Medicare and all of its parts, from A through L, provide different coverage at different costs. Navigating the Medicare map can be almost impossible for people that are aging and dependent upon this care, leaving them befuddled and uncertain about what will be covered by what part and even if that coverage is something they have. Many seniors are filing medical bankruptcy, regardless of their Medicare coverage, because they didn't have what they thought they had or couldn't afford to pay for the higher care plan, which resulted in humongous hospital bills.
So, what does Medicare Part A cover? This is one kind of hospital insurance that covers inpatient care in critical access hospitals, nursing homes, hospitals and skilled nursing facilities. Certain people may meet the requirements for hospice or home health care, but even those explanations are impossible for many to understand and unless they have someone who is their advocate, will not avail themselves of these services. Part A does not, however, include long-term or custodial care.
Many seniors are also surprised at medical bills they receive when first being treated under Medicare. They unexpectedly find that not only does Medicare not cover everything; it doesn't, in many cases, cover the total cost of 'covered' services or supplies. Coverage amounts are based completely on which plan you have and Part A only covers 'medically necessary' services and there are rules and regulations at every turn.
Medicare, Part A, for instance, will cover blood transfusions that are received during a 'covered' stay in a hospital or skilled nursing facility. And, Part A also covers hospital stays, including miscellaneous hospital services, meals, general nursing requirements, a semi-private room and miscellaneous hospital supplies. But...a hospital stay must be at least 72 hours (3 days) and the time does not begin until the first midnight after admission and does not include any hours on the day that you are discharged. WHAT? If you are admitted at 12:05 a.m., your time does not start until the following midnight, and then you have to stay a full 72 hours, not including any of the hours on the day you are discharged. Let's do the math here. You will spend 23 hours and 55 minutes in the hospital until such time as your Medicare allowable time will start. Then, you have to stay 3-24 hour periods before you can even think about being discharged, which takes you to 12:05 a.m. on the 4th day following your admission, and then you can't be discharged until after midnight the following night because otherwise the 23 hours and 55 minutes on the 4th day following your admission will disqualify you for Medicare, Part A benefits by 5 minutes. And the hospitals are griping about how little they receive in benefits, when under this plan, they were able to keep the patient for 5 days rather than 3? And let's reiterate here: blood transfusions are only covered during a 'covered' hospital stay. By the way, you can also be covered for up to 190 days in a mental care facility (in your lifetime, on Medicare, Part A), which you will need once you've tried to figure Part A out.
On to Nursing Homes and Skilled Nursing Facilities. Your requirement for these services must be associated with a diagnosis obtained during a hospital stay. It is unclear if the 'covered' hospital stay language is in effect here. Anyway, say you have a stroke and then need rehabilitative care in one of these facilities. Medicare will allow you up to 100 days-in a benefit period. Medicare will gladly pay the first 20 days in full, but the rest of the time, up to 80 additional days, will require co-payment, which can add up to quite a few dollars. You're really lucky if you have your stroke on September 22nd (September 21st in leap years) because then you can stay to the end of the year and start a new benefit period and get an additional 100 days. Oh, wait a minute...maybe you have to have your stroke 5 days earlier so that your hospital stay is a 'covered' one. I think more research may be required.
Home Health Services are also covered, but include only limited 'reasonable' and only 'medically necessary' part-time care. It also includes services such as occupational or physical therapy, speech/language pathology, skilled nursing care, home health aide service and medical social services. As long as it is 'medically necessary' and 'reasonable' Medicare will also cover certain medical equipment for home use, such as wheelchairs, oxygen, walkers and hospital beds. There is no mention of toilet seat risers or shower seats, so you will probably have to buy them yourself, though gauze, bandages and other medical supplies will be covered.
Hospice Care is only for the terminally ill with 6 months, or less, to live. Medicare, Part A will not cover your care in a hospice center, but will cover a hospice caregiver that comes to your home. Drugs to provide pain relief and to control symptoms will be covered, though this may be reviewed since Medicare does not cover prescription drugs. Support and medical services and other services are also covered as is additional care in order to give the usual caregiver a time of rest. The hospice care agency must be Medicare-approved and be aware that there are many services provided by hospice that Medicare Part A does not cover.
If you are totally confused about Part A, you are not alone. As baby boomers become golden boomers, the numbers of Medicare-confused seniors will continue to rise. Maybe it's time for some real people, rather than politicians and bureaucrats, to look at the wasted money (5 day hospital stay instead of 3) that occurs throughout the system and to make this system that is supposed to help seniors more user-friendly and able to provide more for less.
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