by Kristin P. Sinclair – March 2, 2019
We know that Medicare has several different parts. Today we will be focus on Medicare Part A of Original Medicare.
Medicare Part A has a Hospital Deductible of $ 1,364.00 per benefit period deductible. You might be wondering what a benefit period is ? Well it is a continuous or unbroken number of days within a calendar year. So a person in the hospital as an inpatient on different occasions during a year could face several Part A Hospital Deductibles. It is very important to understand the potential Part A Deductible financial responsibility you might face. Therefore, it is very important to understand that Medicare does not cover all potential costs.
Another factor to consider with Medicare Part A. If a person were to be continuously hospitalized for a period greater than 60 days, then the beneficiary would be responsible for $ 341.00 per day for days 61 through day 90. Medicare would pay all Medicare approved costs above and beyond the $341.00 per day for days 61 through day 90.
With Medicare Part A if a person were to be continuously hospitalized for a period greater than 90 days, then day 91 through day 150 Medicare would pay costs after the beneficiary paid their cost sharing of $682.00 per day. For example, if you were hospitalized for days 91 through 150, then Medicare would pay all Medicare approved costs except for $682.00 per day. Note that Hospitalization days 91 through 150 are called Lifetime Reserve Days. Once these days are used they do not become available again. Each of the 60 Lifetime Reserve Days in Original Medicare are only available to be used one time. So please remember that while Medicare provides fabulous coverage; Medicare does not; cover all of your potential medical expenses.
You should also plan on additional Medicare insurance products. You do have choices and We will discuss those options in a different article.
Medicare will also pay for needed blood, only after the Medicare Beneficiary has paid for the first three pints of blood. This is an additional example of how fortunate we are to have Medicare Part A when we need to start receiving those benefits. Again, Medicare alone is not enough coverage.
If the Medicare Beneficiary was a hospital admitted as an inpatient for three full nights and days, and within 30 days after the hospitalization, needed to receive Skilled Nursing Care related to that hospitalization which has just occurred, then Medicare Part A would pay the first 20 days of Medicare approved Skilled Nursing Care. Skilled Nursing Care may be received in a Skilled Nursing facility or in your home. In the event that additional days of Skilled Nursing Care were needed, then Medicare would pay all but $ 170.50 per day for day 21 through day 100. Medicare pays for no additional days after day 100 of Skilled Nursing Care. Medicare does not cover Long Term Care.
Skilled Nursing Care is a higher level of care than Custodial Nursing Care. Medicare does not pay for Custodial Nursing Care. You might not have been aware that most people who reside in a nursing home are actually receiving for the most part Custodial Care. Again, regarding Custodial Care, Medicare normally does not pay for that level of care. Those with assets will be paying for Custodial Care with their Assets until the spending down has occurred.
Please note that your health care professional and Medicare might determine that ongoing Skilled Nursing Care could help further your at-home recovery. This would help you become more self sufficient again. Skilled Level Home Health Care would only be indicated if the Medicare Beneficiary were homebound, and leaving the home is extremely difficult. Plus care is needed by trained medical professionals such as a nurse, an occupational therapist, a speech therapist, or a physical therapist. Plus the care must be provided by a Medicare Approved Home Health Agency and trained professional care providers. This care is intermittent which means you need Skilled Nursing Care just not continuously.
Sometimes, the level of care a person requires is the type of care which is provided by Hospice or Palliative Care. This care would only be indicated once the Medical Professionals offering your care have determined that the Medicare Beneficiary health status has reached a level of terminal illness therefore likely that death is anticipated within 6 months. You sign a statement saying you are seeking Hospice Care rather than Medicare services to seek treatment for the condition. Medicare will normally pay for 95% of the Medicare approved costs associated with Hospice care. So the Hospice Patient could have a 5% responsibility for the respite care received. Medicare does not cover the costs associated with Room and Board when in home care is sought, nor when Room and Board costs would be a factor when hospice care is being offered in another facility such as a nursing home. Often a patient would receive care in a Hospice Facility that has a mission in their charter to assist with care at end of life.
Medicare also helps to cover the costs of the medications which are indicated for palliative and comfort care during the period of Hospice care. The Medicare Beneficiary would be responsible for a $5 co-pay for the medications used to help alleviate pain during this end-of-life period for the medications covered by Medicare Part A. It is possible that help will be needed by the Medicare Part D provider for the medication items that are covered by that formulary rather than Medicare Part A. Hospice care is not the type of care that is to be sought when a cure for your condition is the goal. Rather Hospice and Palliative Care is desired to make the patient as comfortable and pain-free as possible during these difficult final days of life. To help the patient have a peaceful period during the end of life period that Hospice Care and Palliative Care is being sought.
Since Medicare does not cover the full costs associated with Hospice Care this is an additional example of the need for additional insurance to help lessen the financial responsibility for family members and the medicare beneficiary during Hospice Care.
Updated in Rock Hill SC and Charlotte NC
by Kristin P Sinclair (803)329-0615
March 2, 2019