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Medicare Part A is sometimes called “hospital insurance.” It is funded by a payroll tax of 1.45% paid by employees and employers. Most individuals do not pay an annual premium for Part A coverage.
The services covered are:
- Hospitalizations
- Skilled nursing facility stays
- Home health care
- Hospice care
- Blood transfusions during a hospitalization or nursing facility stay
Service coverage is not all-inclusive, and there are guidelines for reimbursement and deductibles. For example:
- Time spent in a hospital is covered if ordered by the doctor and determined to be appropriate under Medicare guidelines. Lengths of stay in the hospital are reviewed by Utilization Review Committees. Medicare has a deductible for hospital stays as well as co-payments for days 61-90 and 91-150 during a hospital stay. The payment amounts change from year to year.
- Time spent in a Medicare-certified skill nursing facility is covered if a three-day related hospital stay preceeded the individual’s stay and a doctor prescribes skilled care. After day 20 there is a co-payment for each additional Medicare qualifying day up to day 100. A person must meet Medicare skilled criteria to continue receiving benefits up to day 100. During each episode of care, Medicare will no longer reimburse nursing home care after day 100.
- Home health care services are covered if a doctor prescribes skilled care provided by a health care professional such as a nurse or therapist and if it qualifies under Medicare guidelines. The are must come from a Medicare-certified home health care agency and the services must be intermittent in nature. The person receiving the care must be homebound, which means that the person is not normally able to leave the home and leaving the home takes considerable and taxing effort. A person may leave on occasion such as for doctor visits or to attend religious services. Medicare does not cover 24-hour in-home care or the use of an aide or assistant for personal care services on an on-going long-term basis.
- Hospice benefits are available for those covered under Medicare Part A. Individuals choosing Medicare hospice benefits would be selecting them instead of their regular Medicare benefits for care of their terminal illness. The hospice benefit covers an array of services to support individuals who are terminally ill and their families. The Centers for Medicare & Medicaid Services (CMS) produces a booklet that describes how the hospice benefit works. It can be printed from the web site at www.medicare.gov.
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