nursing and rehab services, and other supplies
hospice care
under certain conditions, hospital insurance can help pay for hospice care for terminally ill insureds, if the care is provided by a medicare certified hospice. covered services include doctor services, nursing services, medical appliances, supplies including outpatient drugs for pain relief, home health aide, homemaker services, therapies, medical social services, short term inpatient care including respite care, and counseling.
initial enrollment period
when an individual first becomes eligible for medicare (starting 3 months before turning age 65, ending 3 months after 65th birthday)
