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Medicare Part A

 

Medicare Part A helps pay for Inpatient Hospital Care, Skilled Nursing Facility (SNF) Care, Home Health Care, and Hospice Care.

Medicare Part A Premium for 2016:

  • Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of paid Medicare taxes through employment.
  • If you purchase Part A, the premium is $411.00 per month.

Medicare Part A Deductible amount in 2016 is $1,288.

 

Inpatient Hospital Care - Medicare covers up to 90 days each benefit period plus 60 lifetime reserve days in a hospital. It also covers up to 190 lifetime days in a Medicare-certified specialty psychiatric hospital.

Inpatient Hospital Copayment and Co-insurance:

  • $1,288 (2016) deductible and $0 co-insurance for days 1-60 each benefit period.
  • $322 (2016) per day for days 61-90 each benefit period.
  • $644 (2016) per lifetime reserve day after day 90 each benefit period (up to 60 days over your lifetime).
  • All costs for each day after the lifetime reserve days.
  • Inpatient mental health care in a psychiatric hospital limited to 190 days in a lifetime.

Inpatient Hospital Stays include a semi-private room, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. Medicare doesn’t cover private-duty nursing, a television or telephone in your room. It also doesn't cover a private room unless medically necessary.

Skilled Nursing Facility Care - Medicare covers up to 100 days each benefit period. Includes semi-private room, meals, skilled nursing and rehabilitative services, and other services and supplies that are medically necessary after a 3-day minimum inpatient hospital stay for a related illness or injury. An inpatient hospital stay begins the day you’re formally admitted with a doctor’s order and doesn’t include the day you’re discharged. To qualify for care in a skilled nursing facility, your doctor must certify that you need daily skilled care like intravenous injections or physical therapy.

Skilled Nursing Facility Copayment and Co-insurance:

  • $0 for the first 20 days each benefit period.
  • $161.00 per day for days 21-100.
  • All costs for each day after day 100 in a benefit period.

Home Health Care is limited to medically-necessary part-time or intermittent skilled nursing care, speech-language pathology, or a continuing need for occupational therapy. A doctor enrolled in Medicare, or certain health care providers who work with the doctor, must see you before the doctor can certify that you need home health services. That doctor must order your care, and a Medicare-certified home health agency must provide it. Home health services may also include medical social services, part-time or intermittent home health aide services, and medical supplies for use at home. You must be homebound, which means that leaving home is a major effort.

Home Health Care Copayment and Co-insurance:

  • $0 for home health care services
  • 20% of the Medicare-approved amount for durable medical equipment

Hospice Care is for people with a terminal illness. Your doctor must certify that you’re expected to live 6 months or less. Coverage includes drugs, for pain relief and symptom management; medical, nursing, and social services; certain durable medical equipment and other covered services as well as services Medicare usually doesn’t cover, such as spiritual and grief counseling. A Medicare‑approved hospice usually gives hospice care in your home or other facility where you live like a nursing home.

Hospice care doesn’t pay for your stay in a facility (room and board) unless the hospice medical team determines that you need short‑term inpatient stays for pain and symptom management that can’t be addressed at home. These stays must be in a Medicare-approved facility, such as a hospice facility, hospital, or skilled nursing facility which contracts with the hospice. Medicare also covers inpatient respite care which is care you get in a Medicare-approved facility so that your usual caregiver can rest. You can stay up to 5 days each time you get respite care. Medicare will pay for covered services for health problems that aren’t related to your terminal illness. You can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies that you’re terminally ill.

Hospice Care Copayment and Co-insurance:

  • $0 for hospice care
  • A copayment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management
  • 5% of the Medicare-approved amount for inpatient respite care (short-term care given by another caregiver, so the usual caregiver can rest)

     

     

The Facts

The Insurers

Medicare Supplement Insurers
 

The States

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Medicare Supplement Plans by State
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Alaska D.C. Iowa Michigan New Hampshire Oregon Utah
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Arkansas Georgia Kentucky Mississippi New York Rhode Island Virginia
California Hawaii Louisiana Missouri North Carolina South Carolina Washington
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