Understanding Medicare Part A: What Counts As An Event?

Medicare is a federal health insurance program for individuals aged 65 and older, as well as some individuals under 65 with certain disabilities or conditions. Original Medicare, which includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), covers inpatient hospital care, doctors' services, tests, and preventive services. Medicare Part A specifically helps cover inpatient care in hospitals, skilled nursing facilities, hospice care, and some home health care. Special Enrollment Periods allow individuals to make changes to their Medicare coverage when certain life events occur, such as moving or losing other coverage. These periods provide a window of time to join or switch plans.

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Inpatient hospital care

Medicare Part A is federal health insurance for anyone aged 65 and over, as well as some people under 65 with certain disabilities or conditions. It is also available to those who are receiving dialysis treatments or a kidney transplant. Part A helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

To be eligible for premium-free Part A, an individual must meet certain criteria. They must have worked and paid Medicare taxes for a certain period, known as quarters of coverage (QCs), and filed an application for Social Security or Railroad Retirement Board (RRB) benefits. Alternatively, they can be the spouse or dependent child of someone who meets these requirements. Additionally, individuals receiving regular dialysis treatments or a kidney transplant may qualify for premium-free Part A.

It is important to note that Medicare Advantage, also known as Part C, is an alternative to Original Medicare offered by private companies. These plans typically include Part A, Part B, and sometimes Part D, and may have different out-of-pocket costs and provider networks than Original Medicare. However, they are still required to cover all the services that Original Medicare covers.

Hospice care

To qualify for hospice care under Medicare Part A, patients must meet specific criteria:

• The patient must be certified as terminally ill by their attending physician or primary care provider, with a prognosis of six months or less to live.
• The patient must sign an election statement, choosing hospice care and waiving rights to Medicare payments for curing their terminal illness and related conditions.
• The patient must accept comfort care (palliative care) instead of treatment to cure their illness.
• The patient must receive hospice care from the chosen hospice provider, and all care for the terminal illness must be given or arranged by the hospice team.

Medicare pays hospice agencies a daily rate for each day a patient is enrolled, covering routine home care, continuous home care, and short-term inpatient pain control and symptom management. Hospice care can be provided at home, in a skilled nursing facility, an assisted living facility, or an inpatient hospice facility. It is important to note that Medicare does not cover room and board costs if the patient receives care at home or in a nursing home/hospice inpatient facility.

Medicare hospice benefits can provide significant financial assistance, but understanding the qualifications, coverage, and rules can be challenging. Working closely with the patient's primary doctor and hospice team is essential to ensure the necessary treatment and maximize the benefits available through their Medicare plan.

Home health care

Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health services as long as you need part-time or intermittent skilled services and are "homebound". Being homebound means that you have trouble leaving your home without help or special transportation due to an illness or injury. It is not recommended that you leave your home because of your condition, and you are normally unable to leave your home because it requires a major effort.

To be eligible for home health care under Medicare Part A, you must have spent at least three consecutive days as a hospital inpatient or have had a Medicare-covered SNF stay. Medicare Part A will then cover the first 100 days of home health care. You must also receive home health services within 14 days of your hospital or SNF discharge to be covered under Part A. Any additional days past 100 are covered by Part B. Regardless of whether your care is covered by Part A or Part B, Medicare pays the full cost.

Under Medicare Part B, you are eligible for home health care if you are homebound and require skilled care, even if you have not been previously hospitalized. There is no prior hospital stay requirement for Part B coverage of home health care, and there is no deductible or coinsurance for Part B-covered home health care.

Home health services that are covered by Medicare, when ordered by your doctor, include:

• Part-time or intermittent skilled nursing care
• Physical therapy
• Occupational therapy
• Nutrition support
• Speech-language pathology services
• Part-time or intermittent home health aide care, but only if you are also receiving skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy at the same time
• Injectable osteoporosis drugs for women
• Medical social services
• Medical supplies
• Durable medical equipment (DME)

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Eligibility for premium-free Part A

Medicare is federal health insurance for anyone aged 65 or older and some people under 65 with certain disabilities or conditions. To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child.

If you are eligible for Medicare due to a disability, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS), you are eligible for premium-free Part A. If you return to work, you can keep your Medicare coverage indefinitely as long as you remain medically disabled. For the first 8.5 years of being back at work, you will not have to pay the Part A premium. After that, you will have to pay the Part A premium yourself. If your income is too low to afford the premium, you may be eligible for the Qualified Disabled and Working Individuals (QDWI) program or the Qualified Medicare Beneficiary (QMB) program, which pays for your Medicare Part A and Part B premiums and other Medicare costs.

To receive premium-free Part A, the worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. The exact number of QCs required depends on whether the person is filing for Part A on the basis of age, disability, or ESRD. An individual who is receiving monthly Social Security or RRB benefits at least four months prior to turning 65 does not need to file a separate application to become entitled to premium-free Part A. In this case, the individual will get Part A automatically at age 65. An individual who is not receiving monthly Social Security or RRB benefits must file an application for Medicare by contacting the Social Security Administration.

Individuals are also eligible for premium-free Part A if they receive regular dialysis treatments or a kidney transplant, have filed an application for Medicare, and meet one of the following conditions: they have worked the required amount of time under Social Security, the RRB, or as a government employee; they are getting or are eligible for Social Security or RRB benefits; or they are the spouse or dependent child of a person who has worked the required amount of time under Social Security, the RRB, or as a government employee, or they are getting Social Security or RRB benefits. You may also be eligible for premium-free Part A if you were a federal employee anytime after December 31, 1982, or a state or local employee anytime after March 31, 1986.

Disenrollment from Part A

Disenrollment from Medicare Part A is only possible if you pay a premium for it. If you have premium-free Part A, you cannot voluntarily terminate your coverage. This is because, once enrolled, you are no longer eligible to contribute to an HSA.

To disenroll from Part A, you usually need to send a written request with your signature. You can contact your local Social Security office to do this. If you have recently received a welcome packet for automatic enrolment in Medicare Part A and Part B, you can follow the instructions in the welcome packet and send your Medicare card back. If you keep the card, you will be keeping Part B and will have to pay the monthly premium. Your coverage will end at the end of the month after you file the request.

If you are dropping Part B and keeping Part A, you will receive a new Medicare card showing that you only have Part A coverage. If you change your mind about cancelling your coverage, you need to contact the SSA before the date your coverage ends.

If you qualify for multiple Special Enrollment Periods, you can use them to make changes to your Medicare Advantage and Medicare drug coverage. For example, you can join a stand-alone Medicare drug plan by dropping a Medicare Advantage Plan with drug coverage.

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