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Michigan Elder Law Today

Wednesday, July 11, 2012

Medicare Part A

Medicare Part A provides health care coverage for care in hospitals as well skilled care in nursing home or rehabilitation centers.  Medicare Part A also provides coverage for care provided in hospice facilities and certain home health care services.

An important distinction to note is that Medicare Part A does not provide coverage for custodial care in nursing homes.  Custodial care is care that is needed when an elderly person needs assistance with the activities of daily living, such as bathing, eating, getting dressed, transferring, medication management, help in the bathroom, or needs to live in a protective environment.  That care is expensive and is either paid for out of an individual’s savings, long-term care insurance, or if one qualifies for Medicaid.

Anyone who is 65 years or older and who is entitled to Social Security is eligible for Medicare Part A.  There are no premiums for Medicare Part A after attaining age 65.  However, during the years someone is working and receiving a paycheck, there is a Medicare tax of 1.45% on all earnings.  This amount is withheld from one’s paycheck as a contribution to fund the Medicare program that one will be entitled to receive benefits from after obtaining age 65 and becoming eligible for Social Security benefits.

Medicare Part A’s Hospital Benefit

Medicare Part A will pay for up to 90 days of hospital care per spell of illness. In addition, Medicare will pay for another 60 lifetime reserve days of hospital care.  A spell of illness begins when a person is admitted to the hospital and ends after the person leaves the hospital and then goes another 60 days without being readmitted to a hospital.  There is no limit on the amount of spells of illness one may have and still receive coverage.  However, there is a $1,156.00 deductible that individuals must pay before Medicare begins paying for services.  Many people have supplemental health insurance policies that will pay for all or part of this deductible.

After the deductible is paid, Medicare will pay for virtually all hospital charges during the first 60 days of a patient's hospitalization, other than television and telephone expenses. Medicare coverage includes:

  • Nursing services in the hospital
  • Operating room, coronary unit charges, and intensive care unit charges.
  • Medications provided by the hospital
  • X-rays
  • Laboratory tests in the hospital
  • a bed in a semiprivate room, meaning a room with at least one other patient. Medicare will pay for a private room only if it is medically necessary.
  • Medical supplies
  • Medical social services
  • Therapy - physical and occupational
  • speech therapy

Medicare Part A does not pay for treatments or procedures that are considers medically unproven or experimental.

If the hospital stay extends beyond 60 days, the Medicare patient must beginning paying more of the cost of his or her care. From day 61 through day 90, the patient pays coinsurance of $289 a day in 2012. Beyond the 90th day, the patient begins to use his or her 60 lifetime reserve days. During hospital stays covered by these reserve days, patients must pay coinsurance of $578 per day in 2012. The 60 day reserve is not reset after each "spell of illness." Once they have been exhausted, the patient will receive coverage for only 90 days when the next spell of illness begins.

Medicare Part A also pays for stays in psychiatric hospitals, but payment is limited to a total of 190 days of inpatient psychiatric hospital services during a person's lifetime.  This coverage is used more than one would expect, because many age related health issues, such as dementia, have a psychiatric component that may require treatment in a psychiatric hospital.  This typically happens when an older person’s dementia causes them to become violent.

The next post in this series will discuss hospital discharge issues under Medicare Part A.

 


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