Understanding What Medicare A Pays For

Introduction

Medicare is a federally funded health insurance program that provides coverage for individuals who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD). Medicare is divided into four parts—A, B, C, and D—each of which covers different types of medical services and supplies. This article will focus on Medicare Part A, which covers inpatient hospital care, skilled nursing facility services, home health care, and hospice care.

Explaining the Basics of Medicare A Coverage

In order to be eligible for Medicare A coverage, you must be enrolled in Medicare Parts A and B. Medicare Part A is free if you or your spouse worked and paid Medicare taxes while employed. If you do not qualify for premium-free Part A, you can purchase it from the Social Security Administration. Once you are enrolled in Medicare A, you will have access to a variety of medical services and supplies.

Medicare A covers inpatient hospital care, skilled nursing facility services, home health care, and hospice care. Inpatient hospital care includes hospital stays, including doctor visits, lab tests, surgery, and other treatments received while in the hospital. Skilled nursing facility services provide care from nurses, therapists, and other medical professionals in a nursing home or rehabilitation center. Home health care provides nursing visits and other health care services in the patient’s home. Hospice care is end-of-life care provided to a terminally ill patient in their home or a hospice facility.

Outlining What Medical Expenses Medicare A Covers

Medicare A covers a wide range of medical expenses related to hospitalization, including:

• Inpatient hospital care
• Skilled nursing facility services
• Home health care
• Hospice care

Inpatient hospital care covers hospital stays, including doctor visits, lab tests, surgery, and other treatments received while in the hospital. It also covers some outpatient services such as emergency room visits and certain diagnostic tests.

Skilled nursing facility services cover care from nurses, therapists, and other medical professionals in a nursing home or rehabilitation center. These services may include physical therapy, occupational therapy, speech therapy, and other specialized services.

Home health care covers nursing visits and other health care services in the patient’s home. Services may include wound care, intravenous therapy, and other medical treatments provided by a nurse or therapist.

Hospice care is end-of-life care provided to a terminally ill patient in their home or a hospice facility. Services may include pain management, spiritual counseling, and emotional support.

Examining How Medicare A Pays for Hospitalization

When you are hospitalized, Medicare A pays for the costs associated with your stay. The amount of coverage depends on whether you are admitted as an inpatient or an outpatient. Medicare A has two payment components: a deductible and coinsurance payments.

The Part A deductible is a set fee that you must pay before Medicare A will cover any of your hospital costs. The deductible for 2019 is $1,364 per benefit period. A benefit period begins when you enter a hospital and ends when you have been out of the hospital for 60 days in a row.

After you have met the deductible, Medicare A will cover the remaining costs, up to a certain amount. This amount is known as coinsurance. For each day of hospitalization, you are responsible for a coinsurance payment of $341. This payment is due per benefit period.

Understanding the Difference Between Medicare A and Medicare B

It is important to understand the difference between Medicare A and Medicare B. Medicare A covers inpatient hospital care, skilled nursing facility services, home health care, and hospice care. Medicare B covers physician services, preventive services, outpatient care, and medical equipment.

The main difference between Medicare A and Medicare B is that Medicare A does not cover outpatient services or medical equipment. Medicare B covers these services and items, as well as physician services, preventive services, and laboratory tests. Medicare B also requires a monthly premium and an annual deductible.

Each type of coverage has its own pros and cons. Medicare A is free and covers hospitalization and skilled nursing facility services, but does not cover outpatient services or medical equipment. Medicare B requires a premium and deductible, but covers a wider range of services.

Describing What Medicare A Does Not Cover

It is important to note that Medicare A does not cover all medical expenses. Medicare A does not cover long-term care, most dental care, eye exams, hearing aids, and prescription drugs. Medicare A also does not cover non-medical services such as meals, transportation, and personal care.

Exploring Supplemental Insurance Options with Medicare A

Medicare A does not cover all medical expenses, so it is important to consider supplemental insurance options. One option is Medigap, which is a supplemental health insurance policy that helps cover the gaps in Medicare A and B coverage. Medigap policies are available through private insurance companies and can help cover the cost of deductibles, coinsurance, and copayments.

Another option is a Medicare Advantage plan, which is a type of private health insurance plan that is offered by Medicare-approved private insurance companies. Medicare Advantage plans often offer additional benefits such as vision, dental, and prescription drug coverage. They also typically have lower premiums than traditional Medicare.

Investigating Cost Sharing with Medicare A

When you are enrolled in Medicare A, you may be responsible for cost sharing. Cost sharing refers to the amount of money you must pay out of pocket for medical expenses. Common cost sharing expenses with Medicare A include deductibles, copayments, and coinsurance.

The Part A deductible is the amount you must pay before Medicare A will cover any of your hospital costs. After you have met the deductible, you will be responsible for coinsurance payments. Coinsurance payments are a percentage of the total cost of your hospital stay.

You may also be responsible for copayments. Copayments are a fixed fee that you must pay for certain services, such as doctor visits or laboratory tests. Copayments vary depending on the service received.

Conclusion

Medicare A is a federal health insurance program that covers inpatient hospital care, skilled nursing facility services, home health care, and hospice care. Medicare A does not cover all medical expenses, so it is important to consider supplemental insurance options such as Medigap and Medicare Advantage plans. When enrolled in Medicare A, you may be responsible for cost sharing expenses such as deductibles, copayments, and coinsurance.

For more information about Medicare A and other Medicare programs, visit the official website of the Centers for Medicare & Medicaid Services at www.cms.gov.