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Medicare Part A covers Medicare inpatient care, including care received while in a hospital, a skilled nursing facility, and, in limited circumstances, at home

Original Medicare consists of two parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Medicare Part A covers Medicare inpatient care, including care received while in a hospital, a skilled nursing facility, and, in limited circumstances, at home.

Most people are automatically eligible for Medicare Part A at age 65 if they’re already collecting retirement benefits from the Social Security Administration or the Railroad Retirement Board. You may qualify for Medicare Part A before 65 if you have a disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS). You must be either a United States citizen or a legal permanent resident of at least five continuous years.

In general, Medicare Part A coverage includes*:

  • Hospital care (inpatient)
  • Limited home health services
  • Skilled nursing facility care, provided that custodial care isn’t the only care required
  • Hospice care

*Please note that some of the above benefits are only covered in limited situations and if certain conditions are met.

Medicare Part A home health care benefits

No matter what type of insurance you are looking to buy, it is important to us that you get it right first time. This could save you a lot of stress - and possibly lots of money.

Home health care services may include:

  • Part-time or intermittent skilled nursing care
  • Physical therapy
  • Speech-language pathology services
  • Occupational therapy
  • Medical social services
  • Part-time or intermittent home health aide services
  • Durable medical equipment, when ordered by your doctor*

*If your doctor orders durable medical equipment as part of your care and the equipment meets eligibility requirements, this cost is covered separately under Medicare Part B. If you’re eligible for coverage, Medicare typically covers 80% of the Medicare-approved amount for the durable medical equipment.

Medicare Part A does not cover 24-hour home care, meals, or homemaker services if they are unrelated to your treatment. It also does not include personal care services, such as help with bathing and dressing.

Medicare Part A covers the entire cost of covered home health care services. If you need durable medical equipment that is ordered from your doctor, this will be covered under Medicare Part B; You will be responsible for 20% of the Medicare-approved amount.

Home health care is provided by a Medicare-certified home health service company, and a doctor must certify and determine that you are home-bound. Medicare, states you are “homebound” if both of the following are true:

  • Under normal everyday circumstances, you cannot leave home on your own and doing so would require substantial effort.
  • Your doctor states it is medically inadvisable for you to leave home on your own without the help of another person, specialized equipment or transportation.
Medicare Part A home health care benefits

Medicare Part A benefits for home health care services are covered when deemed medically necessary and ordered by your doctor.

Home health care services may include:

  • Part-time or intermittent skilled nursing care
  • Physical therapy
  • Speech-language pathology services
  • Occupational therapy
  • Medical social services
  • Part-time or intermittent home health aide services
  • Durable medical equipment, when ordered by your doctor*

*If your doctor orders durable medical equipment as part of your care and the equipment meets eligibility requirements, this cost is covered separately under Medicare Part B. If you’re eligible for coverage, Medicare typically covers 80% of the Medicare-approved amount for the durable medical equipment.

 Medicare Part A does not cover 24-hour home care, meals, or homemaker services if they are unrelated to your treatment. It also does not include personal care services, such as help with bathing and dressing.

Medicare Part A covers the entire cost of covered home health care services. If you need durable medical equipment that is ordered from your doctor, this will be covered under Medicare Part B; You will be responsible for 20% of the Medicare-approved amount.

Home health care is provided by a Medicare-certified home health service company, and a doctor must certify and determine that you are home-bound. Medicare, states you are “homebound” if both of the following are true:

  • Under normal everyday circumstances, you cannot leave home on your own and doing so would require substantial effort.
  • Your doctor states it is medically inadvisable for you to leave home on your own without the help of another person, specialized equipment or transportation.
 


 Medicare Part A nursing home coverage
 

Skilled nursing facility (SNF) stays are covered under Medicare Part A after a qualifying hospital inpatient stay for a related injury or illness. Qualifying for SNF care entails the following; the hospital stay for a minimum of three days, This begins the day you are formally admitted as a patient. The day you are discharged does not count towards the three-day requirement. Any time spent under observation as an outpatient does not count towards a qualifying stay.

Skilled nursing care must be provided in a Medicare-certified facility. Medicare-covered skilled nursing care includes, but is not limited to:
  • Meals
  • Skilled nursing service
  • Medical social services
  • Semi-Private room
  • Medical supplies and equipment used in SNF
  • Medications received while in SNF care
  • Medical supplies and equipment used in SNF
  • Dietary counseling
  • Ambulance transportation to the nearest provider is available if not provided at the SNF
  • Rehabilitation services, if they are medically necessary to treat your illness
A doctor must certify that you need skilled care that you cannot receive at home, such as physical therapy or intravenous drugs. Medicare Part A does not cover long-term care. Medicaid covers long-term care.
Medicare Part A hospice coverage

A doctor will have to certify that you have a terminal illness with an estimated six months or less to live, you should be eligible for hospice care coverage at this point. In hospice care, the focus is on palliative care, not curing your disease. The goal is to make the patient as comfortable as possible and relieve pain.

To qualify for Medicare-covered hospice care, you must meet every one of the following conditions:

  • You must agree to give up treatments for your terminal illness, although Medicare will still cover palliative (comfort-focused) treatment for your terminal illness, along with related symptoms or conditions.
  • Your health provider or doctor must certify that you are terminally ill and have six months or less to live.
  • You have to be enrolled in Medicare Part A.
  • You have to receive hospice care from a Medicare-approved hospice service.

Medicare Part A hospice care is typically received in the patient’s home. It may include, but is not limited to:

  • Medical supplies
  • Hospice aid services
  • Pain relief medications
  • Social services
  • Durable medical equipment
  • Doctor Services
  • Nursing Care
  • Homemaker services
  • Occupational and Physical therapy
  • Dietary counseling
  • Short-term respite care
  • Short-term inpatient care (if necessary for managing pain or symptoms)

If a patient is under hospice care, Medicare Part A may also cover some costs that Medicare does typically not include, such as spiritual and grief counseling. Medicare Part A only pays for room and board in a hospital if the hospice medical team orders short-term inpatient stays for pain or other symptom management.

Although you have to give up treatments for your terminal illness to receive Medicare coverage, you also have the right to stop hospice care at any time. If you are thinking about going back to curative treatments, talk to your doctor about making the changes.

Are You Eligibility for Medicare Part A

You are eligible for Medicare Part A generally if:

  • You have reached the of age 65 or older, and you are a U.S. citizen or permanent legal resident of at least five years in a row.
  • You have (ESRD)end-stage renal disease.
  • You are already receiving retirement benefits.
  • You are disabled and receiving disability benefits.
  • You have(Lou Gehrig’s disease or ALS) amyotrophic lateral sclerosis.

Most people will not pay a premium for Medicare Part A if they have worked at least (40 quarters) or ten years and paid Medicare taxes while working. If you do not, qualify for the premium-free Medicare Part A, you can still enroll and pay a premium. If you delay enrollment until after you first become eligible for Medicare Part A you may be subject to a late enrollment penalty once they sign up.

Your Initial Enrollment in Medicare Part A

When you turn 65, and you are receiving Social Security retirement benefits or Railroad Retirement Board (RRB) benefits your enrollment in Medicare Part A will be automatic. Medicare Part A benefits begin the first day of your 65th birthday month. If your birthday is on the first day of the month, your benefits will start the month before you become 65. If you enrolled in Medicare Part B when you applied for retirement, your Part B coverage would start at the same time. Your red, white, and blue Medicare card will arrive about three months before your 65th birthday. IEP begins three months before your 65th birthday month and includes the month you turn 65 and ends three months after your 65th birthday month. The start of your coverage depends on when you enroll during the IEP. Be careful not to wait until the last minute to enroll. If you decide not to enroll during your seven-month IEP, then you will have to wait until the next GEP general enrollment period (January 1 to March 31) to enroll.

If you are disabled, enrollment in Medicare Part A hospital insurance (and Medicare Part B medical insurance) will begin after you have been receiving Social Security disability benefits for 24 months. Your coverage will start in the 25th month. Your Medicare card will arrive about three months before your coverage begins.

If you have ALS (also known as Lou Gehrig’s disease), your Medicare Part A hospital insurance (and Medicare Part B medical insurance) will automatically begin the same month that your Social Security disability benefits begin. Your Medicare card will arrive about one month after you sign up for Social Security disability benefits.

If you have end-stage renal disease (ESRD) and require dialysis, your Medicare effective date is usually the first day of the fourth month of your dialysis treatments. However, you need to apply for Medicare benefits; you’re not automatically enrolled if you’re younger than 65.

 

If you delayed enrolling in Medicare Part A, you may enroll during the next available General Enrollment Period, unless you are eligible for a Special Enrollment period (see below). The General Enrollment Period occurs each year from January 1 to March 31. If you sign up during general enrollment, your coverage will begin July 1 of that year, and your Medicare card will arrive about three months before your coverage begins.

If you are not eligible for premium-free Medicare Part A and did not enroll when you were first eligible, you may be subject to a late-enrollment penalty when you do sign up.

Special Enrollment Period for Medicare Part A

If you (or your spouse) lose your employer- or union-sponsored group hospital insurance, or if you were a volunteer serving in a foreign country, you may enroll in Medicare Part A immediately or during a Special Enrollment Period (SEP). The SEP is the eight-month period that begins the month after your employment or other group coverage ends (whichever happens first). If your employment ends during what would be your IEP (turning 65) you would follow the standard rules for initial enrollment IEP for Medicare Part A. You usually do not have to pay the late-enrollment penalty (if you pay a premium for Part A) if you qualify for a SEP. Your Medicare Part A coverage will begin the first of the month after you enroll.

If you a have general Medicare question or questions on Medicare supplement plans available in your area contact Indiana Insurance Alliance. We have over twenty Insurance carriers and can give you quotes over the phone in 5-minutes.

Contact Indiana Insurance Alliance for a consultation and free quotes. Already have a Medicare Supplement and you tired of paying too much for your Supplement premium let us help you save money. You can change plans and carriers anytime throughout the year

Seniors can sign up for Medicare directly at:

More questions?

Contact: IndianaInsurance Alliance

Website: www.INinsureALL.com

Phone: 765-462-6002

Email: kjones@INinsureALL.com


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