Lesson 05: Medicare Part A
Medicare Part A
Medicare Part A, hospital insurance helps pay for inpatient hospital care, limited care within a skilled nursing facility, some home health care and hospice care. For most people, Part A has no monthly fee or premium. This is because you or your spouse paid Medicare taxes while working. If you or your spouse didn`t pay Medicare taxes, you may be able to buy Medicare Part A.
Inpatient Hospital Care paid for by Medicare includes semi-private room, meals, general nursing, and other hospital services and supplies (this includes care in critical access hospitals). Medicare does not pay for private duty nursing or for a television or telephone in your room. A private room is not covered unless it is medically necessary. Inpatient mental health care coverage in an independent psychiatric facility is limited to 190 days in a lifetime.
There are 90 renewable hospital days within each benefit period. After the deductible has been paid, Medicare pays for all or part of 90 renewable days of treatment. The "first" 60 days are covered at 100% while days 61-90 require a daily co-insurance payment of $341/day in 2019. Remember a new benefit period does not begin until you have been out of the hospital or nursing home for 60 consecutive days.
If a person is in the hospital beyond the 90 days within a benefit period, he/she begins to use the 60 non-renewable "lifetime reserve" days. These days also require a daily co-insurance payment. Click here for information about Medicare premiums and copayments.
Once the 60 non-renewable lifetime reserve days have been exhausted, the patient is responsible for the entire bill unless he/she has supplemental insurance that will pay it. Very few people exhaust their lifetime reserve days. However, even if they are exhausted, Medicare would still cover the first 90 days of a new benefit period.
Note: Coverage for hospital care does not include the doctor visits. They would be billed separately.
Early Dismissal from the Hospital
If the patient feels that they have been sent home too soon, they have the right to appeal the hospitals decision and remain in the hospital at no extra charge while the appeal is considered.
The hospital must offer a written Notice of Non-Coverage. If the patient is not given a copy, they should ask for one! To appeal the early dismissal, the patient must contact the Quality Improvement Organization (QIO) for Ohio before noon of the following business day.
Contact:
Ohio KePro
800-589-7337
Rock Run Center, Suite b100
5700 Lombardo Center Drive
Seven Hills, OH 44131