Medicare Part A and its Role in Long-Term Care

The need for long-term care can be for several reasons. Some elderly patients require extended care beyond the hospital walls because of chronic conditions the confine them to their homes. Other patients need long-term care to cope with terminal illnesses such as cancer and severe kidney failure. Your need for long-term care should not be […]

The need for long-term care can be for several reasons. Some elderly patients require extended care beyond the hospital walls because of chronic conditions the confine them to their homes. Other patients need long-term care to cope with terminal illnesses such as cancer and severe kidney failure. Your need for long-term care should not be overshadowed by the cost for such services. Medicare Part A may be able to help in the instances where long-term care is needed and personal finances are not available to pay.

Just why would a person need long-term care as provided by Medicare Part A, though? Read on to find out!

A general overview of Medicare Part A

There are essentially two components of Medicare health coverage. Medicare Part B is the individual’s medical insurance, which may be used for preventative care such as yearly examinations and prescription services. Medicare Part A, on the other hand, is strictly for hospital visits and long-term stays.

Medicare Part A covers things such as inpatient care along with extended stays at a skilled nursing facility. The coverage may also be used to pay for home care in instances where a doctor who is certified by the Medicare program deems such treatment as necessary. Medicare Part A may also be used to pay for expenses related to hospice care not limited to counseling to help the patient cope with grief brought about by terminal illness.

Hospital Care

Medicare Part A pays for hospital care for individuals admitted for several days. The coverage includes expenses related to life-saving care. Medicare Part A will pay for a patient’s room and board where such includes a semi-private living area. The coverage does not extend to a private room unless such is deemed as absolutely necessary by a medical doctor.

Meals, as well as nursing services, also come as a part of expenses related to hospital care. Medications deemed necessary by a medical doctor are also covered as long as the patient is under the care of hospital staff. The patient may need to rely on other forms of insurance if he is discharged from the hospital and needs to have pharmaceutical prescriptions filled. Medicare Part A typically does not provide coverage in such instances.

There is, however, inpatient coverage that includes:

  • Acute Care
  • Critical Access
  • Access to Rehabilitation Facilities
  • Mental Health Care
  • Access to Long-term Hospital Facilities

Individuals may also receive the opportunity to participate in clinical research studies as legitimate by Medicare.

One thing that Medicare Part A does not always pay for in hospital care is blood. The coverage does not charge the patient if there is enough blood available at the facility. Medicare Part A patients are charged for the first three units of blood, however, if the hospital must place an order for delivery to an outside source.

Private-duty nurses are also not included in Medicare Part A hospital coverage. Personal items such as shampoo and razors are also the patient’s financial responsibility.

Home Health Care

There are many benefits associated with home health care. Many elderly patients require additional assistance at home and, thus, find the need to hire a skilled nurse or nurse’s assistant to help with daily tasks as well as medication schedules.

Home health care is not a given in the world of Medicare Part A. This type of coverage is only paid for by the provider if a medical doctor deems the patient as home-bound and, thus, unable to get out into society without considerable effort. Most patients who qualify for home health care are practically immobile and would require substantial assistance just to make it to the nearest grocery store. Coming to a medical facility frequently is a serious burden for such individuals.

Medical equipment may also come with home health care. Of course, such material must be deemed as necessary by a medical doctor. Medicare Part A does not pay for medical equipment. A patient can, however, seek to have up to 80 percent of his bill for such products covered by his Medicare Part B insurance plan.

It is important to reiterate that Medicare Part A does not cover home health services around the clock, which may include meals and the services of a health aide, unless deemed as absolutely critical to recovery or care by a medical doctor. A patient cannot request such services on his own.

Hospice Care

The focus of hospice care as it relates to Medicare Part A is palliative care. A patient must give up curative efforts to be approved for hospice care coverage through Medicare Part A. While there is no rule that restricts a patient to surrendering his right for curative care forever, an individual cannot have both hospice and curative care at the same time under Medicare Part A coverage.

A patient is eligible for hospice care coverage if his medical doctor has certified that the individual has a terminal illness that only allows for six months or less of life. Individuals in the final stages of cancer may find that Medicare Part A pays for hospice coverage after all curative methods of care have been exhausted.

Palliative care is concerned with providing comfort to the patient as he passes through the final stages of life. There is, therefore, little if any focus on extending the life cycle. In providing comfort to patients, hospice care may include spiritual and grief counseling. Medicare Part A covers such services for the remainder of the patient’s life.

Hospice care under Medicare Part A is usually covered only if the patient receives such treatment at a Medicare-approved facility. There are instances, however, where the coverage extends to individuals who prefer to live out their remaining time from the comforts of home. Of course, a medical doctor would need to approve such long-term care before payment is dispersed.

Who is eligible for Medicare Part A?

Individuals over the age of 65 years old who have paid Medicare taxes are eligible for premium-free Part A coverage. Patients whose spouses have paid Medicare taxes are also eligible for premium-free Medicare Part A coverage so long as they are over the age of 65.

Those patients and their spouses who have not paid Medicare taxes but are eligible for benefits from either Social Security or the Railroad Retirement Board may be able to obtain premium-free coverage even if they have not filed for such benefits. Those individuals and their spouses over 65 years old who had Medicare-covered government employment are also eligible for premium-free Medicare Part A coverage.

What if none of the above eligibility qualifications apply?

You can still reap the benefits of Medicare Part A even if you do not qualify for premium-free coverage. There is an option that allows individuals over the age of 65 to obtain coverage through a premium plan in which they pay a maximum of $437 per month for Part A insurance. You will only have to pay such an amount if you paid Medicare taxes for fewer than 30 quarters when you worked full-time in the workforce. Those individuals who paid Medicare taxes for more than 30 quarters when they worked only need to pay $240 per month in premium insurance fees.

Other Stipulations

Individuals who choose Medicare Part A are also typically required to have Medicare Part B coverage. You may need to pay monthly premiums for both Medicare Part A and Medicare Part B if you do not qualify for premium-free coverage.

In both instances of premium-free and paying a monthly fee for coverage, the individual may find the need to also pay a co-payment for preventive care. The bulk of the costs associated with yearly doctor’s visits may be covered by Medicare Part B. The patient, however, is responsible for paying the remaining balance on the account to remain in good standing with their physicians.

The good news about Medicare coverage is that fees passed on to the patient are typically minimal. An elderly person who needs home care will likely not pay thousands for such services under Medicare Part A. Equally speaking, individuals required to make co-payments will likely pay no more than $50 per visit.

Let a skilled professional help

It is not the best idea to navigate the world of health care coverage alone. There are many ins and outs in the field that, when misunderstood, could lead to denial of coverage. A skilled specialist in the industry can help you get the coverage you need when you need it the most.

Seeking professional help is especially crucial if you believe that long-term care is needed. Medicare is fairly strict when it comes to approving or denying services under its Part A coverage for long-term care. It is difficult to appeal a decision once denied. The patient, then, does himself a great service to ensure that all of his paperwork is in order so that a medical doctor can see the need for long-term care and recommend such service to the provider.

A skilled professional can help you understand the intricate workings of the healthcare industry so that you are better equipped to get the care that you need. Seek out such services in your area today!

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