| Most of us know that The Part A program provides | | | | specialty psychiatric hospital when your Medicare |
| compensation for healthcare or medically needed | | | | coverage goes into effect, Medicare may retroactively |
| services for hospitalization, however there are certain | | | | cover you for up to 150 days of hospitalization before |
| caps in benefits you should be aware of in order to | | | | your coverage began. In all other ways, inpatient |
| make precautionary arrangements. To conceptually | | | | psychiatric care is governed by the same rules |
| grasp and understand Part A, you need basic | | | | regarding coverage and co-payments as standard |
| information about the programs payment allocation, for | | | | hospital care. There is no lifetime limit on coverage for |
| hospitals, nursing facility, or home health care, as well | | | | inpatient mental health care in a general hospital. |
| as benefit periods and coinsurance amounts. How | | | | Medicare will pay for mental health care in a general |
| much Medicare Part A pays depends on how many | | | | hospital to the same extent as it will pay for other |
| days of inpatient care you have during what is called a | | | | inpatient care. |
| benefit period or spell of illness. | | | | Skilled Nursing Facilities. |
| A benefit period or spell of illness refers to the time | | | | Despite the common misconception that nursing |
| you are treated in a hospital or skilled nursing facility, or | | | | homes are covered by Medicare, the truth is that it |
| some combination of the two. The benefit period | | | | only covers a limited amount of inpatient nursing care. |
| begins the day you enter the hospital or skilled nursing | | | | For each benefit period, Medicare will cover only a |
| facility as an inpatient, and continues until you have | | | | total of 100 days of inpatient care in a skilled nursing |
| been out for 60 consecutive days. If you are in and | | | | facility. For the first 20 of 100 days, Medicare will pay |
| out of the hospital or skilled nursing facility several | | | | for all covered cost, which will include all basic services |
| times but have not stayed out completely for 60 | | | | excluding television, telephone, or private room charges. |
| consecutive days, all your inpatient bills for that time will | | | | For the following 80 days, the patient is personally |
| be figured as part of the same benefit period. | | | | responsible for a daily co-payment; Medicare pays the |
| Hospital Reimbursement. | | | | rest of covered cost. Reserve days, available for |
| Medicare Part A pays only certain amounts of | | | | hospital coverage, do not apply to a stay in nursing |
| hospitalization for any one benefit period. | | | | facility. After 100 days in any benefit period, you are on |
| The Deductible. | | | | your own as far as Part A hospital insurance is |
| For each benefit period, you must pay an additional | | | | concerned. However, if you later begin a new benefit |
| amount before Medicare will pay anything. This is | | | | period, your first 100 days in a skilled nursing facility will |
| called the hospital insurance deductible. The deductible | | | | again be covered. |
| is increased every January. | | | | Home Health Care. |
| First 60 Days. | | | | Medicare Part A pays 100% of the cost of your |
| For the first 60 days you are an inpatient in a hospital | | | | covered home health care when provided by a |
| during one benefit period, Part A hospital insurance | | | | Medicare approved agency, and there is no limit on the |
| pays all of the cost of covered services. However, | | | | number of visits to your home for which Medicare will |
| non-essentials, such as televisions and telephones, are | | | | pay. Medicare will also pay for the initial evaluation by a |
| not covered. You pay only your hospital insurance | | | | home care agency, if prescribed by your physician, to |
| deductible within this time frame. If you are in more | | | | determine whether you are a good candidate for |
| than one hospital, you still pay only one deductible per | | | | home care. However, if you require durable medical |
| benefit period and Part A covers 100% of all your | | | | equipment, such as a special bed or wheel chair, as |
| covered cost for each hospital. | | | | part of your home care, Medicare will pay only 80%. |
| Days 61 - 90. | | | | Hospice Care. |
| After your 60th day in the hospital during one spell of | | | | Medicare pays 100% of the charges for hospice care, |
| illness, and through your 90th day, each day you must | | | | with two exceptions. First, the hospice can charge the |
| pay what is called a coinsurance amount toward your | | | | patient up to $5.00 for each prescription of outpatient |
| covered hospital cost. Part A of Medicare pays the | | | | drugs the hospice supplies for pain and other |
| rest of covered cost. | | | | symptomatic relief. Second, the hospice can charge |
| Reserve Days | | | | the patient 5% of the amount Medicare pays for |
| Reserve days are a last resort coverage. They can | | | | inpatient care in a hospice, nursing facility, or the like |
| help pay for your hospital bills if you are in the hospital | | | | every time a patient receives respite care. There is no |
| more than 90 days in one benefit period, however the | | | | limit on the amount of hospice you can receive. At the |
| payment is quite limited. If you are in the hospital for | | | | end of the first 90 day period of hospice care, your |
| more than 90 days in any one spell of illness, you can | | | | doctor will evaluate you to determine whether you still |
| use up to 60 additional reserve days of coverage. | | | | qualify for hospice, meaning your disease is still |
| During those days, you are responsible for a daily | | | | considered fatal and you are still estimated to have |
| coinsurance payment. You do not have to use your | | | | less than 6 months to live. A similar evaluation is made |
| reserve days in one spell of illness, however you can | | | | after the next 90 day period, and again every 60 days |
| split them up and use them over several benefit | | | | thereafter. If your doctor certifies that you are eligible |
| periods. You have a total of only 60 reserve days in | | | | for hospice care, Medicare will continue to pay for it |
| your lifetime. Whatever reserve days you use during | | | | even if it exceeds the original six month diagnosis. And |
| one spell of illness are gone for good. In the next | | | | if your condition improves and you switch from |
| benefit period, you would have available only the | | | | hospice care back to regular Medicare coverage, you |
| number of reserve days you did not use in previous | | | | may return to hospice care whenever your condition |
| spells of illness. | | | | warrants it. |
| Psychiatric Hospitals. | | | | By knowing exactly what Medicare Part A pays, an |
| Medicare Part A hospital insurance covers a total of | | | | educated decision can me made as far supplementing |
| 190 days in a lifetime for inpatient care in a specialty | | | | the gaps. |
| psychiatric hospital. If you are already an inpatient in a | | | | |